Please watch these videos to learn about the intake process and how to use the basic functions of OWL
*How many times should you attempt to contact a client to do an intake (and to schedule a first session as the counsellor)?
If the client has an answering machine:
If the client provides an email address and a phone number:
If the client doesn’t have an answering machine:
Self-Referral/Referral Received: Intake is done through the Hushmail form process or the phone/ text process (see document above for detailed review of the two intake processes), depending on how the client contacted Moving Forward.
Client Assignment: Gary will pass clients along – through another email – counsellor@movingforwardfamilyservices.com and an encrypted program (meets protection of personal info regulations) called hushmail (which allows for secure sharing of client info).
Gary will ask if you want the client, and then you would reply back to let him know if you’d like to take it on or not (if you don’t think it would be a good fit, or you feel the presenting issues are beyond your capacity) – please reply within 24 hours to that email.
Once you confirm you will be taking the client on, you will then go ahead and create a client file on owl and enter the information from the intake form to owl (you would not hear from supervisor unless there are any additional instructions required – so proceed with contacting client and creating file once you’ve accepted client). For guidance please see this document How to create a client file on owl or watch the video demonstrations on our owl orientation page: How to create a client file on owl and Pre-first session checklist
Once the client file is created please make sure to upload the intake document to the client file on owl. If you cannot upload it as a document, please copy and paste the information from the intake document to a non-session note.
Call and schedule the initial session with the client (make sure to also schedule it on owl)
Email consent to services and cancelation/no show policy form either using these forms or send directly through OWL (see detailed review of how to send consent form through OWL in the document below titled ‘Moving Forward Consenting Process for Online Services’ or watch the demonstration on the owl orientation page).
During the first session with the client you will:
Some counsellors like reviewing notes from a previous counsellor when they start their work with a transferred client. Other counsellors prefer to start “fresh” with the client without any preconceived ideas. Both are okay! But before you review notes please keep in mind:
Moving Forward Consenting Process for Online Services
MFFS Consent for Online Services (word doc)
Cancellations & No-shows Policy
How to to discuss recording sessions with clients
Important note to discuss during consent (when relevant)
Services for children 12 years of age and under require consent from any and all legal guardians.
In cases where parents are separated or divorced, court rulings regarding custody or guardianship may limit the rights of one parent to take a child to see a counsellor without the consent of the other.
In completing this referral, you are agreeing that you either have the agreement of the other parent to bring your child to therapy or that you have the legal right to bring your child for therapy without the other parent’s consent.
Please note:
You are required to have a conversation around payment and payment option with your client at the start of your counselling work together. If the client is paying:
While email is acceptable, it should not be the only form of contact made (unless the client has requested that contact only be made by email). Initial contact by emails should be followed up within 1-2 days if the client has not responded.
If emailing client here is a suggested script:
My name is _____. I am a counselling intern at Moving Forward Family Services. I received your request for services/intake form from my supervisor. Please let me know of some dates/times that would be convenient to connect for an initial appointment.
Sincerely,
_____
Counselling Intern, Moving Forward Family Services
your email
your phone contact
Please make sure to use this form to guide you through the information you are required to discuss with the client: First session checklist. Once you completed the items on this checklist, please upload the completed form to the client’s file on owl
When taking case notes:
Imagine that your client is standing over one shoulder, looking over what you are writing; imagine that a family court or criminal court judge / lawyer is looking over the other shoulder at what you are writing.
Would they be upset/confused/question what you have written? Would they take what you have written and interpret it in a manner you never intended? Consider these perspectives before writing the note.
Pre-session assessments for anxiety and depression (can use these forms even if client presenting issues are not anxiety/depression): burns_anxiety_assessment / burns_depression_assessment
Every counsellor at this agency is required to discuss with their clients the additional supports offered in the community. This form is required to be completed within the first few sessions of therapy. These resources can be also be found on our website at movingforward.help; counsellor can also be direct clients to additional resources not listed on our website if they are able to. The purpose of this exercise is to ensure clients are not simply relying on you as their only resource – part of counselling entails assisting clients in finding other resources within their communities to access. You should not have to shoulder the weight of all your clients needs alone
Post-session assessments for anxiety and depression
Discharge report – completed after second-to-last session and reviewed with client in final session. Discharge-or-Transition-Report (pdf) Discharge-or-Transition-Report (word)
*For guidance on what to do with a client file after the end of therapy, see ‘What do I do with a client file on owl once the client has moved on from counselling’ on the FAQ page.
This form is mandatory for any clients who have attended for 12 sessions. While the agency advocates for longer-term therapy, we also need to ensure that clients who have had 12 sessions are still actively engaged and have clinical goals they are still working on. We also need to ensure new clients are being supported in a timely fashion and therefore must balance their needs with the needs of clients who have already had a substantial amount of service. This is also a time that anyone who has been receiving free services needs to be switched to ‘pay what you can’
This form is to be submitted to Gary via ‘hushmail’ and a copy would also be included in client file.
