Intake Form

Intake Form

Transformational Counseling

Neo-Classical Talking Therapy That Really Works

Transformational Counseling

Neo-Classical Talking Therapy

Transformational Counseling™

Client Agreement

Please take a few minutes to carefully read this document.

Downloadable Version

The Counselor

I am an M.Ed. Counseling Therapist. I use an eclectic mix of therapeutic counseling styles that I call Transformational Counseling™. I generally adhere to the ACA Code of Ethics for Professional Counselors.

Confidentiality

Everything that is discussed in our sessions is 100% private and kept in the absolute strictest of confidence. If I feel the need to discuss any aspect of my work with a colleague or qualified supervisor, I will not disclose anything that would enable you to be identified.

If you are receiving treatment by a licensed physician for emotional difficulties or mental problems, it is important that you inform me about this, and specifically disclose any psychoactive medications you are currently taking or any other details that may be relevant to our work. I will not confer with your doctor without your prior knowledge and permission.

However, if there is compelling evidence or reason to believe that you intend to harm yourself or do harm to others, I am required by law to break confidentiality and to inform your doctor, or in serious cases the emergency services or other appropriate third parties. Wherever possible, and if it is considered appropriate, you will be informed of this.

I may sometimes keep concise notes after a session, which are encrypted, password protected and securely stored. I will not make any audio or video recordings without your prior knowledge and permission.

You must likewise agree not to audio record or video record or otherwise capture any part of our sessions without my explicit written permission.

Complete Privacy of your sessions is imperative. Sessions are for pre-registered individuals, couples, or groups only. No one else is permitted to watch, listen, observe or attend the counseling session at any time, for any reason. The only exception to this is that babies or infants under 2 years old may be present if you cannot make child care arrangements with a spouse, guardian or babysitter.

Important Note*

I do not provide crisis intervention services. Should you need emergency support, please contact your General Practitioner or call 911 or your local emergency services immediately.

Sessions

Please prepare for your first session by reading this Agreement in full, submitting a completed Intake Form, and thinking about what you would like to discuss. You may schedule sessions as frequently as you like. All sessions should be scheduled at least 24 hours in advance.

Individual Session – 60 min

A full hour of Transformational Counseling Therapy.

In-Depth Session – 90 min

Dive deeper in a more lengthy session (90 minutes).

Couples Session – 60 min

All intimate relationships are welcome and respected.

Group Session – 60 min

Group synergy can shake things up and accelerate the process.
Minimum 3 people, max. 7.

Payment

Payment is due at the time of scheduling and can be made by PayPal, Credit Card, Stripe, Zelle or Crypto.

Discounts

10% Discounts are available for 10 prepaid sessions, upon request. 10 packs must be used within a 1-year timeframe, after which the sessions expire.

15% Discounts are available for 52 prepaid sessions, which never expire.

Sliding Scale Fees

Sliding Scale Fees are available, upon approval, for clients with Serious Financial Difficulties and for students with Onerous Debt Loads. If you are requesting the Sliding Scale, please be prepared to submit a statement about your financial situation. A link to the Sliding Scale application is found on the Schedule Sessions page.

Cancellation Policy

If you cancel a session with less than 48 hours notice, you will be billed for the full session. If you wish to reschedule a session, you may do so with at least 24 hours notice. When you book a session, the entire session time belongs to you. I will be present and available for the entire time of your scheduled session, whether you are able to attend or not. If you arrive late or part way through the allotted time, I will talk with you for the remainder of the time.

Counselor Cancellation

I make every effort to be available for scheduled sessions, however in the event that I must cancel or reschedule a session, I will give you as much notice as possible and you may reschedule to any available time slot. Sessions missed due to my unavailability, if not rescheduled will be fully refunded.

Refunds

If I am available for your scheduled session, but you are unable to attend, or reschedule within 48 hours of the scheduled session, there are generally no refunds unless you have experienced serious extenuating circumstances such as a death in the family or other tragedies and emergencies, and you chose not to reschedule. These situations will be considered on a case-by-case basis.

Fee Increases

I will give at least one month’s notice prior to any increase in pricing.

Duration of Counseling

Transformational Counseling can be short-term or long-term; the duration and frequency of our work together is entirely up to you. It is common for clients to schedule weekly or biweekly hour-long sessions, though some clients prefer to meet once a month, and some chose to meet every day. Your sincere commitment to the counseling process increases the likelihood of a positive outcome.

Beverage & Bathroom Breaks

It is recommended that both clients and therapist use the bathroom and prepare any desired beverages ahead of time. However, in remote therapy sessions occasional bathroom and/or beverage breaks are normal, and may be requested at any time, by the client or the therapist.

Reasons for Termination

It is my hope that you will terminate our counseling relationship only after you have successfully moved beyond the current difficulties and challenges in your life, or achieved significant improvements. I also aim to help you to discover and pursue your true life dream. I am committed to your evolving happiness, success, and sense of fulfillment and well-being. However there are some valid reasons for which I may have to terminate our sessions:

Safety & Compatibility

I reserve the right to terminate the counseling relationship if you violate the terms of this agreement, or if there is a perceived threat to my well-being or anyone else’s well-being, or if I feel that I am not a good match for you, or I am not professionally equipped to help you with your situation.

