Forms | marifelipe-therapy

INFORMED CONSENT FORM FOR MINORS

Informed Consent:

The purpose of this form is to share some important principles and considerations, which guide my counselling process so that your decision to proceed in working together can be based on accurate, informed expectations. Please read this carefully and feel free to ask any questions about what you have read or to have further clarification.

Expressive Arts Therapy

Expressive Arts Therapy is a nourishing therapeutic practice that focuses on using the arts as a tool and resource for healing, problem solving, and personal growth. Working in this way, we can explore how reconnecting with the senses and imagination can offer new possibilities for resilience. No previous experience in the arts is necessary and we work together to find which tools resonate best for your journey. We will focus on the creation process and what can arise when we let the imagination and senses lead the way. I will create a safe environment that will allow you to explore a variety of creative tools such as play, storytelling, visual art, movement, collage making or work with whatever feels natural and accessible.

Risks and Benefits

Some people find that participating in Expressive Arts Therapy can result in positive changes that were not expected or intended at the outset. Therapy should be a transformative process over time. While benefits are expected from Expressive Arts Therapy, specific results are not guaranteed.

During an Expressive Arts Therapy session, we will engage in arts, sensory, and/or nature-based practices. All prompts are invitational, and participation is voluntary. Know that the minor’s choices take priority over any prompt or invitation I offer in a session. Any outcomes and potential benefits are influenced by the minor’s willingness to engage in this therapeutic process with me.

At times through the therapeutic process, discomfort can be experienced. It may require that the minor discusses experiences and events in their life that may be unpleasant. If at any time you or the minor believe therapy is not progressing in the way desired, feel encouraged to discuss with me.

A parent/caregiver session is recommended if there is a need to further discuss expectations, concerns and the progress of the therapeutic process.

A Contact & Health Form for Minors will be sent to the parent/guardian together with this document and although full completion is not mandatory, it is recommended that relevant information concerning the minor’s health and safety be provided.

Confidentiality

Therapy is most effective when a trusting relationship exists between the counsellor and

the client. Privacy is especially important in securing and maintaining that trust. To ensure a minor’s privacy I will not provide detailed information to the parent/caregiver regarding what the minor shared or session notes unless the minor provides consent. I will keep you updated and apprised of the therapy progress in general terms unless the minor has given permission for more specific information to be conveyed to you.

There are exceptions to confidentiality I must follow such as:

If the minor informs me that they are going to harm themselves or someone else.
If the minor reports, or if there is a suspicion of child abuse or neglect.
If my counselling record has been subpoenaed by a court of law.

Due to my current Registered Therapeutic Counselor (RTC) status with the Association of Cooperative of Counsellors and Therapists of Canada (ACCT), I am required to seek consistent Supervision and will discuss different aspects of therapy sessions with my supervisor or peer group who are bound by the same confidentiality and code of ethics as I am. In such instances, client´s identity is protected.

Tele-Health Considerations

Tele-therapy services have unique considerations in terms of confidentiality and security to navigate. I am following protocols and using programs that ensure the best possible security of your privacy. Here are some things to consider:

I recommended that the minor choose a private space/environment for our sessions that is comfortable, free from distraction and potential disruption.
I will conduct our sessions using the secure tele-health platform Doxy.me. This platform does not store any personal information and calls are peer-to-peer encrypted. You do not need to download anything to use this platform. Supported browsers for using Doxy.me include Chrome and Firefox. For additional info about Doxy.me’s security measures and compliance with Canadian privacy law: https://help.doxy.me/en/articles/95909-can-i-use-doxy-me-in-canada.

All images in tele-therapy are considered confidential. No recordings of sessions are made or artwork shared unless there is expressed reason and consent to do so (e.g., for supervision, consultation or educational purposes).

There may be instances where our session is interrupted due to screen distortions, poor internet signal quality, or technical failures. Should this disrupt the majority portion of a session, I will work with you and the minor to find a time to make up for a disrupted session.
Tele-therapy is different from in person therapy. If you, the minor, or I believe that the minor would be better supported by another form of therapeutic service, you are always welcome to discuss this with me and/or seek other therapeutic support services.

Note that email is considered the least secure method of communication. People with access to your computer may gain access to your email. Thus, contact via email should be used primarily for the purpose of scheduling, billing, sharing art-based resources or medium related logistics. Sharing personal information through email should be avoided.

Fee Payment & Cancellation Policy

Payment by cash, cheque, and e-transfer are accepted before or at the end of each session.

I require cancellation notification no later than 48 hours prior to a scheduled session. If the appointment is not cancelled 48h before, a 50% fee will be issue for the cancelled appointment. If the client does not provide notice and does not show up at the time of the session the full fee will be issued. No fee will be applied in case of emergencies.

I am a Registered Therapeutic Counsellor Candidate with the Association of Cooperative of Counsellors and Therapists of Canada (http://acctcounsellor.com/index.php). You have the right to contact the above organizations if you have concerns regarding my ability to uphold duty to care.