For all clients please fill out this form at the end of your work with them and upload it to their owl client file: Discharge/ Transfer form
For clients who are ending counselling and will not be transferred to another counsellor- you would simply fill the discharge form, upload it to their client file on owl, and mark their file as inactive.
For who wish to transfer to another intern you would fill the form, and send it to Gary via the hushmail link: https://hushforms.com/counsellor
** Please also ensure that any client who received free services is advised that continued services would be under ‘pay what you can’.
After you record your session notes on OWL, please ensure you sign the note, and do not modify the notes once they are complete and signed. To sign the session notes though OWL: In the note window, click on the ‘sign’ button on the left tool bar. This will add your name and date and time stamp to the note.
Read this article for an example of how one therapist begins and ends their counselling session: How I Begin and End a Counselling Session
Also please review these short videos on case notes:
And this video about theory vs. Techniques
What is Informed Consent?
Informed consent is a document that therapists use to make sure that their clients understand what therapy is about, and what their rights are.
· It is the therapist’s responsibility to make sure that the client fully understands the information in the document before they sign it.
Informed consent describes the purpose of counselling, the benefits, and the possible risks.
· Benefits could include:
o Gaining new skills.
o Changing unwanted behaviours.
· Risks could include:
o Opening painful memories.
o Producing strong emotions.
Informed consent includes the therapist’s qualifications and what professional associations they belong to.
· It should also provide contact information for filing a complaint against the therapist, if the client feels that they need to.
Informed consent explains the purpose for collecting information about the client, how the therapist uses it, and to whom they might share this information with.
· It should also explain the client’s right to access their information.
Informed consent explains confidentiality,and the limits to it.
Informed consent explains that the client has a right to say no or withdraw from any part of therapy at any time.
Informed consent can be given by a minor if the therapist believes that they fully understand what they are agreeing to.
Informed consent can be given in written form, verbally, or through an action such as a head nod or thumbs up.
· During the first therapy session, however, informed consent should be formal and the client should provide written consent whenever possible.
o This is also true when exercises that might cause strong emotions are going to be used.
Informed consent is created to protect the client’s rights and provides proof that the therapist has done their job to make sure the client understands all aspects of therapy.
· Informed consent does not protect the therapist from any inappropriate or harmful behaviour towards theclient.
An informed consent document helps clarify who the client is.
· For example, if a parent brings their child in for individual counselling the child would be considered the client.
Informed consent should discuss the therapist’s fee policy, and what happens for cancelled or missed appointments.
Informed consent is continuous - this means that the therapist might need to ask for consent more than once.
· A therapist should ask for consent again when any new aspect of therapy is being introduced.
References
BritishColumbia Association of Clinical Counsellors (2010, October). Standard forInformed Consent to Clinical Counselling and the Collection, Use and Disclosureof Personal Information. Retrieved from https://bc-counsellors.org/wp-content/uploads/2015/09/1BCACC-Standards-Informed-Consent-2010.pdf
Pope,K.S., & Vasquez, M.J.T (2016). Ethics in Psychotherapy and Counseling: Apractical guide. Hoboken, New Jersey: John Wiley and Sons.
What is Confidentiality?
Confidentiality means that the therapist has a responsibility to the client to make sure that what is discussed in therapy is not shared with anyone else.
There are certain circumstances where the therapist must break confidentiality. These circumstances include:
· When the client has given the therapist reason to believe that they are going to harm themselves, or others.
· When there is reason to believe that a child is being harmed or neglected.
· When there is reason to believe that adults who can’t protect themselves, such as elderly or disabled individuals, are being harmed.
· If the client’s records have been requested by the courts.
o The records should only be provided by the therapist after they have talked with a lawyer to understand what they must provide.
· If others, such as employers or insurance providers – known as a third party – request client information, it may have to be provided.
o The therapist should discuss this with their client and let them know what is being asked and why.
o If the third party takes legal action to obtain information about the client the therapist should talk to their lawyer about what information they must submit,if any.
· In the case of family or couples counselling, secrets will not be kept by the therapist.
o This means that what one person says to a therapist might be discussed with the other people that are considered a client.
· When the therapist shares information about the client with their supervisor.
o This information is shared to ensure that the therapist is providing the best possible care for their client.
· Confidentiality must be kept by the therapist, except in the case of any of the above circumstances.
· It is illegal and/or unethical for thetherapist to break confidentiality.
References
British Columbia Association of ClinicalCounsellors (2014, May). How private is private?A detailed consideration of a clinical counsellor’s legal duty of confidentialityand the exceptions created by the duties to report or warn. Retrievedfrom https://bc- counsellors.org/app/uploads/2015/10/140501-How-Private-Is-Private- REVISED.pdf
Owl does not allow for screen recording. However there are a number of ways you can record your session
Please make sure your client has signed a consent for recording before you record a session!
