Dr. Earon Kavanagh, B.Sc., M.Sc., CPsychol, AFBPsS, MPCC
Canada Registered "Master Practitioner in Clinical Counselling", #4887
Office phone number (709) 800-0689; Email dr.earonkavanagh@proton.me
INFORMED CONSENT AND AGREEMENT FOR COUNSELLING
My “fee-for-service” counselling and psychotherapy private practice adheres to the Canadian Professional Counsellor's Association (CPCA) Code of Ethics, CPCA Standards of Practice, and CPCA's Ethical Framework and Guidelines for online counselling and psychotherapy. More information on these can be found at http://thecpca.ca/about-us~.aspx
CONFIDENTIALITY AND SECURITY
The information shared with me is held in strict confidence and all notes and assessment information are stored in a locked filing cabinet. Information, including that you are my client, will only be released with your signed consent to release information.
EXCEPTIONS TO CONFIDENTIALITY
In adherence with the CPCA ethical code, and the laws, I am obliged to break confidentiality for the following:
• a. There is known, immediate, and/or life-threatening danger to the client or known individual;
• b. When there is reasonable suspicion of abuse or neglect of a child, elderly person, or vulnerable person;
• c. When the clinical counsellor, or client records, are subpoenaed by a court of law or judge.
INITIAL STAGES OF COUNSELLING/THERAPY
• Before we start therapy or evaluation of your situation, this consent form needs to be agreed to, as it addresses your rights, privacy, fees, etc.
• A 15-minute free consultation is available prior to the start of therapy.
• Prior to the start of therapy, a basic information form (“intake form”) is then filled out by yourself. Filling it out ahead of the first meeting saves you time and money, and helps me get started.
• The initial appointment assesses your situation (often called the “assessment”).
• By the end of the assessment, we will discuss whether I am the right therapist for you, and, if so, I will soon offer a treatment plan. If I believe someone else is better suited, I will make a recommendation.
• I practice through online tele-health, and only provide in-person office sessions in Newfoundland's Avalon Peninsula.
• Although I am skilled in several models of therapy, my orientation is centered in brief therapy, which uncovers your strengths, aids evaluation, and easily integrates with other treatment methods.
• Brief therapy seeks to find solutions that can be immediately employed to decrease negative symptoms, and create and build on observable changes. Brief therapy is also very goal-directed.
• A typical brief therapy process takes between one 1-2 sessions, and up to 6-10 sessions, including initial evaluation.
• It depends on the presenting problem, client participation in the process, and what the client decides is needed. Couple and relationship challenges can require up to 12 sessions.
Challenges such as addictions, re-occurring anxiety, depression, and other related conditions can take longer, and the client can seek more sessions if desired. This is discussed in the treatment plan.
YOUR RIGHTS AS A COUNSELLING/THERAPY CLIENT
• You can ask questions about my credentials, the counselling services I am providing, and any other questions pertaining to counselling;
• You can ask for a review of your progress and any other items in this agreement;
• You can ask to be provided with a referral to another counsellor or health professional;
• You can withdraw your consent to the collection, use, or disclosure of your personal information, except where it is precluded by law;
• You can end the counselling relationship by advising me of your decision;
• Your file is closed automatically, for case management purposes, if there is no activity for 30 days;
• If desired, you can request re-opening your file, at a later date, with an updated assessment;
• You can convey your concerns or complaints to myself. If necessary, you also have the right to inform the Canadian Professional Counsellor's Association of any unprofessional or unethical behavior by myself;
• You can have access to your personal information or ask for corrections to this information. Your right of access to, or to obtain a copy of your personal information continues after the end of the counselling relationship.
BENEFITS AND DISCOMFORTS OF ONLINE COUNSELLING/ THERAPY
In counselling and psychotherapy your needs and growth get full attention. Online counselling and therapy is a way for you to access counselling using Internet technology. You can benefit from exploring areas that trouble you and hold you back in life. Such areas can include relationships, behaviors, thoughts, feelings, work-life stresses, sleep patterns, and even dreams. Gaining insights about yourself and these areas can result in positive personal change. However, the process can also produce occasional emotional discomfort, as the psychic/emotional energy that co-exists with unresolved problems, emerges into conscious awareness.
Seeing your counsellor's face gives you benefits you get from face-to-face counselling. You can also hear tone of voice, which is a way to convey empathy, and by video you see non-verbal communications such as facial expressions. You can also elect use Audio only with system I use, if that is more comfortable for you.
ONLINE COUNSELLING/ THERAPY, AND PROTECTING YOUR PRIVACY
I use the “Zoom for Healthcare” video meeting system which is encrypted, and sometimes the “Psychology Today” system, which is also encrypted. I also use the password-protected “Proton” healthcare-grade email system. Should you choose this method of counselling, you will need to have an Internet connection. You do not need a webcam to use Zoom counselling, and the meeting link is sent to you from my computer.
USE OF EMAIL CORRESPONDENCE
• At this time, I only use email to send encrypted documents, and to make any appointments, etc. My email system, Proton, is healthcare-grade to protect your privacy.
