Consent Form

 

 -- SUBJECT TO CHANGE --

Finding Change Stress and Trauma Psychotherapy
J. Kumar and R. Ginsberg Social Work Professional Corporation

 

Before starting sessions with us, you will be asked to agree to the terms stated below. Please review the following document carefully as it contains important information about how we will work together. Please email us at findingchangeinfo@gmail.com with any questions or concerns.

PROFESSIONAL BACKGROUND AND TRAINING

Jyotica (Joy) Kumar and Rachel Ginsberg each hold a Master’s of Social Work degree from the University of Toronto and are registered social workers (RSWs) in good standing with the Ontario College of Social Workers and Social Service Workers (OCSWSSW). Joy and Rachel provide counselling and practice the controlled act of psychotherapy, as authorized by the OCSWSSW.

Please note that for regulatory reasons, Joy and Rachel are only authorized to provide services to clients who are residents of Ontario and physically present in Ontario at the time of service. We may not be able to have sessions with you if you move outside of the province or are travelling outside of the province. If this is a concern for you, please get in touch with us to discuss your situation, before your first appointment. 

SERVICES OFFERED

We offer individual (one-on-one) sessions in-person, virtually and over the phone to adult clients (age 18 and above) in Ontario.

Joy practices the following therapies: Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT), Mindfulness Based Cognitive Therapy (MBCT), Mindfulness Based Stress Reduction (MBSR),  Emotion Focused Therapy (EFT), Dialectical Behavioural Therapy - PTSD and Prolonged Exposure Therapy for Trauma.

Rachel practices DBT, CBT, Motivational Interviewing, and is a Certified Clinical Trauma Professional, Level II (CCTP II). 

We continuously engage in professional development and will be adding more modalities to our practice in the future. 

WHAT TO EXPECT

During sessions, we will discuss your current concerns relating to mental health, relationships, work/school, life goals, and other topics. We will work collaboratively with you to set goals and find strategies aimed at improving your mental health, overall well-being, and ability to solve problems. We specialize in working with individuals who have experienced trauma. 

We will regularly check in with you about how you are feeling during sessions and how well the strategies we try are working for you. Please feel free to ask questions or raise concerns to us at any time so we can ensure that sessions are helpful and that we are working towards goals that are important to you. 

Reaching your goals in therapy is not always easy and requires commitment. We may suggest home practice exercises for you to do; if you have any concerns about your ability to practice outside of sessions, please discuss this with us so we can problem solve with you. If you find yourself having a hard time engaging with the therapy process, we are happy to discuss this with you to figure out what could be blocking you and what might help you to be successful in reaching your goals.

In some cases, we may not be able to assist you with certain issues you are facing (for example, if they are outside of our areas of expertise or scope of practice). If this happens, we will inform you as soon as reasonably possible and attempt to assist you in finding alternative resources. 

RISKS AND BENEFITS

Therapy is an opportunity to explore and process difficulties related to behaviours, thoughts, feelings, memories and relationships. Therapy can provide greater self-awareness, insight, and skills for managing difficult aspects of life, in the pursuit of a life with meaning. Therapy may involve the risk of exploring unpleasant feelings, events or experiences which can lead to strong emotions or reactions. We will always attempt to mitigate these risks by staying within our scope of practice, using evidence-based approaches, and regularly checking in with you.

The risks of not engaging in therapy when it is needed may include mental health issues getting worse as well as worsened functioning in many areas of life. 

We may ask you to renew your signature on this consent form from time to time, especially if there are significant changes to our policies or the nature of our work.

TERMINATION OF SERVICES

Sometimes the relationship between a client and their therapist cannot or should not continue. As per the Code of Ethics and Standards of Practice set out by the OCSWSSW, we may terminate services with you when our services are no longer required or requested, or if one or more of the following situations exists:

• you request that we terminate services;
• you withdraw from our services;
• our services no longer benefit you;
• continuing to serve you would require us to violate ethical and/or legal requirements;
• providing you with services has created a situation where our values, ethics and/or boundaries have been violated to the extent that we are unable to provide appropriate services;
• you have repeatedly, and without adequate explanation, cancelled or changed appointment or meeting times to the extent that we experience or believe that financial hardship and/or service disruption will occur;
• you are unable or unwilling to reimburse us for services rendered, when such reimbursement has been previously agreed to by you and is both appropriate and required as a condition of providing services; or 
• continuing to provide the services would place us at serious risk of harm.

