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Permission for Digital Video Recording and Transcription of Therapy Sessions

THERAPIST EXPLANATION:

This is an informed consent allowing permission to video record psychotherapy sessions. As a primary tool in the Gottman Method Couples Therapy, and in order to augment your therapy work, I use videotape feedback as part of the therapy sessions. This means that I may ask to videotape you during specific dialogues or exercises, or during entire sessions. We may play back these tapes in session to help you see patterns of behavior between the two of you and to help you process conflicts. By viewing the videotape in session, it allows us to “stop action” and process how you might approach a conflict in a more productive way. It also allows you to witness your progress as your relationship becomes more satisfying to both of you. These recordings are destroyed immediately after the session.

In addition to in-session use, I may wish to use the video to receive consultation from Drs. John or Julie Gottman or a Gottman Institute senior clinician. This may occur during the time of treatment or thereafter for purposes of peer review, education and quality assurance. Copies may be sent to the Gottman Institute for the purposes noted here. Prior to consultation, should you wish to review these tapes for any reason, we will arrange a session to do so. These materials will remain in locked facilities at all times. During this process, your name will be kept confidential. In addition, all matters discussed in consultations will remain completely confidential within the Gottman Institute clinical staff. The recordings will be erased immediately after consultation.

The video recordings will be used for no other purpose without your written permission and they will be erased when they are no longer needed for these purposes. These recordings are my property and will remain solely in my possession during the course of your therapy until they are destroyed.

VOLUNTARY PARTICIPATION

I understand and accept the conditions of this statement and give my permission to have my therapy sessions video recorded. I understand I may revoke this permission in writing at any time, but until I do so, it shall remain in full force and effect.

Client's Name*
Signature*

Consent to Audio Transcription

I also use a note-taking aid to support documentation, treatment planning, and assessment. With your permission, it may record and transcribe session audio so I can stay focused on you and capture important details more effectively.

WHAT WILL HAPPEN

  • The note-taking aid may record and transcribe the session to support my documentation.
  • I review and finalize any draft before it becomes part of the clinical record.
  • PRIVACY AND DATA HANDLING

    Session information will be handled as confidential health information under my practice privacy notice. The current Gottman Connect Privacy Policy and Terms are available in the website footer at all times. Gottman Connect is a fully HIPAA-compliant platform and uses AES-256 encryption at rest and in transit.

    VOLUNTARY PARTICIPATION

    Recording and transcription are voluntary. You may ask questions, decline, or withdraw consent at any time by telling me. If either partner declines or asks me to stop, I will use an approved alternative. This decision will not negatively affect your care.

    Client's Name*
    Signature