Consent and Disclosure for Therapy
Please read carefully and complete the form at the bottom of the page.
Philosophy of Practice and the Therapeutic Relationship
My integrative, trauma-informed practice takes into account the neurobiological underpinnings of emotional and behavioural health, and I draw from neuroscience, attachment theory, interpersonal and EMDR therapies to provide uniquely-designed treatment plans for each client. I always relate to you as my authentic self and provide a professional, nonjudgmental space for your authentic self to come forward. I am active and passionate about professional development and social justice advocacy.
Education and Training
Biofeedback Certification International Alliance approved training in Neurofeedback (in progress)
Doctor of Psychology degree from California Southern University (in progress, third year)
Advanced EMDR Therapy Certification (in progress)
Trained in Neuromodulation (TCDS) from NeuroCare Group
Master’s degree in Counselling from City University
Certification in Level B Assessments from Queen's University
Bachelor of Education from UBC
Licensed Canadian Certified Counsellor with the Canadian Counselling and Psychotherapy Association (CCPA #10001584)
Licensed Registered Clinical Counsellor with the British Columbia Association of Clinical Counsellors (BCACC #17787)
Licensed Professional Educator by the BC Teacher Regulation Branch (#L174080)
Confidentiality and Limits of Confidentiality
In order to establish trust and for counselling to be effective, anything that is shared with me during our sessions will remain strictly confidential, and information you share will be received without judgment.
There are important exceptions to confidentiality:
I am legally required to tell the Ministry of Children and Families if I learn of a child being abused.
I am legally required to warn anyone whose life is in danger.
I am legally required to warn the authorities if a client has a plan to kill him/herself and is at serious risk to carry out this plan.
I am legally required to comply with a subpoena to appear in court or to provide my personal notes to a court.
It may become useful during the course of treatment to communicate by email, text message (e.g. “SMS”) or other electronic methods of communication. Receiving receipts for services by email or text message fall into this category as well.
Be informed that these methods, in their typical form, are not confidential means of communication. If you use these methods to communicate with me, there is a chance that a third party may be able to intercept these messages.
Some of the potential risks you might encounter using these methods of communication include:
People in your home or other environments who access your phone, computer, or other devices that you use might read your email or text messages.
Loss of cellular phone, computer, or other devices.
Email accounts can be hacked.
Text messages and emails are stored on servers.
Misdelivery of email to an incorrectly typed address.
Third parties on the Internet such as server administrators who monitor Internet traffic might intercept your communication.
Telehealth counselling refers to providing counselling and/or therapy services remotely using telecommunications technologies, such as telephone or video conferencing. Although there are benefits of telehealth service, there are some differences between in-person therapy and online counselling, as well as some risks (such as those outlined above) and responsibilities.
Confidentiality and Telehealth
Although online appointments are only held via platforms with end-to-end encryption, there is always a risk that our electronic communications may be compromised, unsecured, or accessed by others. You should also take reasonable steps to ensure the security of our communications (for example, only using secure networks for online counselling sessions and having passwords to protect the device you use for online counselling).
The limits to confidentiality that are outlined for in-person counselling still apply in online counselling.
Remember, you have the right to participate in therapy as little or as much as you feel comfortable with, and you always have the right to terminate counselling at any time. I encourage you to exercise your right to ask questions about, change, or stop any therapeutic techniques introduced in therapy if you wish. If you are unhappy about anything that happens during therapy with me, please bring it to my attention so that I may address your concerns.
Fees and Terms of Service
Rates for private services start at $150/session for individual counselling. Payment is due before the start of each session and can be paid with cash, credit, email money transfer, or PayPal. I also offer a range of services at no cost to clients, including a free clinic, and First Nations Health Benefits program delivery.
To avoid being charged for a missed appointment, twenty-four hours notice is required for appointment cancellation or rescheduling.
Your file is maintained under the provisions of the Personal Information Protection Act (BC January 1, 2004).
Your file is owned by the counselling agency and kept in a secure place. It is kept for seven years after the end of contact.
You own the contents of your file and are welcome to see your file at any time. You can ask for a copy of your file for yourself or to be given to another professional.
Contact between Appointments
You can contact me between appointments at this number: 250-266-1476, or email firstname.lastname@example.org. I will respond to your call within 48 hours.
If you are experiencing a crisis or emergency, please visit the Tonquin Medical Clinic or Ucluelet Medical Clinic, the Emergency Room at Tofino General Hospital, or phone one of these numbers:
Crisis Line 604 872-3311 or 1-866-661-3311
BC Crisis Line for Suicide 1-800-SUICIDE
Kids Help 1-800-668-6868
BC NurseLine 811