If any of the above occurs, we will make reasonable efforts to hold a termination session with you and provide an explanation for discontinuing the services.

For more information, please visit: https://www.ocswssw.org/sop/principle-iii-responsibility-to-clients/

SAFETY, CONFIDENTIALITY, AND RECORDKEEPING

We take your privacy very seriously and will keep information about you and what is discussed in our sessions private. We comply with all applicable privacy laws for health care in Ontario. 

However, it is important for you to know what there are limits to confidentiality, including situations where we will be legally or ethically obligated to disclose certain information to the appropriate authorities. Some examples include: 

• If we believe a child under the age of 16 may be at risk of harm or in need of protection due to neglect or abuse
• If we believe you are at imminent risk of suicide (if chronic suicidal ideation is something you experience, we will create a safety plan together early on in our sessions) 
• If you disclose that you intend to harm someone else, we will be obligated to attempt to warn that person and contact emergency responders
• If there are reasonable grounds to believe that there is a significant risk of death or serious bodily harm to yourself or others
• If we are subpoenaed by a court of law
• If you disclose abuse or other serious misconduct by a social worker or social service worker
• If you disclose information about elder abuse in a long-term care or retirement home
• If we are required to disclose information in order to comply with an investigation by the OCSWSSW

If one of the above situations occurs, we will attempt to discuss it with you and answer any questions you have, if possible, before or after we disclose the necessary information.

In addition, Joy and Rachel may at times engage in consultation or clinical supervision with each other or other mental health professionals regarding your care. If this occurs, your identifying information will still be kept private. Consultation and supervision are done to ensure that we are providing high quality, evidence-based care, and ensuring our own well-being and growth as professionals. Consultation and supervision are very common and are considered best practices, even for experienced therapists. 

Except where required or allowed by law, no information about you or our sessions will be released to a third party without your prior written consent. At any time, you have the right to withhold or withdraw consent to, or place conditions on, the disclosure of your information.

We will keep records of our sessions and other interactions for at least 10 years after our sessions end, in order to ensure a high quality of care and compliance with the OCSWSSW Code of Ethics and Standards of Practice. These records can only be accessed by authorized Finding Change therapists, administrative staff, and practicum students, and can be provided to you directly, upon request. Except in cases where confidentiality is limited (see above), your records will only be shared with a third party with your prior written consent. We use Jane App to store your records, which complies with all applicable privacy laws in Ontario. 

Once a year, we will review our records and securely destroy any records that are over 10 years old unless, in our judgment, there is a reasonable possibility that future access to the record may be needed (such as, but not limited to, in cases involving minors, sexual abuse and/or current or future litigation).

We will always conduct virtual and phone sessions from a password protected phone or computer and we suggest that you ensure the devices you use are password protected as well. Please do your best to ensure you have a private place to talk during your sessions and are using a password-protected internet connection (in the case of videocalls). If any sensitive or confidential documents need to be sent to you or a third party, we will send them via secure fax or Jane App.

See our full privacy policy here: https://findingchangetherapy.ca/pages/privacy-statement 

For more information about the obligations of social workers or health information custodians, please visit:
https://www.ocswssw.org/sop/

https://www.ipc.on.ca/

POTENTIAL FOR CONFLICT OF INTEREST

We may be providing services to other members of your family or close social network. We cannot disclose this fact to you. However, if you become aware of this fact on your own and it is of concern to you, we would be happy to refer you to another member of our team or another provider in the community.  

FEES AND CANCELLATION POLICY

Our fee is $170 per regular 50-minute session or $300 per 100 minute session, unless we mutually agree on a reduced fee, in advance (in this case, you will be asked to sign a Reduced Fee Agreement Form). Initial assessments may take longer than regular sessions (60-90 minutes, based on client needs) but the fee will be the same as for a regular follow-up session ($170 or the mutually agreed upon fee). We review our fees once a year and will always inform you in advance if our fees will be increased. 

