Relationship counselling Contract & Consent form
Welcome to Turning Tides Life Coaching and Counselling. Please take a moment to review and complete this contract and consent form. If you have any questions please be sure to ask your counsellor. Each Individual in Relationship Counselling will complete and submit their own form.
Relationship counselling is a form of therapy or psychotherapy that seeks to help people address and repair conflicts, attachment dynamics, communication difficulties, intimacy, ruptures, or trauma and loss. Relationship Counselling can also help with preparing for a positive transition, or in moving towards separation in as healthy a way as possible. In relationship counselling, learning to recognize and track one’s own and others inner states and activation, in order to experience co-regulation and vulnerability with one another, can be a goal. Fostering the conditions that lead to the relationship becoming a secure safe haven is another goal.
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Risks and Benefits:
Relationship Counselling may involve the risk of remembering unpleasant events, feeling unfamiliar sensations, or arouse strong or unanticipated feelings or memories. You may face issues or aspects of yourself that are uncomfortable, and therapy may lead to unforeseen changes in your relationships or take you out outside of your comfort zone to explore and expand your growing edge. Benefits may include increased self-regulation, improved communication, and greater harmony or closeness. You may experience relief or resolution of trauma symptoms, and develop skills, increased resiliency and a healthier relationship with yourself and others.
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Permission to Transcribe Sessions:
By signing this agreement, I understand and consent to the transcription of Zoom sessions for the purpose of creating accurate session notes. These transcriptions will be securely stored and used solely for therapeutic purposes, in compliance with confidentiality standards outlined in this agreement.
Outcomes and Ethics:
The outcome of relationship therapy is difficult to predict or guarantee, since it is dependent on a number of factors, such as the fit between you and your therapist, current adverse conditions that are actively contributing to your challenges, and your readiness and willingness to work towards set goals. However, our counsellors will do their best to help you to handle the risks safely and experience at least some of the benefits. If you have any questions or concerns, we encourage you to discuss these your counsellor at any point.
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“No Secrets” Policy for Relationship Counselling
This written policy is intended to inform you, the participants in relationship counselling, that when we agree to work with more than one individual (couple/family/other), we consider them (the treatment unit) to be the client. For instance, if there is a request for the treatment records, I will seek the authorization of all members of the treatment unit before I release confidential information to third parties. Also, if my records are subpoenaed, I will assert the psychotherapist-client privilege on behalf of the client - the treatment unit.
During the course of my work with couple/family/other (treatment unit), we may see one individual in the relationship for one or more sessions. These sessions should be seen by you as a part of the work that we are doing with the unit, unless otherwise indicated. If you are involved in one or more of such sessions, please understand that generally these sessions are confidential in the sense that we will not release any confidential information to a third party unless required by law to do so or unless we have your written authorization. In fact, since these sessions can and should be considered a part of relationship therapy, we would also seek the authorization of the other individuals in the treatment unit before releasing confidential information to a third party.
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However, we may need to share information learned in an individual session with the unit, if we are to effectively to do our jobs as counsellors. We will use our best judgment as to whether, when, and to what extent we will make disclosures to the couple/family/other (treatment unit), and will also, if appropriate, first give the individual the opportunity to make the disclosure. Thus, if you feel it necessary to talk about matters that you absolutely want to be shared with no one, you might want to consult with a separate individual therapist who can treat you individually.
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This “no secrets” policy is intended to allow us to continue to treat the client (the couple/family etc.) by preventing, to the extent possible, a conflict of interest to arise where an individual’s interests may not be consistent with the interests of the unit being treated. For instance, information learned in the course of an individual session may be relevant or even essential to the proper treatment of the couple or the family. If we are not free to exercise our clinical judgment regarding the need to bring this information to the family or the couple during their therapy, we might be placed in a situation where we will have to terminate treatment of the couple or the family. This policy is intended to prevent the need for such a termination.
Service Fees
• 90-minute couples session: $190 CAD.
• 60-minute 1:1 session for members of the couple: $130 CAD.
• Non-clinical support: Work done outside of sessions (letters, reports, resume writing, check-in calls over 10 minutes, offsite services, etc.) is also charged by the hourly rate.
• Sliding scale: Limited sliding scale spots are available for people who have been marginalized due to race, students, and individuals facing significant financial hardship.
Payment Policy
Full payment is required upon booking online prior to the start of session.
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Cancellations and Missed Sessions
• Cancellations within 24 hours from the session and missed sessions will be billed at the full rate.
• If it is possible to reschedule within the same week, the cancellation fee will be waived (please be advised that sometimes there are no other available times within the same week).
• If you cancel or miss 3 consecutive appointments, or fail to respond to our attempts at contacting you, we reserves the right to discontinue your treatment and you will be provided with information about other services that might be of assistance if this is of interest to you.
• Fees for missed or cancelled sessions are not typically covered by extended health benefits plans.
• Cancellation or missed session fees will be waived on compassionate grounds, for example: in the event of sickness, a medical emergency requiring urgent professional treatment, or death in the family.
In the case of a power outage or technical difficulties with video calling, sessions will still take place by phone to ensure continuity of care, provided phone is still available. We will attempt to call you at the number you have provided or reach you by email. Cancelling a session due to failed video call will follow the same cancellation policy as above. Some approaches cannot be conducted by phone, in which case the session may be cancelled or rescheduled without penalty if a different focus for the session cannot be identified.
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Acknowledgements and Agreements
