Consent Form

This form below is to be read and accepted by any client receiving counseling or supervision session(s) from a therapist or trainer authorized by EMDRHK.

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By proceeding with the first session, you confirm that you have read, understood, and agreed to all listed below: –

EMDR (Eye Movement Desensitization and Reprocessing) is a powerful psychological treatment method. EMDR was proven to have a high success rate in healing, within a relatively short time, cases of post-traumatic stress (PTSD), recent traumas’ effects, anxiety disorders, panic attacks, phobias, troubling memories and thoughts (including sexual and physical abuses), and complicated grief. 

Points to note

  1. Most clients experience relief or positive effects in just a few sessions of EMDR therapy. Disturbing memories, images and thoughts, bad physical sensations, and painful emotions will be significantly reduced, or even no longer be present. 
  2. You may experience various physical and emotional sensations. This is normal. 
  3. During or after EMDR therapy sessions, additional associated memories may be brought up, including flashbacks, feelings, sensations, and dreams associated with the memory. As with any other therapeutic approach, reprocessing traumatic memories can be uncomfortable. Some clients won’t like or won’t be able to tolerate well EMDR therapy and in such a case the therapist may delay the EMDR process to prepare the client for the process.  The therapist, and /or the client, may also decide at any time not to proceed with the EMDR therapy process (and there are no known adverse effects for interrupting the EMDR therapy process before it is completed). 
  4. Processing memories using EMDR may cause memories to fade away or get blurred.   

You hereby declare

  1. You will tell only the full truth about what you are experiencing.
  2. You are prepared that some emotional disturbance may occur during the EMDR session.
  3. After a session, you will follow the debriefing instructions provided by the therapist.
  4. You have no known condition, history, or medical risk that may put you at a health risk during or following any session. Such include heart conditions, elevated blood pressure, occasional seizures, etc. In any event, you hereby declare that you will not hold the therapist responsible in any way for any medical situation which may occur to you during any session or afterward. 
  5. You will declare to the therapist, before the first session, the following: –
    1. Any medications you have taken in the last 30 days (you may omit occasional painkillers or over-the-counter seasonal cold medications).
    2. Any addictions in the past or at present (e.g. of alcohol, drugs, or other substances). Full confidentiality (see below) will apply.
    3. Any dissociative disorders (e.g. dissociative Identity disorder), unexplained somatic symptoms, sleep problems, flashbacks, derealization, depersonalization, hearing voices, unexplained feelings, memory lapses, psychiatric hospitalizations, and /or any other psychological issues. 
  6. You will not cause, directly or indirectly, that the therapist will be required to testify as a witness in a court-of-law, or through an affidavit, on any matter relating to information that you have revealed to the therapist. 

Confidentiality

Any information you reveal to the therapist will remain confidential, with two exceptions – (a) when you pose a serious risk to yourself, and (b) should a law of Hong Kong require the therapist to breach confidentiality. 

Cancellation of a session

You may cancel a scheduled session anytime before the session. Cancellation is free of charge if you cancel the session by an email /Whatsapp notification not less than 24 hours before the scheduled time of the session. In the event of a no-show to a scheduled session, or a cancellation made within less than 24 hours from the scheduled session, 60% of the session fee is payable.

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