OVERVIEW

An effective counselling relationship works, in part, because of clearly defined rights and responsibilities held by each person. This frame helps to create the safety to take risks and the support to become empowered to change. As a client in counselling, you have certain rights that are important for you to know about. There are also certain limitations to those rights that you should be aware of. This page aims to explore these themes in more detail.

ABOUT PSYCHOTHERAPY

Psychotherapy is a broad field that varies tremendously based on the approach used, and on the particular relationship between practitioner and client. Generally, it is a collaborative treatment which takes place in a supportive environment and allows you to resolve, transform and integrate mental and emotional challenges or issues, which may be causing suffering or preventing you from living your life to the fullest.

In the beginning, you will collaborate with your therapist to establish clear goals for the outcome of your work together. During this time, your therapist will be able to offer you their initial impressions of how they can support you and which approaches might be useful. Together, you will develop a plan for reaching your goals. Over time, you and your therapist will define specific areas of focus, identify particular skills and capacities to be developed and/or healed, and implement approaches that can help you develop/heal them. As part of this, we ask that you please keep your therapist informed about your experience. You are invited to ask questions, express concerns and give your therapist feedback on a regular basis—doing so will optimize your therapeutic relationship and ensure that you get the most out of the work you do together.

Your therapist will always inform you about what you are doing and why, include you in the decision-making process, and endeavour to answer any questions you may have.

ABOUT THE THERAPIST

Taylor Loesekam is a Registered Psychotherapist (Qualifying) currently in good standing with the College of Registered Psychotherapists of Ontario. She is eligible to work with individuals, couples, and families across Ontario.

In addition to regular practice, Taylor actively engages in regular clinical supervision with other qualified psychotherapists and mental health professionals. If you would like to learn more about Taylor's supervisor(s) and their credentials, you are invited to ask at any time.

CONSENT & CONFIDENTIALITY

Counselling provides a space and opportunity for you to explore behaviour, relationships, feelings, or thoughts, which trouble you and cause difficulty in your life. Counselling is also a legitimate source of support in a crisis or during a difficult time. Counselling can bring deeper personal insight and awareness, better ways of understanding and coping with problems, and improved relationships. You should know, however, that counselling sometimes requires that you be willing to examine difficult topics or times in your life, to experience stronger than usual emotions, and to try out new and different behaviours. If you ever have questions about the pacing or intensity of our work, please do ask me.

Confidentiality: Personal information gathered in the course of counselling will be used in accordance with the purposes outlined in the paragraph above and will not be disclosed except in cases of the exceptions outlined below.

Confidentiality is key to the effectiveness of the counselling process, so the personal information you share in counselling will be kept confidential. Confidentiality continues after the end of the counselling relationship.

There are, however, some limitations to confidentiality, in particular:

LIMITATIONS TO CONFIDENTIALITY (please read carefully)

YOU(1) Duty to Report: Vulnerable adults, children, and animal abuse (including cases of neglect and/or hoarding). Mental health professionals are required by law to report stated or suspected abuse of a child or vulnerable person to the appropriate social service agency and/or legal authorities.

(2) Duty to Ensure Safety/Prevent Harm: If it is my opinion that you are in clear risk of serious imminent bodily harm to yourself I have a duty to report to ensure your safety.

(3) Duty to Warn: If it is my opinion that another person is at clear risk of serious and imminent bodily harm I have a duty to warn the intended victim and/or legal authorities to ensure safety.

(4) Duty to Inform: If you disclose that a regulated health care professional has been sexually inappropriate or abusive I would have to inform their regulating college.

(5) Supervision: I am currently receiving regular clinical supervision and will occasionally discuss my work with supervisor(s) and other peers. While I may disclose information, the purpose of a professional consultation is to advance the quality of care provided and great care will be taken to remove any identifying information.

(6) If your record is subpoenaed by a court of law.

(7) If information is requested by insurance providers including names and dates, times, cost, and length of service.