The simplest way to record a session when you are using owl video is to record your screen.
For Mac users:
follow the steps in this link: https://support.apple.com/en-us/HT208721#quicktime
*Make sure you follow all the steps to all the use of microphone, otherwise the audio won't record
** Make sure to test it a few times before recording with a client
*** Always inform your client when you begin recording
For PC users:
Hit 'alt+windows button+R'to record.
Once you click stop recording you can hit 'alt+windows button+G' to go to the capture window and see/find the file location of what you've recorded.
** Make sure to test it a few times before recording with a client
*** Always inform your client when you begin recording
Yes. If a client sees more than one counsellor throughMoving Forward, they should sign a consent form with each of the counsellors. This is to ensure that each counsellor knows for sure the client was informed of limits to confidentiality in case we ever need to break confidentiality.
An example for that is: If a client starts general counselling with one counsellor and CBT coaching with another, they should sign consent form with both counsellors.
No, clients can attend as long as you feel they are doing the work. However, you would be required to complete the 12-session file review to Gary so that he can review progress. Our online referral form does indicate the following: note that interns are expected by their schools to see a diverse range of clients - and therefore can only offer short-term services. Maximum # of sessions with one intern: 12. The reason we have this is to deal with a small segment of clients who may want to keep attending even though they aren't really working on goals, tend to become somewhat dependent on one person (their therapist) or perhaps the therapist feels like the client is somewhat stuck and perhaps a new therapist with a different style may be more appropriate - therefore we want to be firm and clear about the 12 session maximum policy to clients however in reality there is flexibility (something that should not be divulged until the client is nearing those 12 sessions). The point made on our website is also valid - we want interns to have diverse experiences so having several clients for long-term would not really allow for that diverse experience.
You would first double check that - you would contact the client and ask if they have an email where you can send the forms/link to access sessions through OWL.
You may also want to encourage them to create one in order to have services online.If they are not interested/able to create an email, then you would proceed with telephone services.
Whether they do or not, at the first session, you would still verbally review the service consent and check if the client has any questions.
In the case where they don't have email, then you will need to make note that you went over the forms (part of your first session case note) and obtained their verbal informed consent (and that you did this as they were not able to review and send back forms electronically).
Ideally you would have them send you a text message if possible, mentioning their given consent for the session. However if they have no way of giving written consent, verbal consent is acceptable while making sure to recording the consent process in detail at the top of the first session note.
Moving Forward is privileged to have many quality supervisors, in addition of course to quality interns; often when there is a rupture between a supervisor/intern at other sites, the intern has no option but to continue while feeling unsafe, or to leave as they have no one else to work with (when there is only one supervisor on site). If such a rupture happens at Moving Forward, we have several options we can explore.
To increase the likelihood that there is a good fit between intern and supervisor, we ask interns to fill out a background information form that outlines their interests as well as covers other key topics such as how they prefer to receive feedback. This form is shared with the supervisor though we encourage interns to directly send that form to their supervisor and even spend some of their initial supervision session(s) going over it. Some supervisors also share their backgrounds in their initial email contact; prospective interns can also view supervisor backgrounds on our website.
We also ask each intern to have a preliminary phone or online conversation with the supervisor to decide if there is a good mutual fit. (Note to Stenberg College students - there is a subcontract in place, so you are assigned a supervisor, and we do our best to match you up to one of the two part-time supervisors - what that subcontract covers. More specific information on how we address issues that arise in this instance will be provided to anyone in that program).
While we make every effort towards ensuring a good fit, there are times when the supervisor or supervisee may decide it is not a good fit. By 'good fit' we mean the decision is made to discontinue so that the intern counsellor can be matched up with a supervisor whose theoretical orientation more closely aligns with theirs. Sometimes as well as intern may want to expand their knowledge base and work with other supervisors who practice in an intervention that they may wish to learn more about.
The decision to switch is not one that anyone should take lightly - as part of your professional development is that you are expected to find ways to address any concerns within the supervisor/intern relationship. We liken it to your having a client that you may sometimes struggle to connect with - in such a case you are asked to work through that concern and only discontinue services if there is a significant rupture in that therapeutic relationship. We also as an agency need to ensure that an intern is receptive to constructive feedback and is not wanting to switch because they were upset by such feedback. Of course, we would equally expect our supervisors to provide feedback in a constructive and safe manner.
So, if a decision is made by a supervisor or intern to discontinue, they must first speak to Gary. Prior to making any changes, we would ask you to reflect on the reasons you may wish to switch and consider if the issues that have arisen can instead be resolved with the supervisor through dialogue. For example, if there are certain unmet needs or unclear expectations, consider first expressing what those needs may be or asking for clarification around expectations. Our supervisors will also check in with you around whether you are meeting your clinical supervision goals regularly, while also letting you know what their expectations would be.
