Therapeutic Disclosure Sessions: Informed Consent, Assumption of Risk, and Waiver of Liability

PLEASE READ CAREFULLY BEFORE SIGNING. THIS DOCUMENT INCLUDES A RELEASE OF LIABILITY AND WAIVER OF CERTAIN LEGAL RIGHTS.

This Informed Consent, Assumption of Risk, and Waiver of Liability (“Agreement”) is between the undersigned adult clients (“Clients,” individually “Client”) and Dr. Kacie LaChapelle, PhD, LMHC, doing business as Grace Happens Therapy, (“Therapist” or “Practice”). By signing below, each Client acknowledges reading, understanding, and voluntarily agreeing to the terms of this Agreement.

Nature and Scope of Services

  • Therapist provides couples with a Therapeutic Disclosure (“TD”) process designed to improve relational functioning, communication, trust, and emotional regulation.

  • Services may include: assessment; psychoeducation; skills training; exploration of relational patterns; facilitated disclosure processes; and referrals where clinically indicated.

  • Therapist may also work individually with each party while serving as the couple’s therapist.

No Guarantee of Outcomes

  • TD involves complex human behavior and factors beyond Therapist’s control. Therefore, Therapist makes no promises, warranties, or guarantees regarding outcomes, changes, or results.

  • Clients expressly acknowledge that progress may be non-linear; symptoms or conflict may initially intensify; disclosures may be destabilizing; and the relationship may improve, remain unchanged, or deteriorate, including separation or divorce.

Known Risks/Assumption of Risk

  • TD, and couples work in general, can be emotionally intense. Long-held secrets and betrayals may be disclosed; such disclosures can feel like “emotional bombs,” potentially triggering acute distress, rage, grief, shame, traumatic responses, or impulsive behavior.

  • Potential risks include: increased conflict; temporary or prolonged dysregulation; disruption of family systems; loss of trust; decisions to separate/divorce; financial or legal consequences stemming from disclosures; social or occupational impacts; and reactivation of prior trauma.

  • Clients assume these and all ordinary risks inherent in therapy and agree to notify Therapist of safety concerns (e.g., suicidal ideation, self-harm, threats, or domestic violence). Safety planning will be addressed as needed. Therapist does not provide emergency services; in an emergency, call 911, go to the nearest emergency department, or contact a crisis line.

Polygraph Recommendations (When Deception Is Alleged)

  • Where there is a long-term pattern of deception regarding material issues (e.g., fidelity, finances, addictions), Therapist may recommend a voluntary polygraph process to reduce impasse and support transparency.

  • Clients understand: (a) polygraph participation is voluntary; (b) it involves costs and third-party providers selected by Clients; (c) polygraph results are not infallible and may be inaccurate or inconclusive; (d) Therapist is not responsible for the accuracy, interpretation, decisions arising from, or consequences of any polygraph process; and (e) declining a polygraph may impact treatment planning but is not a condition of therapy.

Informed Consent to Treatment

By signing, each Client:

  • Consents to TD sessions as described in this Agreement, acknowledges having an opportunity to ask questions, and understands the potential benefits and risks.

  • Understands they may withdraw consent at any time, subject to payment for services rendered and any cancellation fees.

  • Agrees to participate honestly and respectfully, and to refrain from violence, threats, or harassment.

    WHEN A BETRAYED PARTNER SEEKS A TD, THEY WILL PROVIDE GUIDANCE ABOUT THE SPECIFICS OF THE HISTORY THEY WOULD LIKE TO OBTAIN INFORMATION ABOUT. THERAPIST IS NOT IN THE POSITION OF DETERMINING PARTIAL TRUTHS TO BE SHARED. THEREFORE, THE PARTNER/VICTIM OF DECEPTIVE SEXUALITY IS NOT TO HOLD THERAPIST RESPONSIBLE FOR THE TRUTH OR LACK OF TRUTH THAT IS PROVIDED BY THE BETRAYING PARTY.

Professional Boundaries and Forensic Limitations

  • Therapist provides clinical treatment, not legal advice, forensic evaluation, or expert testimony. Therapist does not determine “truth,” fault, or legal liability.

  • Therapist will not provide evaluations for court, custody, or fitness-for-duty, and will not provide written opinions on ultimate legal issues. If subpoenaed or court-ordered, fees apply.

Coordination of Care and Referrals

  • Therapist may recommend adjunctive services (e.g., individual therapy with a separate provider, group therapy, medical or psychiatric evaluation, financial counseling, or specialized programs). Clients are responsible for selecting providers and associated costs. Therapist is not responsible for services provided by third parties.

Risks Related to Intimate Partner Violence and Safety

  • If intimate partner violence (IPV), coercive control, or safety risks are present, couples therapy and the TD process may be contraindicated. Therapist may recommend alternative treatment, safety planning, or higher levels of care. Therapist may pause or terminate couples therapy if safety cannot be reasonably maintained.

Informed Decision-Making About Disclosures

  • Clients understand that disclosures (e.g., infidelity, substance use, financial misconduct, or other betrayals) may have legal, financial, or occupational consequences. Clients are encouraged to consult independent legal counsel as needed.

  • Therapist may structure planned disclosure processes and pacing to mitigate harm, though distress may still occur. Clients are responsible for decisions they make inside and outside of sessions.

NO GUARANTEE, LIMITATION OF LIABILITY, & INDEMNIFICATION

NO GUARANTEE: CLIENTS ACKNOWLEDGE AND AGREE THAT THERAPIST DOES NOT AND CANNOT GUARANTEE ANY PARTICULAR OUTCOME OR RESULT FROM THERAPY OR THERAPEUTIC DISCLOSE PROCESSES.

LIMITATION OF LIABILITY: TO THE MAXIMUM EXTENT PERMITTED BY LAW, CLIENTS AGREE THAT ANY CLAIM ARISING FROM SERVICES SHALL BE LIMITED TO DIRECT DAMAGES NOT EXCEEDING THE TOTAL FEES PAID TO THERAPIST BY CLIENTS IN THE TWELVE (12) MONTHS PRECEDING THE EVENT GIVING RISE TO THE CLAIM. NOTHING IN THIS AGREEMENT WAIVES RIGHTS THAT CANNOT BE WAIVED BY LAW OR LIMITS LIABILITY FOR GROSS NEGLIGENCE, WILLFUL MISCONDUCT, OR VIOLATIONS OF LAW.

INDEMNIFICATION: CLIENTS AGREE TO INDEMNIFY AND HOLD THERAPIST HARMLESS FROM CLAIMS, LOSSES, OR COSTS ARISING FROM CLIENTS’ OWN UNLAWFUL CONDUCT, MISREPRESENTATIONS, OR BREACH OF THIS AGREEMENT, EXCEPT TO THE EXTENT CAUSED BY THERAPIST’S GROSS NEGLIGENCE OR WILLFUL MISCONDUCT.

Entire Agreement/Severability/Governing Law/Venue

  • This Agreement, together with any attached Notices or Practice Policies, constitutes the entire agreement regarding the subject matter and supersedes prior understandings.

  • If any provision is found unenforceable, the remainder shall continue in effect to the fullest extent permitted by law.

  • This Agreement is governed by the laws of the Commonwealth of Massachusetts. Venue for any dispute shall lie in the state or federal courts located in Massachusetts.

  • Mediation Encouraged: The parties agree to consider good-faith mediation prior to initiating litigation, where clinically and practically appropriate.