Payment is required in advance or at the time of the session. Payment must be made online via the Payments Page
Policies (Informed Consent)
Full Policy can be accessed below. This policy must be agreed to prior to your first session. Please download & submit the “Informed Consent” Form under “Forms”.
Purpose: For you to understand the process and nature of counselling as well as the associated risks and benefits, in order for you to make informed decision about whether to participate or not.
Welcome to Counselling
Congratulations! Engaging in counselling takes a lot of courage and provides you with the opportunity to discover much about yourself. For many individuals, this will be your first experience with online and or phone counselling, and I believe it is important to be clear and transparent about what counselling is, and what counselling looks like. Please read through the attached materials carefully and bring up any questions that you have so that we can discuss them. I will ask that you sign the form. You are welcome to address me with any questions or concerns.
About Counselling: Some Risks and Benefits
Counselling is different than talking to a friend or family member. Our conversations have specific goals, and although your counsellor will be supportive, they also will challenge you. Sometimes you might feel annoyed, tired or upset following a session. This can happen as you are processing new ways of thinking or because you have spoke about something that has been upsetting to you. As a result of counselling, you may experience changes in your relationships or beliefs that have unexpected results. Usually these changes are very positive in the long term, but it may be difficult to experience as they are occurring.
Your counsellor may suggest trying specific techniques in counselling (i.e. relaxation exercises). If you have any questions about these techniques its important you ask. Its also important to know you have the right to stop any exercise at any time during the session. Counselling is one form of treatment for individuals problems- other forms include medications for psychological symptoms, support groups, and physical activity (i.e. yoga). Feel free to ask your counsellor for referral information.
The Relationship with Your Counsellor
The relationship you have with your counsellor is different than other relationships. You will be sharing important details with your counsellor, but you will know little about them. This can be difficult sometimes, but as a professional, your counsellor is part of an association that has rules about the types of interactions they are allowed to have with clients. Your counsellor is prohibited from engaging in a dual relationship with you, or one another than that of client and counsellor.
As part of these rules your counsellor:
- Cannot have any other kind of business relationship with you besides the counselling itself.
- Cannot be your counsellor if they are related to you or if they are your friend
- Cannot give legal, medical, financial, or any other type of professional advice
- Cannot have any kind of romantic, friendship, or sexual relationship with a former or current client
- Cannot give or receive gifts from clients except tokens with personal meaning to the counselling process
- Cannot be your supervisor, teacher, or evaluator while engaged in counselling with you
- Cannot attend personal parties/events of clients even if you invite them
Because your counsellor is very concerned about protecting your confidentiality, your counsellor will not approach or acknowledge you if they see you in the community. This is not meant to be rude, but rather to protect your privacy.
When you have a counsellor, its important you feel safe with this person. Counsellors should seem real or genuine, and should listen to you and help you find the answers you already know. Sometimes, even though counsellors might be a great fit for a friend, they may not be a good fit for you. If you realize you are not comfortable with your counsellor, you have a right to request a referral.
Likewise, counsellors have a right to feel safe in their work, and also can ask that your care be transferred should they feel uncomfortable or that they are not the best counsellor for you. This can occur if counsellors believe their personal values, experiences, or reactions will interfere with their ability to provide you with the best care possible.
As you and your counsellor have the right to feel safe, it is asked that you do not attend sessions while under the influence of drugs or alcohol. This helps to enhance your participation and disclosures in counselling are voluntary and deliberate. If it becomes apparent that your judgment is impacted by drugs or alcohol, your counsellor may end the current session and ask you to come back and you will be billed for this session.
Jacqueline Thibodeau Counselling is not a crisis service and does not provide 24 access to a counsellor. It is important to note that if there is a crisis that it is the clients responsibility to access a formal crisis line or contact 911 in an emergency.
Except in specific situations, you have the right to confidentiality in your counselling. Your counsellor cannot tell other people about your counselling. If you would like us to share information with other people, such as a doctor, you must give us written permission. You have the right to change your mind and revoke that permission at any time.
Legally, we may need to share our concerns with others if we have concerns about safety. Your counsellor is legally bound to break your privacy if they believe:
- You are in danger of harming yourself
- You will harm another person
- A child (age 0-18) is being abused, neglected or is a witness of abuse
- If your record is subpoenaed. The counsellor may advocate limiting the information admissible, but the court can access your file.
Your counsellor will most likely inform you of who they are contacting to help ensure the safety of yourself or others.
It is important to note the risks of online counselling. Although every effort will be made by your counsellor to preserve your confidentiality using an online service (such as Skype or WebEX) limits the control that a counsellor has in regards to online safety, however the programs used for online counselling have been researched and are seen as appropriate for online counselling.
Should we need to contact you, we will try to reach you via the telephone number you have provided to us on the intake form. At times, we may communicate via email. Please be aware that email is not completely confidential. Any email received or sent to your counsellor could potentially be intercepted so discretion on your part is advised.