Inebriation

Please avoid the use of alcohol or excessive use of mind-altering substances during or just prior to our sessions. I am not opposed to the moderate use of legal substances during the course of life, either for recreation, or for pain management, or to treat insomnia, or for consciousness expansion, etc. However, if you are significantly impaired during our counseling work, I may find it necessary to end the session, in which case you will still be charged the full rate.

Civility

Anger and frustration are normal human emotions that we can discuss and work on during our sessions. However, our interaction will begin and remain civil, respectful and polite at all times. Abusive speech or behavior is completely unacceptable and will not be tolerated. If you cannot control your anger, if you vent abusive comments or exhibit threatening behavior, I reserve the right to inform you that I will end the session immediately, with no refund. Repeated verbal abusive or threatening behavior is grounds for permanent termination.

Nudity

While I have nothing against the unclothed human body, nudity or partial nudity is not permitted in the counseling space. You may take off a sweater or jacket if you are hot, but please keep your clothing on. Nudity is a valid reason for me to terminate the session without refund.

Contact Outside of Sessions

The intensely private and nonjudgmental nature of our psychotherapeutic counseling work is intended to create a very special relationship wherein you can feel completely safe and comfortable to talk about absolutely anything.

Successful counseling dyads are thought to be among the most intimate human relationships that exist. However, to protect you, no matter how close the therapist and client may become within the counseling environment, there is a permanent protective boundary to the relationship in the real world.

Should we happen to inadvertantly meet outside of your sessions, please be aware that I may not greet you if you are not alone, or I may only acknowledge and greet you briefly and politely if you are alone. This is to protect your privacy and confidentiality, while maintaining normal psychotherapeutic boundaries. It is not my intention to make you feel alienated or disrespected. I adhere to well-established therapist-client boundary norms, as your privacy is my utmost concern.

Social Media

Please do not invite me to friend you on social media, including: Facebook, Twitter, LinkedIn, Instagram, TikTok, etc. As a Professional Therapist I am not permitted to do this under strict Codes of Professional Ethics, and refusal can cause offense where none is intended. Our counseling sessions must protect your right to privacy and my right as a counseling therapist to limit self-disclosure.

Encrypted Communication

Encrypted Communication Services provide a reasonable degree of privacy. Encrypted services such as Telegram and Zoom are used for video, audio, and text chat communication. When using e-mail to communicate, it is recommended that you use FastMail, ProtonMail, Tutanota or a similar encrypted e-mail service, some of which are free.

Text Dialog

Text Dialog outside of sessions is preferably conducted via encrypted texting in the free, user-friendly, encrypted, privacy-focused Telegram app.

If you are unable to download and setup Telegram, or if we cannot contact each other due to technical problems, written communication can be achieved via private, encrypted e-mail such as: FastMail or Zoho or ProtonMail or Tutanota. However, no e-mail is truly 100% secure, and sending confidential information via unencrypted e-mail may present certain privacy risks for which I assume no legal responsibility.

Audio Sessions & Video Sessions

Transformational Counseling™ Sessions may be conducted by safe, private, encrypted Audio Call or Video Call. There are differences and advantages inherent to each modality.

Some people prefer a visual connection, while others enjoy the lack of visual distractions and increased conversational focus of Audio Sessions. Audio Sessions also require less bandwidth, and therefor tend to be slightly more stable and technologically simple to achieve.

There may be times that I will explicitly request an Audio Session or a Video Session for reasons that I may or may not disclose. You may also do the same. The fee is the same for Audio Sessions and Video Sessions.

Group Sessions

Group Sessions are conducted remotely via encrypted Zoom Video Conferencing. You can download the Zoom app here.

Conferencing Set-up

Audio & Video Sessions are conducted remotely using the free, encrypted Telegram app, a user-friendly, multi-platform communication app with a focus on security and privacy. You can download Telegram here (web) or here Telegram (Apple App Store).

Alternatively the Signal app may also be used, though I recommend Telegram.

Technical Support

At this time I do not offer technical support for setting up e-mail or texting and communication apps.

Computer Privacy, Safety & Data Protection

When working online, it is important to maintain security by taking reasonable measures to ensure confidentiality and privacy. Privacy and data protection on the client side is entirely your responsibility. I assume no responsibility for your digital privacy other than what I can control on my side of the interaction.

Firewalls and Antivirus Apps can be configured or installed to protect your software and hardware from third parties, malware, and/or viruses. I highly recommend the use of firewalls and/or antivirus apps.

Password Protection should always be used. Any computer, phone, or other electronic device used for Transformational Counseling™ sessions should be private and have adequate password protection.

Records

The Counselor owns all transcripts, messages, e-mails, and notes that are made as a part of our work together. When we have completed our work, any materials such as text or email exchanges, etc., are removed from my password-protected, firewall-protected, private computer and temporarily stored on an external password-protected, encrypted device that is not connected to the Internet, prior to being permanently destroyed.

Privacy

Please do not post or share extracts or whole copies of any of our commu­nication to social media or anywhere else. Our sessions are strictly private and confidential to protect you, the client. Thank you.