CONSENT FOR ONLINE COUNSELLING SERVICES
Nature of Online Counselling
Online counselling (also referred to as teletherapy or virtual counselling) is a form of psychotherapy delivered using secure internet-based technologies. This may include real-time audio and/or video sessions, telephone consultations, and limited electronic communication for administrative purposes.
Online counselling has the same therapeutic purpose and intent as in-person psychotherapy. However, due to the use of technology, it may feel different from face-to-face sessions and may involve additional risks related to privacy, security, and technical reliability.
By providing informed consent, you acknowledge that you understand the nature, benefits, limitations, and risks of receiving counselling services online.
Description of Services and Professional Credentials
I, Cherisse Klassen, hold a Master of Arts in Counselling Psychology and am a Canadian Certified Counsellor (CCC) and a member in good standing with the Canadian Counselling and Psychotherapy Association (CCPA).
At Mountain Peak Counselling, I provide professional mental health counselling services to individuals. My work is grounded in a person-centred and trauma-informed approach, recognizing each client’s inherent resilience and capacity for healing. I collaborate with clients in their personal exploration and do not position myself as the sole expert on their lived experience.
I have received clinical training in multiple therapeutic modalities, including:
Eye Movement Desensitization and Reprocessing (EMDR) - I meet the requirements to practice EMDR under EMDRIA guidelines.
EMDR for Chronic Pain
Cognitive Behavioural Therapy (CBT)
Internal Family Systems
Narrative Therapy
I am committed to ongoing professional development and maintaining competence in accordance with CCPA ethical standards.
Professional Boundaries
The counselling relationship is a strictly professional relationship. Dual or multiple relationships are not permitted. This includes, but is not limited to, friendships, romantic or sexual relationships, business relationships, and social media connections (e.g., Facebook, Instagram), during or after the conclusion of therapy.
Client Eligibility and Rights
By consenting to online counselling, you confirm that:
You are a resident of Canada
You are legally able to provide informed consent
As a client, you have the right to:
Ask questions about the counselling process at any time
Withhold or withdraw consent without penalty or impact on future access to care
Decline or discontinue services at any point
Confidentiality and Limits to Confidentiality
Confidentiality is maintained in accordance with the CCPA Code of Ethics and applicable Canadian privacy legislation, including PIPEDA. Information shared during online counselling is generally confidential and will not be disclosed without your written consent, except in the following legally mandated circumstances:
Risk of Serious Harm to Self
If there is reasonable belief of imminent risk of suicide or serious self-harm, confidentiality may be breached to protect your safety. Efforts will be made to collaborate with you and use the least intrusive intervention possible.
Risk of Serious Harm to Others
If there is credible information indicating an imminent risk of serious harm to an identifiable person, I am legally obligated to take steps to protect that person, which may include notifying appropriate authorities and/or the intended individual.
Abuse or Neglect of a Child or Dependent Adult
Disclosure of suspected abuse or neglect of a child or dependent adult must be reported to the appropriate protection authorities, as required by law.
Legal Proceedings and Court Orders
If counselling records are subpoenaed or ordered by a court, disclosure may be required without your consent. Only the minimum information legally required will be released, and you will be informed whenever possible.
Professional Consultation and Supervision
I may consult with other qualified professionals for the purpose of supervision or professional support. Identifying information will be minimized to protect your privacy.
Coordination of Care
Information may be shared with other service providers only with your written consent, specifying the nature and scope of information to be disclosed.
Where possible, efforts will be made to discuss any required breach of confidentiality with you in advance.
Risks and Limitations of Online Counselling
You understand that participation in online counselling involves potential risks, including but not limited to:
Technical failures or disruptions
Interruption of sessions due to internet or software issues
Unauthorized access to electronic communications or stored data
Reduced ability to respond to emergencies compared to in-person services
Mountain Peak Counselling uses Zoom as its online platform. While reasonable steps are taken to protect privacy, complete confidentiality cannot be guaranteed due to the nature of internet-based communication.
Emergency and Crisis Situations
Online counselling is not appropriate for emergency situations. In the event of a crisis or emergency, you agree to seek immediate assistance by:
Calling 911
Attending the nearest hospital emergency department
Contacting a local crisis line or emergency service
Potential Benefits
You understand that online counselling may provide therapeutic benefits; however, no specific outcomes can be guaranteed.
Personal Records and Access
Personal information collected for counselling purposes is securely stored and maintained in accordance with ethical and legal requirements.
Records will be retained for:
10 years from the last point of contact if you are 18 years or older, or
10 years after you turn 18 or 10 years from last contact, whichever is longer, if you are under 18
You have the right to request access to your personal records, subject to legal and ethical limitations.
Fees and Cancellations
Online counselling fees are as follows:
$165 per 50-minute session
$240 per 80-minute session
Payment is by credit card only and is due at the beginning of each session.
A minimum of 48 hours’ notice is required for cancellations or rescheduling. Late cancellations or missed appointments will be charged the full session fee.
Some extended health benefit plans cover services provided by Canadian Certified Counsellors (CCC). Please consult your provider to confirm coverage. Receipts are available upon request.
Complaints and Professional Accountability
If you have concerns regarding the competency or professionalism of services provided, you are encouraged to discuss them directly with Cherisse Klassen. If concerns are not resolved to your satisfaction, you have the right to submit a written complaint to:
Canadian Counselling and Psychotherapy Association (CCPA)
www.ccpa-accp.ca
Consent and Acknowledgement
By signing below, you acknowledge that you have read, understood, and agreed to the terms outlined in this Consent for Online Counselling Services and voluntarily consent to receive online counselling services from Mountain Peak Counselling.
Client Name: _______________________________
Client Signature: ____________________________
Date: __________
Counsellor Name: Cherisse Klassen
Counsellor Signature:
________________________
Date: __________