Informed Consent for Counseling Services - University of Houston
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Informed Consent for Counseling Services


All Counseling services of the University of Houston Counseling and Psychological Services (CAPS) are available to currently enrolled students at the University of Houston. Certain limited services are also available to faculty and staff, and partners of students currently enrolled at the University of Houston.

Counseling Services

We primarily provide group and short-term individual and couples counseling. In an effort to serve as many students as possible, and to ensure that we are providing the best care for clients, there are situations, including but not limited to, the situations listed below in which CAPS may limit services and/or may lead to referral by CAPS for you to obtain treatment outside of CAPS.

  • Ongoing treatment for a student who presents imminent danger to self or others, or is unable to care for themselves. (e.g., a student who seems determined to harm themselves, and has feasible plan to do so; or a student who is experiencing hallucinations and delusions).
  • Court-ordered or forensically oriented treatment (e.g., substance abuse treatment, treatment for criminal behavior such as rape or pedophilia, etc.).
  • Treatment for disorders of such severity that we cannot provide adequate care (e.g., treatment for a full-fledged eating disorder that requires closely coordinated medical, nutritional, psychiatric, and psychological care).
  • Treatment that falls beyond our areas of expertise or outside the scope of services provided by this facility (e.g., a student requesting a higher frequency of services than our available resources).
  • Treatment for a student who seeks counseling but nevertheless is fundamentally unwilling to address the disorder in question (e.g., a student who is addicted to cocaine, but adamantly refuses to consider curbing or receive treatment for their drug use).
  • Treatment for a student who seeks counseling but nevertheless is noncompliant with the clinician’s treatment recommendations (e.g., client who does not take prescribed medication).
  • Treatment for a student whose behavior creates a hostile working environment at the Counseling and Psychological Services office, affecting staff and/or other students (e.g., a student who is grossly verbally abusive towards and/threatens staff).
  • Treatment for a student who seeks counseling but nevertheless is noncompliant with CAPS’ policies (e.g., inappropriately utilizing daytime and/or after hours crisis services).
  • Other situations that are determined to be outside of the scope of services provided by this facility or in which case an appropriate clinical staff member determines that treatment to a particular student/client would not be in the best interest of the student/client, another student/client or the proper functioning of this agency.

If CAPS is unable to offer services, other local treatment options will be discussed.

The Counseling Process

The counseling process is a partnership between you and a CAPS clinician (“clinician”) to work on areas of dissatisfaction in your life or assist you with life goals. For counseling to be most effective, it is important that you take an active role in the process. This involves keeping scheduled appointments, listening to the clinician, being honest with the clinician, discussing the counseling process with the clinician, and completing outside assignments agreed upon with the clinician. Counseling can have both benefits and risks. While counseling can be of benefit to most people, the counseling process is not always helpful. The counseling process also can evoke strong feelings and sometimes produce unanticipated changes in one’s behavior. It is important that you discuss with a clinician any questions or discomfort you have regarding the counseling process or any behavioral changes you may be experiencing. Your clinician may be able to help you understand the experience and/or use different methods or techniques that may be more satisfying.


CAPS recognizes that confidentiality is essential to effective counseling. We believe that for counseling to work best, you must feel safe about sharing personal information about yourself with your clinician. When you share information about yourself with your clinician, he or she will respect the importance of that information. Your records from CAPS are not part of your student record. Counseling records are destroyed 7 years after your last contact with us in a way that protects your privacy. Under most circumstances, all information about you obtained in the counseling process (including your identity as a client) is confidential and will be released to other parties only with your expressed written consent. However, it is because of the strength of our belief in the importance of you feeling safe about sharing information about yourself with your clinician that we want to inform you about the circumstances in which we may share information about you without your consent.

  • Information Released to other professionals involved in your treatment. Most commonly, this would be the other members of the counseling staff at CAPS, or the psychiatric staff of the University of Houston Student Health Center (“Student Health Center”) if you are also being seen there.
  • If you are under 18, your parents or legal guardian(s) may have access to your records and may authorize their release to other parties.
  • If you are reasonably suspected to be in imminent danger of harming yourself or someone else.
  • If you disclose abuse or neglect of children, the elderly, or disabled persons.
  • If you disclose sexual misconduct by a therapist.
  • To qualified personal for certain kinds of program audits or evaluations.
  • In criminal proceedings.
  • In legal or regulatory actions against a professional.
  • Upon the issuance of a court order or lawfully issued subpoena
  • Where otherwise legally required

The above is considered to be only a summary. If you have questions about specific situations or any aspect of the confidentiality of CAPS records, please ask a member of the counseling staff.