If intern’s concern is that their theoretical orientation is considerably different than supervisors (which is something that may not have been evident at onset of internship, considering intern’s theoretical orientation is typically not well defined at that point) we would suggest remaining with primary supervisor (as there is undoubtedly still much one can learn from their background/approach) and considering the option of consulting with a secondary supervisor from within the agency. If an intern has two individual supervisors, we just ask that at least one has had an appropriate amount of direct supervision time to provide the required feedback for the school/registering body.
Prior to determining whether to discontinue and switch to a different supervisor, Gary will require the party that wishes to discontinue to speak to the other party.
While one request to transfer would be accommodated (after all the above noted steps are undertaken), unless there are rare and extenuating circumstances, a second transfer would be unlikely.
It happens. Sometimes despite your best efforts, you may not be the best fit for a client. Almost always this has nothing to do with you.
Maybe you remind the client of someone in their life that has had a negative impact on them, and they just can’t get past that; it may be resemblance, sound of voice, even a certain word that you used that reminded them of someone, and now they just cannot get past that. In such cases they may feel that way but are not able to come out and express it – they instead just ask to be transferred.
Sometimes they may be upset by a comment you made or a question you asked – again that can happen but just remember your intent was to try to understand something – it was not intended to upset them. So, you can reflect on what happened, but you should never be afraid to make comments/ask questions that are respectful and intended to help you better understand something about the client/their circumstances.
You may also start to see a pattern with a client and decide that you are going to challenge what you believe may be a cognitive distortion or unhealthy coping (i.e. a client who believes many people have done them wrong, but doesn’t see the role they played in those relationships going south, and the client seems to keep repeating similar patterns in new relationships) and so you decide to respectfully challenge it rather than offering unconditional positive regard out of concerns for reinforcing those distortions. Ultimately your purpose in doing this was to help client break out of the patterns, but they may respond by becoming upset and wanting to change therapists.
Ultimately you felt that it was inappropriate after several session to continue to explicitly or implicitly support behaviour that could be destructive and so your reasons to do so were genuine, and so that was an appropriate course of action even if there wasn’t a desired outcome (compared to client continuing to attend and having those same behaviours reinforced – leaving them basically stuck in the same patterns that led them to therapy in the first place). Anyway the purpose for doing so was not to upset them, it was genuinely to support them (even if they did not perceive it that way). Note prior to taking such an approach you should consult with supervisor(s).
At the same time, if you did do something that directly lead to therapeutic rupture (i.e. you forgot about the appointment, you were distracted and not truly engaged with client within the session) then you need to reflect on that experience – and commit to do better in future.
Regardless of the reason(s), we will accommodate requests; however we are also keeping an eye on the case - as if a client is repeatedly asking to be transferred any time they are respectfully challenged then we certainly will not continue to enable such behaviour (that is something that Gary would deal with). We want to be respectful to client needs but we will not enable such behaviours.
Helping Clients find Reasons for Change
Helping Clients Open Up
Helpful Approaches for the First Session
Working with Resistant/Unmotivated Clients
Are You the Right Fit?
Yes we do. However, if a client wants to work with an intern,you must explain to them (either at intake or at first session – whenever you learn that they may have such a case) that our interns, as students and newcounsellors, are not in a position to provide comprehensive reports/ assessments/diagnoses/ recommendations that ICBC, courts, Worksafe, CVAP, etc. may want. Therefore,the client should be seeing a registered therapist who has experience in suchwork. Note we have several registered therapists who are affiliated with MovingForward and can provide those services – for minimum fees.
In the case of ICBC,the client needs to determine if they can have their counselling covered – something they need to discuss with their lawyer or the ICBC Adjuster. For Worksafe BC cases, they should be speaking to Worksafe Rep as they have their own contracted counsellors that they can refer clients to.
If they chose 'pay what you can' couples counselling then frankly they need to accept our parameters - that our interns will see them first individually before bringing them together, and only when intern (in consult with supervisor) feels it is appropriate (this allows the intern to assess for safety and motivation of each person - plus it is more comfortable for that new intern counsellor to do it this way as they don't have to manage what could be a highly conflictual couple from the outset -when clients opt for higher fee-based services they would see a more experienced therapist who can manage those dynamics).
Couples counselling is rarely ever free or 'pay what you can' and ultimately anyone wanting that service needs to agree to our service parameters (that they will first be seen individually). Anyone paying $200 per session (about the traditional rate for couples counselling with an RCC) has a lot more say (and while I don't want to generalize as there are exceptions the clients paying $200 per session tend to be more committed to working on their relationship, whereas those receiving free/'pay what you can' may not necessarily have same level of motivation)
So if the couple refuses to come individually first then they can go elsewhere - in my experience that doesn't happen as they won't find the free/low fee couples counselling services anywhere.
