Doute' Counseling Services provides a variety of services to our clients. It also supports the teaching and training mission of the marriage and family therapy program at Touro University Worldwide. Your assigned therapist is a trainee therapist in practicum under the supervision of a licensed clinician to satisfy their educational requirements. Audio taping and video recording of sessions are a significant component of therapist training and an extremely useful learning and teaching tool with the ultimate intent of ensuring you, the client, is
getting the best treatment possible!
No recording is ever done unless the client has given permission to do so. Therefore, we
use this consent form to obtain your permission to audiotape and/or video record sessions
to use in supervision. Feel free to ask your therapist any questions about the purpose of
recording their sessions for training purposes.
Your signature below indicates that you give Stacii Jae Johnson permission to be audiotaped / videotaped (circle one or both) and that you understand the following as the client:
- I can request that the tape recorder or video recorder be turned off at any time
and may request that the tape or any portion thereof be erased. I may
terminate this permission to record sessions at any time.
- The purpose of recording is for use in training and supervision. This will
allow the above referenced trainee therapist to consult with his or her
assigned supervisor(s) in an individual or group supervision format, who
may listen to the tape alone or in the presence of other therapists in training
involved in direct supervision.
- The contents of these recorded sessions are confidential, and the information
will not be shared outside the context of individual and group supervision.
- The recording(s) will be stored in a secure location and will not be used for
any other purpose without my explicit written permission.
- The recording(s) will be erased after they have served their purpose.