Your clinician may discuss information about you with other professionals within CAPS for the purpose of diagnosis, treatment planning, or clinician supervision. When appropriate, clinicians consult with the psychiatry staff of the Student Health Center. This includes sharing information between agencies (i.e., between CAPS and the Student Health Center), which may be helpful in the conduct or planning of treatment.

Counseling Records

Counseling records are stored in locked files and/or electronically on a secure server that is only accessible by our staff. Upon request, you may review your counseling records. In order to ensure the information contained is clearly understood, you will be asked to arrange an appointment with your clinician or another member of the counseling staff to go over the information. Appropriate fees will be charged for making copies of client records.

Clinician Qualifications

To ensure a high standard of services, clinicians may request that your sessions be recorded or have a supervisor observe in person to be used only in the context of supervision. CAPS will not record your counseling sessions unless you sign a separate consent form authorizing CAPS to record your counseling sessions. Any clinician that may view sessions or session recordings at CAPS is bout by the confidentiality standards detailed in this Informed Consent for Counseling Services form as well as in the Consent to Record Counseling sessions form.

Counseling Decisions

Frequency of sessions, number of sessions, goals, type of counseling and any alternative counseling methods will be discussed and negotiated between you and your clinician. You are encouraged to regularly discuss your progress and review your goals with your clinician. If you have questions about recommendations or the approached used by clinician, please discuss your questions or concerns with the clinician. If you feel these recommendations are not appropriate, you may refuse to accept them. If you feel you are not making satisfactory progress toward your goals, please discuss this with your clinician, if you are able to resolve questions or concerns you have about the progress of counseling, you may request to be transferred to another clinician or agency.

Access to Service

Counseling services are generally available during normal business hours throughout the year (including breaks between semesters) except on University designated holidays. Some services are available until 7:00 p.m. on Monday and Tuesday during the Fall and Spring semesters. Please call CAPS at (713) 743-5454 for current information. A University of Houston student, staff or faculty in crisis can come to CAPS at any time during office hours and be worked into a schedule for a brief evaluation. If it is after office hours and you are in imminent crisis, please call 911 or one of the following numbers:

  • MHMRA: (713) 970-7000
  • Crisis Intervention of Houston: (713) HOT-LINE (468-5463)
  • University of Houston Department of Public Safety at (713) 743-3333 and ask tobe transferred to your assigned therapist.
  • Mobile Crisis Outreach Team: (713) 970-7520
  • National Strategy for Suicide Prevention: 1-800-273-8255


CAPS seeks at all times to maintain and respect the confidentiality of each client, including not only the details of any services rendered, but also the fact that an individual may in contact with CAPS. With this in mind, CAPS wishes to remind each person that email is not a secure form of communication. Because confidentiality cannot be assured, the use of email is discouraged in regard to communications with CAPS. When necessary, email may be used for scheduling appointments but should not be used for counseling purposes. The suitability of any clinical consultations or recommendations can only be determined through counseling sessions. E-mail messages are not appropriate for emergency or time-critical situations. The fastest way to contact CAPS is by phone. Please call your clinician or the office directly (713-743-5454) if your message is time-critical. If it is after office hours and you are in imminent crisis, please call 911 or one of the numbers listed in the above paragraph.

Counseling Appointments

The clinician can be expected to respect you as an individual and to convey this respect by keeping appointments or contacting you if a change in times is necessary, by giving you his/her complete attention during sessions, and by avoiding interruptions during sessions. On rare occasions however, sessions may be interrupted if the clinician is called to respond to a crisis. It is also expected that you will be prompt for appointments, and that you will call the center in advance if you will be more than a few minutes late or have to miss an appointment.


Fees are charged for some CAPS services, including some psychological testing services. Initial consultation (ICON) appointments, treatment planning sessions, group therapy and referrals are free for students. Effective January 02, 2013 students will be charged a $5 co-pay for each individual counseling session. Couple’s counseling sessions remain unchanged at $10 per session. Staff and faculty are eligible for initial consultation (ICON) appointments and individual treatment planning (when clinically indicated) at a flat fee of $25.

No-Show/Late Cancellation Charges

Beginning January 02, 2013 CAPS will begin charging clients $25 for failing to provide advanced notice when unable to attend an individual counseling session, couples’ counseling session or LD/ADHD testing appointment. IF a client does not provide notice within 24 hours of his/her scheduled appointment, the $25 fee will be charged to the client’s student account. If the client is not affiliated with UH, the client will be asked to pay at his/her next scheduled appointment. Clients may leave a message on CAPS’ voicemail to cancel an appointment; however this message must be left at least 24 hours before the scheduled appointment.

Client Satisfaction Surveys

CAPS will periodically administer satisfaction questionnaires in the course treatment.

Consent Form