Yes! The protocol is listed on our website:
Protocol is listed on our site
https://hushforms.com/counsellor2955
"While service is available Canada-wide, be advised we follow regulations related to counselling practices within British Columbia."
It is natural for clients to request counselling and then change their minds or their motivation changes between the time they contacted us and the time we contact them. This is partially the reason we work hard to contact clients as soon as possible.
If you have made all the efforts to contact a client (twice if they have an answering machine and or email, and 3 times if no answering machine or email), and recorded your attempts to contact on their client file, you can move on to accept other clients. At that point you can set the file inactive and you do not need to let anyone know, as long as you make sure all attempts to contact were recorded under the ‘non session notes’ section of the client file. This will ensure that when the client contacts us again we can be sure that previously attempts were made to contact them.
Once an intern says they will take client then they would undertake next step of creating file on OWL and reaching out to client within 24-48 hours to book appointments (Gary doesn't reply back once they say they will take a client - assumption from that point is intern will follow up and reach out to client. Intern notes all efforts to contact clients in non-session notes). The expectation is that you contact a client within 24-48 hours from when Gary sends you the client information. One of the things that sets MFFS apart is our quick response time. We want to instil hope in clients and often we have found that when interns take a week or even a few days to contact the client, the client may have changed their mind about counselling which is why we want to make sure we reach out to the client quickly. You don't have to have the sessions within that time frame, but at least make the first contact and schedule their appointment for the following week
Ask away! We would rather you check than proceed if uncertain. At the same time please ensure you have reviewed all orientation materials. Also you can bring your questions to group supervision as well as ask it in our Whatsapp Group Chat.
Our services are not crisis nor urgent (so please provide #s to crisis lines and Wellness Together Canada line. The coaching especially is not direct therapy and if she wants to discuss things that are outside the set structure then she also should opt for general therapy. However, that additional support should be done with another therapist. You can let her know it's agency policy - clients can do both CBT coaching and general therapy simultaneously, however it needs to be two different counsellors - and the rationale is that the agency does not want clients to become over-reliant on one person. So, agency wants them (clients) to expand their network of support ... and while clients may decide not to proceed the agency is firm about that (and while you would not share with point with client but what is going on i.e. their regularly messaging you and relying on you to help them feel better is the reason why have this policy).
Also reminder that we have a policy that emails/texts are just for passing along homework/next appointment reminders, not for therapy/sharing info that is best left to discuss at the next session.
No, these sessions are to be done one-to-one. If the partner also wants to do it, then they would need to do it separately
The reason it is one-to-one only is that it's not counselling yet it may bring up a point of contention that can lead to conflict so we will not see couples together - and the only way to ensure this cannot happen is to do it one-to-one
If they want to attend together they would need to ask for general therapy (and there are fees for it)
If they have any issues with and of this they can speak to me at 778-321-3054
We do not offer character references - instead you would stick to tangible points such as number of sessions attended, general areas discussed, and some 'positive' comments i.e. that client attends sessions as scheduled and is engaged in sessions.
We will not do 'character' references that may imply that the client is a better parent than their ex, or the ex is abusive, etc. (as you have not met their ex nor were you assessing their or their ex's relationship/ability to parent - even if you have interacted with them you are not in a position to assess them) or that the client is 'healed' from what brought them to counselling ... I've had people ask me to write a letter that indicates that they won't drink/do drugs/get violent again and I say I won't do that as a judge would discount everything I wrote if I am making such comments (i.e. how can I say such things as I can't predict the future?) plus it hurts my credibility to make such sweeping statements so again I won't do it. In fact such comments can hurt the client as basically anything that is more tangible and positive would all be discounted.
Remember that any letters need to be reviewed by Gary before sending out.
Yes it is possible, but you would need to first discuss this with Gary. Ultimately taking clients with you into private practice without speaking to Gary would be a significant practice/ethical concern – especially as Gary would likely support the plan.
Some considerations:
If they want to pay $20 or less then I would suggest they continue with an intern however again I’m not going to tell you what you should charge; I just say take a critical lens to the situation – it is understandable that client wants to continue with you however you need to consider if it is really worth it for you to continue when you have every right to earn more. If you do proceed then continue to be critical – if they are paying low fees for therapy but revealing they are spending a great deal on non-essentials elsewhere, you should probably reconsider the low fees.
I would recommend strongly NOT to take clients on for pro-bono after internship – the purpose of agency is offering low fee/free services to those who would not otherwise receive it, with interns – with the caveat that eventually intern would move on … so the client can continue with another intern in this case. They were aware of this arrangement and frankly if they had accessed public services they would have been dropped after 6-8 sessions … so it is not only a fair arrangement but it is well beyond what they would have received anywhere else. Of course a client would prefer to stay with one therapist for as long as possible but that is not a realistic expectation
Couples and family sessions can be anywhere between 55-90 minutes long.