Confidentiality and Supervision
To ensure the best service to you, your counsellor engages in supervision. This means that they share information with trained supervisors to help others learn, or to get feedback on what they may want to do differently in the sessions. These discussions are focused on helping improve the quality of work your counsellor does, and only the details relevant to a particular aspect of your care will be discussed.
Your counsellor may access consultation from trained professionals in the community and may engage in group supervision. The names of external supervisors and participants are available upon request. When participating in supervision, your counsellor will not share your name or indentifying information in order to protect your confidentiality.
Release of Information Forms
Should you or your counsellor wish to discuss your situation with another individual or agency, you will need to complete a release of information form stating who they are allowed to speak with and the type of information they can release. Please know that other units and health centers may not be bound by the same confidentiality rules as Jacqueline Thibodeau Counselling. If your counsellor is writing a letter on your behalf, you will have an opportunity to review the letter and may request a copy for your own records. Often you will be expected to take the letter to the other party yourself, as opposed to faxing or mailing options.
When you make contact with Jacqueline Thibodeau Counselling, a file will be started with your identifying information on it. This file will include:
- your information form
- consent to release information forms
- consent to participate in counselling forms
- copies of any letters written on your behalf
- case notes
- case file from previous counselling contact should you be a returning client
You have full access to your file, and may request it at any time. You may request your counsellor copy the case notes as counselling proceeds, so you can keep your own file.
- Files are kept digitally on a password protected program.
- Files will be deleted after 10 years once therapy is discontinued.
Fees and Access to Services
Payment is required in advance or at the time of the session. Payment must be made online via the PayPal link or email transfer.
All appointments require 24 hours notice for cancellations. If an appointment is missed without notice payment is still expected for that session.
If your counsellor needs to cancel a session no payment will be expected for this session.
Due to the nature of online counselling Internet connections and computer difficulties can provide a barrier to service. If there are technical difficulties in accessing online counselling your counsellor will attempt to connect with you over the phone to conduct the session. It is your responsibility to test and prepare your Internet connection, computer, and phone service in order to access your counselling session.
If you have a concern about your counselling, we hope you will talk to your counsellor. We take criticisms and suggestions seriously, and will try to respond with care and respect. If you are unable to resolve things with your counsellor, believe that your counsellor will be unwilling to listen and respond, or that they have behaved unethically, you can contact Ontario College of Social Workers at: 1-877.828.9380 ext. 223
Client Consent to Counselling
I have read the Informed Consent document, had sufficient time to consider it carefully, asked any questions that I needed to, and understand it.
I understand the limits to confidentiality required by law, and those indicated by my counselor._____(initial)
I understand that if I threaten or indicate that I will harm myself, others, and/or a child/dependent adult, my counsellor is required to protect these individuals at the expense of protecting my privacy._____(initial)
I understand my rights and responsibilities as a client, and my counsellors responsibilities.
I know I can end therapy at any time I wish, can request another counsellor and that I can refuse any requests or suggestions made by my counsellor.
I am over the age of eighteen, or have been designated a mature minor, or I am the consenting guardian of a client who is a minor.
I understand that I have the right to talk openly and honestly with my counsellor, and will try to provide my counsellor with feedback about how I think counselling is working.
I will do my best to attend scheduled appointments even if I do not always feel like it. If I cannot attend an appointment, I will contact my counsellor prior to the appointment to cancel or reschedule. If I am late for an appointment, I understand it will still end at the original time.
I understand that this counselling service is not a crisis service and if I am experiencing distress I will access a 24 hour crisis line or emergency services (such as 911)
I understand that it is my responsibility to manage my Internet, computer, and phone services so that I can engage in my counselling sessions.
I understand the risks involved in using applications such as Skype and WebEX to engage in online counselling, accept these risks as reasonable, and choose to engage in online counselling
I agree to engage in counseling under the conditions outlined in this document.
|Client Name (print)||Signature||Date|
For your counsellor:
I, the counsellor, have discussed the issues within this consent with my client
My observations of this persons behaviour and responses indicate that this person understands the rules and provisions of counselling as set out above and is competent to give informed and willing consent at this time.
|Signature of Therapist||Date|
Below you will find forms which can be downloaded and completed in one of two ways:
Standard PDF forms can be printed and filled out manually. To submit, please scan the completed form and submit via the form at the bottom of the page or on Document Submissions Page.
Client Information (Print/View)
Client Information form PDF
Informed Consent (Print/View)
Informed Consent form PDF
Release Information (Print/View)
Release Information form PDF
Client Information (Digital Form)
Client Information form PDF – Open and fill out in Adobe Reader.
Informed Consent (Digital Form)
Informed consent form PDF – Open and fill out in Adobe Reader.
Release Information (Digital Form)
Release Information form PDF – Open and fill out in Adobe Reader.
Files are kept digitally on a password protected program & will be deleted after 10 years once therapy is discontinued.