(8) Upon your request, if there are any reasons you may wish to disclose your protected confidential information you will be provided a “Consent to Release” form before any information is disclosed.

In counselling, it is your right at any time to:

(a) have a review of your progress and of any of the topics in this form;

(b) be provided with a referral to another counsellor or health professional;

(c) withdraw consent for the collection, use, or disclosure of your personal information, except where precluded by law;

(d) end the counselling relationship by so advising the counsellor;

(e) access or obtain a copy of the information in your counselling records, subject to legal requirements.

Your right of access to or to obtain a copy of your personal information continues after the end of the counselling relationship. Your record is retained for at least 10 years from the date of the last interaction with The 4th Space, or for 10 years from your 18th birthday, whichever is later.

YOUR CLINICAL RECORD

Our session notes tend to focus on safety issues, how clients make meaning of their experiences, and topics related to change (goals, treatment planning, etc.).

Following guidance from the CRPO, our notes will focus on recording themes (e.g., feelings, thoughts) that emerge during our sessions together.

As a result, the clinical notes taken by your therapist are NOT an objective record and are NOT intended to reflect a historical account of your life experiences.

Any jot notes that are taken on a word document or paper notebook are immediately destroyed (deleted or shredded) following session.

NATURE OF THE THERAPEUTIC RELATIONSHIP

The therapeutic relationship is a professional, supportive relationship designed specifically to help you explore your experiences, emotions, and patterns in a way that promotes insight, healing, and growth. It is a space that prioritizes your well-being, safety, and autonomy, and is guided by clear ethical standards that protect you and the integrity of the work we do together.

Because of this, there are clear limitations as to how your therapist can show up for you outside of the therapeutic relationship:

• We cannot, now or ever, be a close friend of socialize with clients.

• We cannot provide therapy to someone who is a close friend or family member.

• We cannot engage in any sexual or romantic relationship with clients, before, during, or after the course of therapy.

• We cannot have a business relationship with clients.

In sum, we cannot have any relationship with you outside of the therapeutic relationship.

To protect your privacy, if you ever see your therapist in public, contact will not be initiated on their part. If you choose to say hello, we will respond warmly in a way that does not disclose the nature of our relationship.

SESSION FEES AND PAYMENT POLICY

At this time, current fees established by The 4th Space include:

(1) Individual 50-minute session: $175.00

(2) Individual 80-minute session: $250.00

I understand that my therapist and I may establish an alternative sliding scale payment, which will be documented during our initial intake session.

If a sliding scale rate is agreed upon, The 4th Space aims to re-initiate conversations around the rate every 6 months or as needed. Clients are also welcome to initiate conversations about their session rate at any time if a change would be supportive.

By agreeing to this policy, you are additionally agreeing to the following:

I agree to ensure payment for each session is provided to the therapist by the end of each session. By signing this form, you are agreeing to keep a credit or debit card on file that can be charged. Payment is accepted by credit card or debit visa or mastercard and must be paid in full by the end of the session. Services will not be permitted to continue if there is an outstanding balance on your account. If the session fee is not paid immediately following the session, the credit card on file will be charged. In the event that the session fee is unable to be paid and alternative arrangements have not been made, any upcoming session bookings will be cancelled until the outstanding balance is paid in full. If you are late or miss a payment, it is our policy that we then charge the card at the beginning of the session to prevent any payment issues from occurring in the future that could interrupt the therapeutic process or therapeutic alliance.

If I desire to pay for sessions via e-transfer, I understand I must verbally discuss this with my therapist before this payment option is accepted. This discussion will be documented in my file, and a new consent form will be provided to me to confirm this payment arrangement. All above specifications outlined in the paragraph above will still stand.

If you and your therapist choose to continue your session beyond the scheduled time, it will be billed in a prorated manner in increments of 15 minutes.

