INFORMED CONSENT FOR PSYCHOTHERAPY
Mindful Sasquatch PLLC
Rendering Provider: Ryan Q Patterson, MA, LMHC
Service Address:
14090 Fryelands Blvd, Suite 316
Monroe, WA 98272
Mailing Address:
PO Box 2354
Snohomish, WA 98291-2354
Phone: 425-205-9332
Effective Date: January 27, 2026
GENERAL INFORMATION
Effective psychotherapy is possible through a strong client–therapist relationship. Before beginning therapy, it is important to define our professional relationship and clarify what is expected of both you and me in order to create an environment that supports meaningful work together.
Although your basic rights as a client are addressed in this document, it would be impossible to anticipate every situation that may arise during the therapeutic process. Psychotherapy is continually evolving and may require ongoing discussion and clarification as treatment progresses. This document represents one of several opportunities to review our work together.
Participation in psychotherapy is voluntary, and you may refuse recommended interventions or discontinue treatment at any time.
The role of technology in services, including telehealth and electronic communication, is addressed in the separate Telehealth Agreement and the Electronic Communication Authorization and Policy.
THE THERAPEUTIC PROCESS
We will be entering into a therapeutic relationship. This is strictly a professional relationship. This means that professional boundaries, as defined by ethical standards, must be maintained at all times, and dual relationships are not permitted. Our relationship will not extend beyond therapist and client. This is necessary in order for me to offer you my full abilities as a therapist with your best interests in mind, as well as to ensure that your rights as a client are protected.
Although this is a professional relationship, due to the nature of psychotherapy it is common to develop a meaningful emotional connection that differs from other relationships in your life. Establishing this connection can be beneficial in supporting the emotional work you wish to do, while still maintaining clear professional boundaries.
Psychotherapy often involves exploring thoughts, feelings, memories, behaviors, and relational patterns. This process may result in emotional discomfort, including but not limited to sadness, anger, confusion, frustration, loneliness, anxiety, or guilt. These reactions may occur during sessions or between sessions and are considered a normal part of the change process.
Psychotherapy is a significant commitment. Meaningful change often depends on your willingness to engage in the process, attend sessions regularly, complete mutually agreed-upon therapeutic tasks, and communicate openly. While psychotherapy is often beneficial, outcomes cannot be guaranteed. I cannot promise specific results, symptom relief, or behavioral change. I can commit to supporting you, working to understand patterns that may be affecting you, and helping you clarify what you want for yourself.
Alternatives to psychotherapy — including medication consultation, group therapy, or services with another provider — are available and may be discussed at any time.
Psychotherapy is not a substitute for emergency or crisis services.
MY ROLE AS A THERAPIST
I hold a Master of Arts degree in Applied Psychology from Antioch University Seattle and am licensed by the State of Washington as a Licensed Mental Health Counselor (License #LH60271324). I adhere to the American Counseling Association (ACA) Code of Ethics and participate in ongoing continuing education as required by the Washington State Department of Health.
I have experience working with a range of mental health concerns, including depression, anxiety, trauma, grief and loss, mood disorders, psychosis, and eating disorders. I have experience working with individuals, couples, and families, and with clients from diverse cultural, ethnic, religious, and sexual identity backgrounds.
My clinical approach is informed by evidence-based practices, including Cognitive Behavioral Therapy, Motivational Interviewing, and mindfulness-based approaches. Treatment methods are individualized and may evolve over time based on your needs. Services may include assessment, diagnosis, and treatment planning as clinically appropriate.
CONFIDENTIALITY
Protecting your confidentiality is of the utmost importance. Information disclosed in psychotherapy is confidential and will not be released without your written authorization except as permitted or required by law.
Limits to confidentiality include, but are not limited to, situations involving risk of serious harm to yourself or others, suspected abuse or neglect of a minor or vulnerable adult, court orders, or other legal requirements. Detailed information regarding confidentiality and its limitations is provided in the Notice of Privacy Practices.
When clinically appropriate and feasible, I will attempt to discuss the need for any disclosure with you in advance. Additional confidentiality considerations apply when working with couples, families, and minors and are described in the Practice Policies.
CLIENT RESPONSIBILITIES
You are responsible for attending scheduled sessions, arriving on time, and engaging respectfully in the therapeutic process. If you attend a session under the influence of drugs or alcohol, services may be denied for that session, and you will remain financially responsible for the appointment.
You are encouraged to take an active role in therapy by reflecting on goals, participating in sessions, and communicating openly about what is or is not working. While I provide professional guidance, insight, and intervention, responsibility for change ultimately rests with you.
LETTERS, FORMS, AND LEGAL MATTERS
Policies regarding letters, documentation requests, forms, and legal matters — including this practice’s policy on participation in legal proceedings — are described in the Practice Policies.
VOLUNTARY PARTICIPATION AND RIGHT TO TERMINATE
Participation in psychotherapy is voluntary. You have the right to refuse treatment recommendations or to discontinue therapy at any time. You also have the right to choose a practitioner and treatment modality that best suits your needs and purposes, including the right to seek a second opinion or a referral to another provider at any time. You are encouraged to discuss any concerns, questions, or dissatisfaction with treatment so they may be addressed collaboratively.
I may recommend termination if therapy is no longer clinically appropriate, if ethical or legal concerns arise, or if I determine that I am unable to provide effective care. Referrals will be provided as appropriate.
CONSENT TO TREATMENT
By electronically acknowledging this document, you confirm that you have read and understood this Informed Consent and consent to psychotherapy services provided by Ryan Q Patterson, MA, LMHC, through Mindful Sasquatch PLLC. You acknowledge that you have had the opportunity to ask questions and agree to the terms described above.
Version date 7/16/2026