We need to ensure that clients are not dependent on their counsellor to get them through the week- that they are seeking out additional resources/support if they need them (i.e. our coaching programs, groups and other programs in the community). If we keep accommodating them (giving extra sessions, answering their calls outside the allotted session time) we are quite possibly enabling what is ultimately a maladaptive coping strategy (a client relying on one resource rather than their having many resources one can rely on).
We want clients to not be solely reliant on one therapist to support them – We want them to access other resources and I know that while it is convenient and comfortable for them to work with one person, they need to expand their support networks, and there is no incentive to do that if we just accommodate such a request.
Furthermore, we want our counsellors to have a diverse range of clients so by seeing a client more than once you are limiting your experiences (as that is one less spot you have to see another client).
We ultimately need to make sure that other clients get the same kind of prompt service this client got - and by giving them an extra session we are potentially delaying support for the next client reaching out
So typically cannot provide more than one session per week (but feel free to check with Gary)
One other note to consider: when a service has a fee clients will consider whether they want to invest the extra fees for extra sessions - but when it is free they sometimes do not value it as much. If client pays and is willing to pay for the extra session I'm more inclined to approve it than someone wanting additional free services from same intern.
You will no doubt experience this often, and while important to reflect, I know there are some reasons why client may discontinue that have to do with counsellor (i.e. not a good fit) while there are exponentially more reasons why client may discontinue that have nothing to do with the counsellor at all. Ultimately if you did everything you can to be genuine, empathetic and respectful, then you did all you could do (all that you had control over). You had zero control over all those other external reasons why the client may have discontinued. I have had clients that came to me seeking concrete action and directions, and thus never returned when I didn’t do that for them. Ultimately it was not a good fit but I was comfortable with that rather than doing and acting in ways that I didn’t feel were appropriate (though if had no doubt they would have continued with me, and even been satisfied even though I had done little to help them develop their own skills to deal with their own issues). Even if the client felt it was not a good fit, you have to be true to who you are and what you do… which it sounds like you were, in that you were willing to let them know that you can assist them in seeing someone else. I suspect if it was an issue of fit they would be receptive to further dialogue – and maybe in future they will be – but for now I suspect it is one of those hundred other reasons (again all external to you and your abilities) why they discontinued. Definitely something to debrief with your supervisor – also if comfortable bringing it up in group supervision. I’m confident most interns have had similar experiences.
We absolutely cannot provide services to children 12 or under if the other parent also has guardianship as they have a say in any major decisions regarding their children (unless there is a family court order that says otherwise, and we need to see proof of that). I always frame it as if someone decided to put my kids into counselling without my knowledge – I would not be happy about that, to put it mildly. So we definitely need consent from any and all legal guardians. The only way around that is if it were a direct referral from MCFD (Ministry of Children and Family Development) where they cite a certain statute ('Section 96') that gives them the authority to request counselling or again if there is a family court order that gives one parent the authority to request counselling. In some cases the parent wants kids to get counselling not necessarily because they care about their child’s wellbeing (although that might be part of the consideration) but because they are case building for family court (wanting kids to get counselling in order to establish that they are the better parent). Because of such issues we need to be clear about not proceeding with counselling unless we have consent from those (and every one of those) who have legal authority to give it.
Probation Clients 101
Many of you are seeing ADULT clients who are on probation. Here is a brief summary of the types of clients on probation that are typically referred to us.
Generally, clients have a court-ordered condition that requires anger management (most often anger that was directed, via threats or physically, towards an intimate partner such as spouse or girlfriend), substance abuse or mental health.
Generally clients who perpetrated a fairly serious offence would be assessed by probation as ‘medium’ or ‘high’ risk to re-offend. In those instances, probation officers are required to refer them to their own in-house programs. These programs can include (I just mention it as you may hear a client speak about it):
Often the clients we get are rated ‘low’ risk – although sometimes a client is ‘low’ risk simply because it’s the first time they got caught – so there is certainly some grey areas and the assessment is generally only as good as the information the PO has available to them.
You may hear the term ‘Peace Bond’ as it is often given to clients who were charged with relationship violence. It basically means ‘keep the peace and be of good behavior’ for a year, and complete counselling as required, and the client will not have a criminal record. A ‘conditional discharge’ is basically the same thing. A ‘suspended sentence’ usually means a criminal record (technically means the judge suspends sentence but can change their mind and re-sentence the client in the future if client is not abiding by court ordered conditions – though this rarely if ever happens).
A client on probation (versus a client coming on their own free will) may tend to be resistant and unmotivated. Now we can certainly turn them away, basically say ‘come back in the future if you feel the need for counselling’ but usually I encourage you to take the client on. I do this for a few reasons:
Clients often want to know how often they will come. I suggest that’s something they can ask PO but a general rule of thumb (based on my own experiences) is 8 sessions is generally sufficient -enough of a number that will satisfy the PO and the court condition. Anything less and PO may send them elsewhere – again an incentive to complete the 8 sessions.