LATE CANCELLATION OR MISSED APPOINTMENTS

Your appointment time is reserved just for you. A late cancellation or missed visit leaves an appointment space in the therapists’ day that could have been filled by another client. As such, we require 48 hours notice for any cancellations or changes to your appointment.

Clients who provide less than 48 hours notice will be charged half of their session fee to their credit card on file. For sessions cancelled with less than 24 hours notice, or miss their appointment altogether, the Client will be charged the full session fee to their credit card on file.

All payments are due by the end of your session. No further sessions will be booked if you have an outstanding balance on your account.

Therapists will give a grace period of 10 minutes if you are running late. Please be respectful of your therapist’s time by letting them know if you’re late or not attending for any reason.

YOUR RIGHTS

You have the right to ask your therapist questions, provide feedback to them about the counselling process, and know your therapist’s qualifications; you have the right to end counselling at any time; you have the right to a safe and secure environment; you have the right to ask about and discuss your therapist’s policies. Should you have any concerns about your therapist’s clinical and/or professional practice, you do have the right to make a complaint to the regulatory body. If such an issue does arise, your therapist will provide you with the necessary information to do so.

As a client, you have certain rights owed to you. You have the right to never be discriminated against and to be offered a space that is open, caring, honest, and judgement-free. Effective therapy can sometimes feel challenging, difficult, or uncomfortable as you push outside of your comfort zone while working towards change. You have a right to be therapeutically supported should it be challenging, and to have your needs and preferences met.

All The 4th Space therapists are registered members of the College of Registered Psychotherapists of Ontario (CRPO). Your therapist is held accountable to their codes of ethics, which can be found at https://www.crpo.ca/code-of-ethics/. Your therapist’s individual registration numbers are found on each of your invoices and also available at your request.

You have the right to withdraw your consent to treatment at any time. We are obligated to document this withdrawal of consent in your client record and include the reason for the change if applicable. As per PHIPA, you may, with limited exceptions, withdraw consent at any time for the collection, use or disclosure of personal health information by providing notice to the custodian.

YOUR RESPONSIBILITIES

As a client, you also have responsibilities. You have the responsibility to participate in your therapy to the full extent of your abilities and potential. You have the responsibility to attend sessions while not under the influence of alcohol or drugs. You have the responsibility to treat your therapist with the same respect and non-discrimination that they offer to you.

Additionally, for your privacy and to receive the most benefit from therapy, you must have a quiet and private space where you feel comfortable and will not be interrupted or overheard during your sessions. For safety, it is asked that you do not drive while in session. You may take sessions in a car if that is the only quiet and private space you can access, but the vehicle must remain off throughout the duration of our session.

REQUESTS FOR DOCUMENTATION OR EXTERNAL COMMUNICATION

Please note that any request for external communications will be charged based on the hourly session fee ($150/hour). External communications may include, but are not limited to, communication with doctors, lawyers or insurance, or therapeutic hand-offs to other practitioners, at your request.

Fees provided below:

• Clinical File Exports Requested by Client: Free of charge

• Clinical File Exports Requested by Third Parties: $125.00

• Letters or Case Summaries: $100 to $200, depending on length and preparation time.

In cases where documentation is requested by a third party, such as an insurance company or lawyer, they sometimes will request full copies of your session notes. As you likely discuss more in therapy than what pertains to your current case, we strongly recommend you opt for a letter summary.

