Hypnotherapy Informed Consent Form

Hypnotherapy Informed Consent

Before proceeding with the treatment of hypnotherapy, it is important that you, as the "Client" understands the necessary information about the treatment.

This form contains the important information about hypnotherapy including our policies. This explains the rights of our patients or clients, the privacy protection, and how we use your personal information.

Signing this document represents our understanding with regard to the agreement. Thus, it is important that aside from reading over the contents of the form, it is wise discuss any questions you might have with your therapist. Hypnotherapy requires establishing a relationship between the client/patient and the therapist..

Just like the rights that persons can have, these rights are limited. There are also legal limitations to those rights that you should be aware of.

What is Hypnotherapy

Hypnotherapy is a mode of therapy conducted on an individual basis. Treatment using hypnotherapy is done while the client/patient is in a trance state. Hypnotherapy uses hypnosis, a relaxed state of being, in which the client is conscious but in a deep state of focused attention somewhat like meditation. All hypnosis is really self-hypnosis, and the client is simply guided to achieve a relaxed state. No one can be hypnotized against their will. Once you have been guided into hypnosis it becomes easier to go back to that state on your own, and easier each time for the hypnotherapy to occur.

Compared to "talk therapy," there is much that can be accomplished with hypnotherapy in short amount of time. The benefits of hypnotherapy is realized as you continue with the sessions over a few weeks.

Sessions and Experience

There are three types of hypnotherapy that we use: 1) relaxation, 2) suggestion and 3) regression. Relaxation and suggestion therapies may occur in a shorter session, or be part of a longer session.

Regression hypnotherapy is usually a longer process. It is used to connect present issues to past issues, and to release negative core beliefs formed earlier in life. It includes relaxation and suggestion, and takes around 1 and a half hours to 2 hours. The regression session occurs by guiding you to reach a relaxed state that when deepened allows for the hypnotherapy and healing to occur. Age regression may be conducted for helping you to be more comfortable to release your behavioral, cognitive, and emotional blockages. The final part of the session is the healing and resolution section and includes bringing in your “inner child” to develop a positive new outlook.

Recording

The initial induction and final healing portions may be recorded. This is so that you can have a copy of an audio file of the relaxing and healing parts of your session so you can practice at home. Online we may be able to record the session and email it to you. In the office just provide us your USB thumb drive where we can transfer a copy of the file(s). We may also send the file via email either as an attachment or by sharing with you a link on how you can download the file. But please take note that by mailing the recording, we cannot guarantee the privacy and security of information sent through this medium.

Risks

Depending on the personality of the patient, some aspects of hypnotherapy can be temporarily experienced as an intense or even unpleasant process. Regression hypnotherapy focuses on emotions, thoughts and behavior patterns that can bring up unpleasant memories or emotions for resolution. At all times you can ask for the hypnotherapy to end, however it is generally best to continue the therapy to the resolution and healing stage. Uncomfortable thoughts, feelings and memories may come up after the session as well. Be sure to bring these to the attention of your therapist.

We cannot guarantee that hypnotherapy works for everyone or happen at the same pace as others. There are those who show progress slower than others.

Legal Involvement

It is suggested that hypnotherapy be postponed if there is legal involvement or there are concerns that there is/was abuse of a minor client. The client should check with their legal help, but it is suggested that the client should complete a written narrative and/or deposition of all memories of abuse or legal issues before hypnotherapy occurs.

Benefits

There are many benefits to hypnotherapy. The hypnotic state allows the patient to be more receptive to discussion and suggestions. Thus, it helps for relaxation, for pain release, and for treating stress, anxiety, traumatic memories, depression, phobias, anger, fears, loss and grief among other conditions. It can also be used as a treatment for controlling and overcoming unwanted habits such as smoking and overeating. To achieve the ideal results, the full and active cooperation of the patient is required.

I acknowledge that I have read and understand the above information. I have had the opportunity to ask questions regarding the therapy and anything related to the treatment and by which answers were given to me to my satisfaction.

I declare that I am of legal age with my mental faculties intact to give full consent. My signature is my express statement that I agree to participate in hypnotherapy sessions.

Session Recording

I allow all my sessions to be recorded.

Client Full Name*

First NameMiddle NameLast Name

Date*

MonthDayYear

Client Signature*

Sign by using a touch tablet/screen or left click and hold as you sign with your mouse.

Parent or Guardian Full Name (if client is under the age of 18)

First NameMiddle NameLast Name

Date

Parent or Guardian Signature (if client is under the age of 18)

Sign by using a touch tablet/screen or left click and hold as you sign with your mouse.