Sometimes POs will reach out to find out if a client is attending / what is being covered – you cannot disclose any information without expressed consent from the client (written consent whenever possible should be obtained… the PO can fax a signed consent form to us) … prior to following up you should consult with your supervisor.
Tips about Case Notes
1. Remember clients have the right to review their case records.
2. Think about what you are going to write before you put anything down.
3. Be sure you are recording in the proper client file.
4. Ensure that there is a date for every entry.
5. Notes should be brief, concise and written as soon as possible (within 24 hours) following the counselling session.
6. Imagine that your client is standing over one shoulder, looking over what you are writing; imagine that a family court or criminal court judge / lawyer is looking over the other shoulder at what you are writing. Would they be upset/confused/question what you have written? Would they take what you have written and interpret it in a manner you never intended? Consider these perspectives before writing the note.
7. Notes should include specific client information that is supported by behavioral observations, assessment measures, and client statements, not just your opinion of what you observed (best to steer clear from opinions).
8. Imagine that you are not going to work with the client any further (even if you are not); there should be enough information that another provider would be able to continue quality care (that they could pick up where you may have left off)
9. Watch abbreviations-use only industry standardized jargon/terminology.
10. Use proper spelling, grammar and sentence structure.
11. Do not use slang or overly informal terminology.
12. Avoid curse words unless directly quoting – and even then, think about whether including that is necessary.
13. Avoid labelling, judging and using terminology that may be stigmatizing to the client.
14. Use client language/quotes that are clinically pertinent. Use descriptive terms.
15. Describe what you observed, not just your opinion of what you observed.
16. Reference identified problems from the treatment plan.
17. Avoid providing client with a diagnosis; instead list client symptoms and any recommendations for follow-up with family physician or referral to psychiatrist.
18. Use power quotes:
i. “Client remains at risk for__________ as evidenced by____________”
ii. “The current symptoms include ____________________________”
iii. “Limited progress in _______________________________”
iv. “ Continues to report as being depressed as evidenced by____________________”
19. Proofread before signing off on note.
It is natural for conflict to arise in a workplace between co-workers, employees and their supervisors, or employees and the company. Moving Forward is similar to a work environment in that conflict may arise. There is an open door policy in Moving Forward, encouraging constructive feedback. We want to hear from you if you have had an experience that caused you discomfort, or even if you just have an idea for a way to facilitate growth within the agency. We realize that sometimes knowing who to talk to can be overwhelming. Here is how we encourage you to address any conflict or issues you are having during your practicum with Moving Forward.
As mentioned, we always welcome constructive feedback and encourage an open dialogue as long as it is done respectfully and professionally. Moving Forward mimics a work environment and learning to resolve conflict peacefully and constructively is an essential skill for future practice and working with other professionals.
Some suggested responses:
In some cases two counsellors may have access to the same client file and will both have to record notes for the same client. This happens if
In those cases, and others, it is the ethical responsibility of each counsellor to respect the privacy of their client and avoid looking in the session notes of the other counsellor. The only circumstance under which one counsellor can review the other counsellor’s notes is if the client signs a release of information form (verbal consent can also be noted, but written consent should be sought – discuss with supervisor if this is not possible) and indicates they would like one counsellor to be aware of the other counsellor’s notes.
Please make sure to review all your client files and ensure that your supervisor’s name appears on the file. To do that: Go to the client’s file–>contact and clinical–>clinical details–>in the ‘basics’ column make sure your supervisor’s name appears under ‘primary supervisor’. If it doesn’t, click edit at the bottom right of the page–>choose your supervisor under default supervisor.
When you are creating a brand new client file, please ensure that your supervisor’s name is automatically populated as supervisor, just under your name as the therapist (which is automatically populated when you are the one creating the file).
If you are having any issues, please email coordinator
The main purpose of an intake is for a supervisor to review the client’s circumstance and determine who would be the best fit. Sometimes a referral/self-referral will come with enough details that the supervisor will pass along the referral and ask if you want to take it on; in this case, you do not have to complete an intake. However, you are welcome to do an intake if you wish (this is totally up to you). If you do an intake, ensure you upload it to OWL afterwards. Or you can simply proceed with first session. Regardless of if you do decide to do a complete intake or not, please make sure you have the client’s address, prior to beginning counselling.
In general it is good practice to review and re-sign the consent form with client that has been transferred to you to ensure they are aware and familiar with the policies and limits to confidentiality.
Primary Supervisor:
Secondary Supervisor:
Other governing bodies have different criteria and it is up to intern to be aware of what the required hours are.