• You will be guided in how to receive and open protected emails and forms. This is a relatively easy process. Proton encryption prevents your emails or attached documents from being intercepted and read by a third party.
SESSION LENGTH
• Sessions are a full 60 minutes, rather than the standard 50-minute hour;
• Sessions start on time and end promptly, but can be extended at an extra cost ($2.20 per minute) if requested by client;
• Any psychometric testing, if employed, will include costs for the tests (subject to client approval).
FEES
• An individual session is $160.00 for 1 hour + HST (Total $184.00);
• Couple and family sessions are also $160.00 per 1 hour + HST (Total $184.00);
• Therapeutic letters, which document your progress, are available, require written permission, and are $60.00 each;
• Telephone consultations are available at $2.20 per minute; session time extensions are available at $2.20 per minute;
• I understand that Canada Revenue Agency may allow personal tax deductions for counselling therapy. Please verify this with
your tax accountant.
CANCELLING A SESSION or NON-ATTENDANCE
• Cancellations require a 24-hour notice;
• If the cancellation period is less than 24 hours, I will bill you in full for the missed session;
• “No-shows” to any session also result in being billed for the full session;
• To cancel a session, email me or leave a message at my phone number.
LATE ARRIVALS TO COUNSELLING/ THERAPY SESSIONS
If you are late to the session, whether online or in-person, the full appointment fee is still charged, and the session ends promptly at the prescribed time. Session time extension can be provided as per the listed fees per minute.
PAYMENT OF COUNSELLING/ THERAPY FEES
• Payment is required by the end of the date on which the session was delivered, by INTERAC e-transfer, PAYPAL;
• The INTERAC e-transfer information and PAYPAL details are made available once you become a client (also see website .
• Payments for Office-based local sessions: payment is in cash at the end of the session.
• If you pay in cash, please bring the exact amount. I cannot provide change.
• If you pay electronically anytime ahead of the session you receive a 10% discount.
EXTENDED HEALTH INSURANCE PLANS:
• Your health benefits plan may reimburses all or a portion of the fee for clinical counselling services;
* In such cases, you pay my fee, receive my professional receipt, and then seek reimbursement from your Plan provider;
* To receive reimbursement, you will need to submit the receipts to the plan administration office;
• For information on using your health insurance plan for counselling fees, visit your Plan Provider website (or plan manual), or phone them.
• Have your plan number ready to find out if your plan covers “clinical counselling”;
* Your health plan may or may not reimburse you for the full cost of clinical counselling services that you have paid;
• You remain responsible for any additional costs and I will not refund the difference.
• Clinical counselling services not covered by health plans may be tax deductible as a medical expense.
* To confirm Canada tax deductions for clinical counselling as medical expense, please consult with your tax advisor.
UNPAID SESSION FEES
• No other sessions will be provided until session fees are paid.
OUTSTANDING FEES
• Missed session fees, admin fees, and unpaid session fees must be paid within 15 days.
• After 15 days these owed amounts are automatically turned over to a collection agent.
COUNSELLING/ THERAPY AND ASSESSMENT OF CRISES
• My private practice, specializing in person-centered talk-therapy, does not provide full-service crisis response.
• If you experience “crisis” such as suicidal ideation or extreme emotional distress please call the following...
• Mental Health Crisis Line (709) 737-4668, or Toll Free 1 (888) 737-4668. Free services and very professional.
• You can also call “9-8-8”, or visit your local hospital emergency ward.
• Signs of crisis may be feelings or thoughts about suicide, or harm to yourself or another.
• If you, or someone you know are in immediate danger, please call 9-1-1 (Newfoundland and Labrador emergency help line)
TERMINATION OF COUNSELLING/ THERAPY
• At the end of our counselling agreement a record of our exchanges will be stored on file in a locked cabinet, for a period of 7 years.
• No identifying names or material is retained on these records, as a client ID number is used.
• After this time, paper documents will be shredded.
OTHER CONDITIONS OF COUNSELLING/ THERAPY
• I ask that you do not record, on audio or video, any of the content of our sessions or consultations, without my prior agreement;
• Email will not be used as a counselling or consultation mode;
• I will support you fully...to declare when you are ready to terminate the counselling relationship;
• I will support you fully, and co-create a plan should you choose to take a break from clinical counselling;
• I will also support you fully to seek a therapist more suitable for your needs, and assist with a referral, if needed.
CONTACT ME ON MY ENCRYPTED EMAIL SYSTEM FOR THE FOLLOWING
• If you are seeking further contact about my services;
• If you have questions on this informed consent and agreement for counselling;
• If you are seeking further information or wish a 15 minute free consultation
• CONTACT: dr.earonkavanagh@proton.me
• PHONE: (709) 800-0689
*
If interested in booking an assessment session, Email me to confirm that you have read this informed consent and that you consent to participate in clinical counselling.
Please note that this is a webpage version of the Informed Consent and Agreement for Counselling
The complete standard version will be emailed to you prior to our initial counselling/ therapy session.