REMOTE & ELECTRONIC COMMUNICATION POLICY

While all attempts to establish and retain a secure connection online/by phone have been made, it is at times not possible to guarantee 100% protection of the confidentiality of virtual communication. Given that virtual therapy means that the client and therapist are not physically located in the same place, an extra step to ensure client safety is required. Specifically, you will be required to provide the physical address of your location at the beginning of each session. This information would only be released in the case of bodily harm to yourself, or another person is being threatened. Please make arrangements to be in a room alone, with a closed door, for your virtual therapy appointment. It is essential that you feel comfortable and are not interrupted during your session. Your therapist will ensure that they are in a room alone with a closed door free from distractions to provide you with their full attention. Therapy services take place on a virtual, secure video platform or via telephone. As such, it is the clients’ responsibility to ensure they have sufficient internet connection, cell phone service, battery power, and audio/video capabilities to engage in online or telephone psychotherapy. Additionally, it is the clients’ responsibility to ensure they have a backup method of communication in the event of power failure, loss of internet connection, or other unforeseen events (i.e., second computer and/or cell phone to complete a session). Any sessions that are prematurely terminated due to fault in the client’s devices, cell phone service, or internet services will not be refunded and must be paid in full. Your therapist will attend sessions with sufficient internet connection, cell phone service, battery power, and audio/video capabilities to engage in virtual or telephone psychotherapy. Additionally, they will be prepared with alternate means of communication if a session is dropped, or if their device fails.

The 4th Space uses e-mail communication for administrative purposes only (e.g., scheduling of appointments). Due to the nature of digital technology, the security and privacy of e-mail communication cannot be guaranteed. E-mail is not an appropriate method of communication for sensitive or detailed personal matters, and you are discouraged from sending me emails of this nature. Please contact your therapist by email or book online to arrange an additional therapy session if you have sensitive information to share that cannot wait until your next appointment.

The 4th Space additionally may send newsletters to individuals who have an active profile with the practice. These newsletters may include relevant updates to the practice, vacation or leave notices of the therapist, and/or general mental health insights or resources. If you'd like to opt out, you are invited to verbally tell your therapist in session.

TERMINATION POLICY

If you have been inactive for 3 months or more, your status will be set to “discharged” in our system. In this context, inactive is defined as (1) not booking a session, and (2) not responding to therapist's attempts to check in.

If clients wish to resume therapeutic services following their discharge, they will need to complete an updated consent form and undergo an additional initial session to resume normal sessions. At this point, sessions will be subject to any updates or changes in fees. Clients will be notified via email following 3 months of inactivity that their status will be changed to discharged.

Best efforts are put forth to avoid the occurrence of a conflict of interest or dual/multiple relationship arising. However, in the event that either of these ethical concerns arises during our work together, the therapist reserves the right to terminate therapy services, where necessary.

EMERGENCY POLICY

If you are ever experiencing an emergency that puts you or someone else at risk of physical or emotional harm, please call 911 or go to your local emergency room. If you are experiencing a crisis, please phone Crisis Services Canada at 1.833.456.4566 or text 741741.

Please note that The 4th Space does not offer emergency services.

INCLUSION & DIVERSITY POLICY

It is very important to The 4th Space to create a counselling environment that is welcoming and affirming to intersecting and diverse identities. This includes but is not limited to racial, cultural, religious, sexual, gender, age, and ability. We try to create a space that is positive and safe for people of identities that have been stigmatized and/or marginalized. We welcome you to share any parts of your identity that are important to you, and to please tell your therapist if there are any specific considerations or accommodations they should be aware of. We invite you to provide any feedback if we are not acting as an ally to a community, you are a member of, and we are committed to changing and improving our practices based on that feedback.

PRACTICE NEWSLETTER

From time to time, I share a brief quarterly newsletter with clients. The purpose of this newsletter is to keep clients informed about practice updates and to share resources that may be supportive or interesting.

The newsletter may include:

• Practice updates, such as scheduling changes, policy updates, therapy groups/course announcements, or anticipated vacation periods

• Resources, including readings, tools, or materials related to mental health

• Professional development updates, where I share ways I have continued to grow as a therapist over the quarter (such as training, learning experiences, or areas of study) as a way to demonstrate continued commitment to my growth as a therapist

These reflections are always shared at a broad level and never include identifying or personal client information.

Receiving the newsletter is entirely optional, but it can be helpful for staying informed about practice updates and accessing additional resources between sessions. You may unsubscribe at any time by verbally communicating your desire to withdraw to your therapist, or by emailing taylor@the4thspace.ca.