Informed Consent Form for Psychotherapy

About Me

I am Vladislav Selivanov, a psychologist registered with the Portuguese Order of Psychologists (Ordem dos Psicólogos Portugueses, OPP), registration number 31348. I work with clients aged 18 and older in accordance with Portuguese law and the OPP Code of Ethics. I do not prescribe medication or provide medical treatment.

In my practice, I use Schema Therapy, Solution-Focused Brief Therapy (SFBT), and Acceptance and Commitment Therapy (ACT).

Education:

• Psychology: Saint Petersburg State University (2013–2017)
• Practical Psychology / MA in Counselling: Moscow School of Social and Economic Sciences ("Shaninka") / University of Manchester (2020–2021)

Up-to-date information about my qualifications is available at vlad.pt/about.

Postal address: EC Palácio dos Correios APD. 4254, 4000-101, Porto, Portugal.

Session Format and Booking

Sessions take place online, usually once a week, and last 50 minutes. I use Google Meet or Proton Meet for video calls. I do not enable—and ask you not to enable—automatic session recording, audio or video transcription, closed captions, AI assistants, or any other features that might compromise the privacy of our sessions.

No online communication channel offers absolute security, and technical disruptions or privacy risks can occur. However, I take every reasonable step to minimize these risks.

I hold sessions in a private room where I cannot be overheard. Please ensure you are also in a private space and use headphones where possible.

I do not record audio or video during sessions and ask that you do the same. Any recording is strictly prohibited unless both parties give explicit written consent for a specific purpose.

You can book sessions directly through the online calendar at Cal.com (link provided during correspondence), or we can agree on a fixed recurring time.

Fees, Payment, and Policy Changes

The fee is 60 EUR per session. Payment details will be sent in our correspondence. Payments are due before the session or within 24 hours afterward. The first session must be paid in advance.

If you need to cancel or reschedule, please let me know at least 24 hours in advance. For cancellations made less than 24 hours before the session, a 50% fee applies. If I cancel with less than 24 hours' notice, your next session will be discounted by 50%.

If you arrive late, the session will not be extended. If I am late, I will make up the lost time in a way that suits you (extending the current session, adding time to a future session, or refunding part of the fee). Emergency or unexpected situations are discussed individually.

Invoices (fatura-recibo) are issued in accordance with Portuguese law. By default, invoices are issued to a "final consumer" (consumidor final) without personal details. If you would like your tax details included, please inform me in advance.

I do not accept gifts. If a third party pays for your sessions, they will not receive any information about the content or progress of our work.

Fees for ongoing clients are reviewed no earlier than one year after starting therapy and no more than once per year, with at least 30 calendar days' written notice before any increase.

Preparing official documents, reports, statements, or formal letters is charged proportionally based on the time required (50% of the session fee per hour).

Confidentiality and Data Protection

Confidentiality

Everything discussed in sessions is confidential. I will not share the content of our meetings or the fact that we are working together without your consent, except in the following circumstances:

• A serious threat to the life or health of the client or others;
• Abuse or neglect of children or vulnerable adults;
• A court order (in which case only the minimum necessary information is disclosed, and I may exercise my right to withhold testimony where legally permitted);
• The defense of the psychologist in legal or disciplinary proceedings.

If I am required to disclose information, I will inform you beforehand whenever possible and explain what data will be shared, to minimize any impact on our professional relationship.

If we meet by chance offline or online, I will act as though we do not know each other to protect your privacy. You are free to acknowledge our acquaintance publicly if you choose to do so.

Data Protection (GDPR)

I process personal data as a Data Controller. Because health data falls into a special category, I collect only the minimum necessary information required for effective therapeutic work. Digital records are stored in encrypted form with two-factor authentication and are accessible only to me.

Records are kept for 5 years after therapy ends, as required by professional standards, and are then deleted. Therapy records (excluding test protocols) belong to you, though they remain under my custody. My personal process notes remain my property and are protected with the same level of security.

You have the right to access your records (which I will explain in clear terms), correct inaccuracies, request restrictions on processing, object to processing, withdraw consent, or request a copy of your records to share with another professional for a second opinion. Deleting records at your request requires a separate consent process to address legal requirements, as mandatory retention periods must still be observed.

To maintain high professional standards, I occasionally consult with colleagues (supervisors, psychiatrists, doctors, or legal specialists). In these discussions, client identities are fully anonymized so that individual clients cannot be identified.

The Psychotherapy Process and Termination

Psychotherapy is a collaborative process between client and psychologist focused on making practical improvements in your life and emotional well-being. While research supports the effectiveness of psychotherapy across a wide range of issues, specific outcomes cannot be guaranteed.

Discussing difficult topics can be uncomfortable and may temporarily heighten emotional distress, but working through these feelings can bring long-term benefits. If therapy feels unhelpful or overly challenging, please let me know. We can adjust our approach, discuss ending therapy, or arrange a referral to another specialist.

You may terminate psychotherapy at any time. I may end or pause therapy when its goals have been achieved, when it is no longer helpful or safe, when the request falls outside my scope of competence, when agreements are repeatedly breached, or when serious obstacles, including threats, prevent its continuation.

Communication and Emergency Protocols

You can reach me via WhatsApp or Telegram at +351 928 351 895 or by email at vladselivanov@proton.me. I suggest saving longer messages for our sessions unless we have agreed otherwise.

Our relationship is strictly professional. I do not enter into romantic, sexual, or personal relationships with clients, even after therapy ends. I also do not work with people close to you if doing so would create a conflict of interest. Please inform me if we know each other outside therapy. I do not connect with clients on social media or look up information about you online. If any conflict of interest arises, I will discuss it openly.

I do not provide emergency or crisis intervention services. If you are in an acute crisis or there is an immediate threat to life, please call 112 or go to the nearest emergency department. In Portugal, you can also contact SNS24 at 808 24 24 24. If I believe your situation is urgent and I cannot reach you or obtain your consent, I may contact emergency services.

During sessions, I will ask for your current location (city and country) and an emergency contact person. This allows me to arrange help if your life is in danger. You may decline to provide an emergency contact, but this will limit my ability to assist in an emergency.

You have the right at any time to ask questions, request clarification, withdraw consent, end therapy, receive a copy of this document, or seek a second opinion. If you believe I have violated professional ethics, you can contact the Portuguese Order of Psychologists (Ordem dos Psicólogos Portugueses, OPP).

Confirmation

By checking the box when booking through the online calendar, you confirm your consent to this document and to the processing of your personal data. You will receive a confirmation email, and a record of your consent will be saved in your file.

Version 1.1 — 03.10.2026