Hold onto your seats…you might get bored. Very bored.

I’ve fallen into writing about boring topics before, and to my surprise, people have been open to reading about them, so I’m at it once again, hoping that readers will be taking an active interest in their counselling rights and the parameters of counselling service delivery, as expressed in counselling consent forms. Sis boom bah!

It’s worth noting that, for those who don’t know, I’m writing this from the perspective of being a Registered Clinical Social Worker (RCSW), practicing in British Columbia and as a Registered Social Worker telepracticing in Ontario. What I highlight today about counselling consent forms is in part regionally influenced and my professional governing bodies may have different standards than the counsellor’s you’re seeing, providing they’re regulated. I’ve repeated it a zillion times before: don’t assume your counsellor is. It’s not a requirement in BC, five other Canadian provinces, and the Territories.

Why Forms?

In an age where there are “terms and conditions” for almost everything, most of us are in a state of fine print overwhelm. I recognize that and I actually feel guilty for how long and extensive my consent forms are. I’m imagining that mine have inadvertently turned off some clients over the years.

I recognize it’s a lot, and I’m probably more ‘extra’ than other counselling professionals, so why do I do it?

The short answer is is that clients have a right to detailed information about counselling services: to actually understand what they are consenting to. (Or alternatively, to refuse counselling if they do not agree with the service contract).

Why Should You Read Them?

And, while you may assume that if you’ve seen one counselling consent form, you’ve seen them all, I have to humbly disagree. While there are elements that many counselling consent forms share, there are some points that will apply to a counsellor’s specific practice or that are unique to their professional college or association (if they have one).

Some unregulated counsellors, (and possibly some regulated ones too) don’t give consent forms, and this is never a good thing. Clients have a right to know that their counsellor is regulated, or registered, which should be verifiable on their professional body’s online directory. Using this tool, the public should also be able to learn if the counsellor is “in good standing” or alternatively, if they are under investigation, have a history of complaints made against them, or if they have been barred from practicing.

The relationship between client and counsellor can be very meaningful but it’s not the same as relationships in one’s personal life.

There are things that can surprise clients about the counselling experience, that they would not necessarily have thought about before: things like contacting a counsellor after hours, late cancellation fees or the limits of confidentiality. And clients need to be informed before counselling starts, so that they can change their mind without penalty.

In other words, please read the consent forms before your appointment–at least 24 hours before, preferably more—so that you can cancel with sufficient notice.

Anatomy of a Counselling Consent Form

There is no universal standard of what counselling consent forms should contain. But because I am a registered clinical social worker, my professional college stipulates that I must adhere to its Code of Ethics and Standards of Practice,  of which includes the following principles which can be applied  to consent forms:

Social workers provide clients with accurate and complete information regarding the extent, nature and limitations of any services available to them.

Social workers inform clients of foreseeable risks as well as rights, opportunities and obligations associated with the provision of professional services.

Let’s look at some of the typical components of consent forms and why they’re there:

Counsellor Credentials

So that potential clients can know what a counsellors’ professional background/training is and whether or not they are regulated, or at least registered, and whether they are in good standing with their professional body.

Services Offered

What types of counselling sessions are offered (name and description) so that clients know what the counselling service choices are and what they are signing up for.

Unique Service Qualities

If the counsellor is offering more than just in-person counselling, what are some features of the other types of counselling that clients should be informed about? For example, what technology is being used? How is clients’ information protected? What is the procedure if client and counsellor get disconnected?

Fees

The cost of the counselling service (or session types) and what forms of payment are accepted. This is especially important as it is sometimes assumed that private counsellors’ services are covered under the BC Medical Services Plan (not so) or that the counselling is being offered for free.

Records

This informs clients that the counsellor keeps notes about each session which typically contain a synopsis of the session content, the therapist’s assessment and the counselling plan. Professional colleges and associations require their members to keep clinical notes, store them securely, and keep them for a certain period of time (for example, 7 years).

Confidentiality

This is a massive topic but the service agreement should spell out all the exceptions to confidentiality, so that clients are aware in advance and can understand the boundaries around this. There is the common misperception that absolutely everything said in counselling is confidential.

Use of Technology

Some colleges, like the BC College of Social Workers, require social workers to have standards of practice that apply to technology so that clients can understand how technology (e.g. computers, software, phone, social media, email etc.) is being used in the therapist’s practice.

Cancellation Policy

The industry standard for counsellors is that the full fee is charged for missed appointments or cancellations with 24 hours notice or less. Some counsellors request 48 hours. These fees exist because it is usually never possible to fill short-notice cancellations, even if there are other clients who are waiting for an opening.

Contacting a Counsellor In-Between Sessions

Details about the procedure for contacting the counsellor and what the parameters are around this. For example, some concerns are not appropriate to be raised over email, due to privacy concerns and the potential that complex issues can be misunderstood in print form. Also, some counsellors have limited availability by phone.

Crisis Procedure

What systems are in place if a client is in crisis in-between sessions? This should be spelled out here, as well as any alternative resources if the counsellor is not available.

Receiving Your Consents

Most counsellors choose to send their consent forms to clients electronically, before the session, although some present them at the first appointment, usually by hard copy.

My feeling is that in-person delivery does not promote clients having sufficient time to read and reflect on the parameters of service. Some clients may even feel awkward or uncomfortable refusing service if they are already in the counsellor’s office. Electronic delivery, at least several days beforehand is ideal, as this allows cancellation frameworks to be met while also offering the opportunity for the client to contact the counsellor beforehand, with any questions they may have.

What To Do If You Don’t Agree

If you are reading anything in the consent forms that you are concerned about, please contact the counsellor. Sometimes it’s a matter of confusing wording, sometimes accommodations to suit your particular circumstances need discussing beforehand and other times it’s crystal clear: you cannot abide by the terms and conditions of the counselling contract.

Counsellors should never made a big deal if you cancel your counselling appointment, providing you give sufficient notice. Cancellations can be made by email or phone and clients also have the right to provide the counsellor with feedback or to give no reason at all. Please take the time to cancel with 24 hours + notice, to allow the appointment slot to be used by another client.