The following Confidentiality Contract for Marital Therapy was adapted from
Jan Hembree, Ph.D., President of the Virginia Academy of Clinical Psychologists,
who describes it as follows:
The statement below is a Confidentiality Contract
which I require to be signed by all parties who request my services
as a couples or marital psychotherapist. It is for the purpose of
protecting information given to me or discussed during therapeutic sessions
from being used outside the session in such circumstances as court cases,
either through subpoenas or in any way requested by either party
to use in subsequent adversarial or collateral situations.

Note: This is not a legally binding contract, but it emphasizes the importance of protecting
the confidentiality of the therapy relationship, and it greatly reduces the likelihood
that either member of the couple would then try to use the information from therapy
as evidence against the other member of the couple.
Some Virginia judges, when making determinations about whether to quash a subpoena,
have given some weight to the existence of this prior agreement about confidentiality.
Note: The form below can also be adapted for use with individual or family therapy.
============================================================= Confidentiality Contract for
Marital or Couple Therapy

This contract is an agreement between the interested parties that neither party shall for any reason attempt to subpoena my testimony or my records to be presented in a deposition or court hearing of any kind for any reason, such as a divorce case.

Both parties acknowledge that the goal of psychotherapy, either individual or marital or couples therapy, is for the sole purpose of the amelioration of psychological distress and that the process of psychotherapy depends on trust and openness during the therapy sessions.

Therefore it is understood by both parties that if they request my services as a psychotherapist, they are expected not to use information given to me during the therapy process against the other party in a judicial setting of any kind, be it civil, criminal, or circuit.

The signatures below reflect that the parties agree to the terms set forth above.

Signed & Dated_______________________________________________________________

Signed & Dated_______________________________________________________________

Signed & Dated_______________________________________________________________

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