The fees we charge not only cover our overhead costs but also help support our own needs and well-being as therapists (and human beings) and allow us to keep our practice sustainable and avoid burnout so that we can keep giving our best to our clients. They also help us continually upgrade our skills and ensure we are providing high quality, evidence-based care. 

We will soon be offering direct billing to some insurance companies. Please note that it is your responsibility to be aware of any limits to your coverage or any special requirements (eg. doctor's referral). If the entire fee is not covered by your insurance, you will be responsible for paying whatever amount is not covered, using the methods of payment offered by our practice. Please check your insurance policy to see if services with a registered social worker (RSW) are covered. If outstanding fees remain unpaid after a significant period of time, we may utilize collection agencies or legal proceedings in order to recover the fees. 

If you need to cancel or reschedule your session, please do so directly through Jane App. If you cannot access Jane App, you can inform us by email that you need to cancel. Please note that if you do not attend your scheduled session or cancel with less than 24 hours’ notice, you will be charged the full session fee, which may not be covered by your insurance company. A 15-minute grace period will be offered for all virtual sessions. For phone sessions, we will attempt to call you twice. If you are on another call and do not have a call waiting service or voicemail, you may not be aware of our calls. Exceptions may be made on a case-by-case basis (eg. in case of sudden illness or injury). 

Fees may also be charged for any requested reports or letters for third parties, such as insurance companies. We will always inform you of the exact fee in advance. We will provide updates to other health care providers (for example, your family doctor or psychiatrist) upon request, free of charge.

COMMUNICATION POLICY

The best way to reach us between appointments is by email. We will always try to answer emails quickly but may not answer on our days off (Sundays and Mondays for Rachel, and Mondays through Fridays for Joy). Our email accounts are not monitored 24 hours a day.

Our practice uses email providers that have security and management controls on their servers.  However, we cannot guarantee the privacy of emails sent and received. Email is best for questions or concerns related to our policies, finding resources, receiving therapy handouts, scheduling problems, etc. If you want to have a discussion about a personal or mental health issue, we encourage you to make a note of it and bring it up in your next session; please note that we are unable to provide therapy over email. Any communication by email may become part of your client record.

In order to maintain healthy, clear, and ethical boundaries, we do not connect with clients using our personal social media accounts (including LinkedIn), even after therapy sessions have ended. If you choose to have phone sessions, we will call you from a blocked/private number; we do not share our personal phone numbers with clients. You can choose to receive automatic text reminders for upcoming appointments through Jane App but we do not communicate directly with clients via text; please do not respond to email or text reminder messages as we will not receive these responses.

Please note that we are not a crisis service and will not be able to assist in case of emergency. We discuss safety planning early on in sessions with our clients to decide what specific steps should be taken in a crisis. Otherwise, if you find yourself in need of crisis support, please call 911 or a crisis line, such as Talk Suicide Canada 1-833-456-4566 (or 988, starting Nov. 30, 2023). After the crisis has been addressed, please book an appointment with us or reschedule your next upcoming appointment to an earlier date, if possible. 

REQUESTS FOR LETTERS, REPORTS, OR ASSESSMENTS

Please note that we are generally unable to provide assessments or documentation specifically for the purposes of supporting a legal case (such as a personal injury lawsuit or custody dispute), priority or subsidized housing application, the use of specific community resources, or obtaining an emotional support animal. These types of assessments require specialized knowledge and qualifications that we do not possess. 

If your primary goal in therapy is to obtain documentation for one of the reasons above, we are unfortunately not the right resource for you and are unable to provide a referral to another provider but we suggest you discuss your situation with your legal representative or search for an appropriate provider on Psychology Today. 

Upon request and with your consent, we may occasionally provide progress reports to your insurance company if you are receiving disability/leave benefits. We will likely need to see you for multiple sessions before we can provide such an assessment. Please note that we are obligated to provide an honest assessment and may charge a fee for any reports or letters provided. 

Requests for other types of documentation will be considered on a case-by-case basis and may be subject to a fee, which you will be informed of before payment is due.

We will always provide you with your own session notes, upon request.