Saturday, February 24, 2018

Informed Consent for Psychodrama Training Program

Informed Consent for Psychodrama Training Program 


I request Psychodrama  Training services from Katrena Hart, MS, LPC-S, CBT, ATA, CETT,  TEP, at Bridging Harts Institute and voluntarily consent to such training services and administrative procedures as may be performed by this psychodrama trainer.


Katrena Hart MS, LPCS, CBT, ATA, CETT, TEP

Degrees, Credentials, and Licenses:

Licensed Professional Counselor (LPC, 15619) in the State of Texas

Master's Degree in Counseling & Development, from Texas Woman’sUniversity

Trainer, Educator & Practitioner  (TEP) of psychodrama certified by the American Board of Examiners in Psychodrama, Sociometry and Group Psychotherapy

Certified Bioenergetic Therapist (CBT) certified by the Dallas Society of Bioenergetics Analysis

Certified Emotional Transformation Therapist (CETT)

Advanced Training Analyst (ATA) of Bioenergetics


Your Rights as a Client and Regulatory Agencies

The practice of both licensed and unlicensed persons in the field of psychotherapy is regulated by the Department of Regulatory Agencies. The Texas Grievance Board telephone number is 800-942-5540, located in Austin Texas.

A client is entitled to receive information about the methods of therapy and techniques used, and the duration of therapy (if known). You may seek a second opinion from another therapist or may terminate therapy at any time.

Generally speaking, all information provided by and to the client during therapy sessions is legally confidential in the case of licensed marriage and family therapists, clinical social workers, professional counselors, and psychologists and certified school psychologists. Exceptions to this will occur when there is client-threatened harm to self, others, or property, or client-admitted incidence of child abuse, neglect or felonies. These will be reported to the proper authorities.

As a Trainee, I understand that I am not a Client of Psychodrama Trainer listed above.


Additional Information about Trainee Expectations in Psychodrama Training:

I have read and understand the above, as well as all, of the training agreements information. I apply for and consent to training as prescribed by the above trainer. 

I hereby authorize Katrena Hart to release information to and to request and receive specific information relative to ongoing treatment from my primary therapist/counselor/supervisor/alternate trainer as disclosed in my online application for Psychodrama Training from the Psychodrama Trainer listed above. 

The sole purpose of this disclosure is to exchange and discuss written and/or verbal information and to coordinate effective and productive training and care.



Bridging Harts Institute & Psychotherapy
203 S. Alma St. Suite #300
Allen, TX 75013
T: (972) 562 5002
Email: info@bridgingharts.com


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