You are welcome to send an email to them. Here is the format to use:
Hope all is well.I was just checking in to see if you are still interested in individual services? Agency protocols require any file that is inactive for a month or longer to be closed it. If you are not interested in continued services at this time, feel free to disregard this email, and feel free to reach out again anytime in the future. If the need arises in the future please do not hesitate to reach out – a self-referral can be completed via the secured link found on Moving Forward Family Services’ website at movingforward.help
or
I will be completing my internship with Moving Forward soon. I wish you all the best and wanted to let you know that if still interested in services, you are welcome to reapply to Moving Forward Family Services and you will be assigned a new intern counsellor – or if your financial circumstances have changed, you may wish to see a private registered therapist – all the various options are listed on the website at movingforward.help
or
Hello, due to multiple misses, I will be closing your file. I wish you all the best and wanted to let you know that if still interested in services, you are welcome to reapply to Moving Forward Family Services and you will be assigned a new intern counsellor – or if your financial circumstances have changed, you may wish to see a private registered therapist. Please note any unpaid balances for services would need to be cleared prior to any resumption of services and that future missed sessions would incur missed appointment fees.
When a client has moved on from counselling you can deactivate their file (NOT DELETE) so it no longer appears under your active client files (you will still be able to view the client file if you remove the ‘active’ filter from the ‘clients’ tab view). Steps to complete before you inactivate a client:
*See video guidance for this process on the OWL orientation page.
If the client has an answering machine:
If the client provides an email address and a phone number:
If the client doesn’t have an answering machine:
If the client doesn’t want to continue, make a note of that in the session notes on owl. If the client never responded to the initial contact, record your attempts to contact them in the ‘non session notes’ section of their file on owl. In general, two attempts of contacting a client is sufficient.
Regarding client payments: you would not use OWL for any payment related matters – you would verbally let them know / email them the info (you can create a free email using any of the free ones (google, hotmail, yahoo) i.e. tom.mffs@gmail.com and then let them know of the payment options)
1.Etransfer to movingforwardfamilies@gmail.com (Please indicate in the subject line/memo/ comment the name of your counsellor)
2. Credit Card or Paypal – enter movingforwardfamilies@gmail.com in the “send to” option (with paypal you can choose to pay by paypal or instead by credit card). (Please indicate in the subject line/memo/ comment the name of your counsellor)
3.Mail Cheque to
Moving Forward Family Services, 101 – 12827 76th Avenue, Surrey, V3W2V3
(Cheque is payable to Moving Forward Family Service)
See this document for guidance on how to discuss payment with clients Discussing Payment with Clients
Evidence shows that when clients pay, they tend to miss less appointments and show greater commitment to counselling. Even a few dollars (versus free) can make a significant difference in terms of motivation/commitment. No one will be refused service due to their financial circumstances but clients also need to know we are not funded by those responsible for counselling services (Fraser Health, MCFD, Schools, Corrections) and every dollar helps to cover our costs so that we can continue to offer low barrier services.
We also have clients who, when services are free, use such services to ‘dump’ their weeks’ worth of frustrations without taking tangible steps (that it is ultimately their prerogative but we do not need to enable that) – and once they are asked to pay they choose to discontinue -so it becomes a way to end the therapy when therapy doesn’t seem to be progressing … but ultimately they chose to end it. Clients who do pay even a few dollars tend to have tangible clinical goals they are working on (they don’t just dump).
And finally as someone who has been around a while, I have heard clients talk about their Caribbean Vacations, second home in White Rock, about how much they love their BMWs, their regular fancy shoe shopping sprees, how they cannot go a day without getting their fancy drink from Starbucks, but then plead poverty when asked to pay. So I don’t have nearly as much empathy for those situations as I do with multi-barrier clients living in poverty or can barely survive on their wage – especially since we receive no funding from government entities responsible for publicly funded counselling (MCFD, Health Authorities, School Districts, Corrections). Such clients, if showing up and being engaged, will never have to worry about having to afford their counselling.
*DUE TO COVID-19 ALL COUNSELLING IS CURRENTLY ONLINE OR ON THE PHONE
Please view this short (approximately 3 minutes) video:
“Having some psychotherapy is just about the most significant and interesting thing you could do to improve your chances of contentment – in relationships, at work, and with friends and family.”
Next review this video on Basic Skills of a Counsellor:
click on this link to review Orientation manual:
Watch this video of a role play for an initial session:
Before your first session with a client, provide them with instructions on how to access the client portal. You can either send them the form directly from OWL (see ‘creating a client portal on OWL’ video above for guidance on how to send the form through owl), or send them a copy of this document through your Moving Forward email Client-Instructions-for-Client-portal.
See this document for common issues and how to troubleshoot them OWL-Video-Troubleshooting
(only applicable if your supervisor requests for you to do this)
Booking-supervision-with-your-supervisor-through-owl
