Informed Consent Form  - Alexia Wensing - psykoterapi & rådgivning– English 

Psychotherapy is a talk-based therapy and is intended to help improve and maintain mental health and wellbeing. It is a collaborative process and involves active participation on your part as a client. Psychotherapy can have benefits and risks. Since therapy often involves discussing unpleasant aspects of your life, you may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, and helplessness. On the other hand, psychotherapy has also been shown to have benefits for people who go through it. Therapy often leads to better relationships, increased self-awareness, clear paths forward, and significant reductions in feelings of stress and overwhelm. There are no guarantees of what you will experience. 

Although I am a thoroughly trained, licensed professional in Ontario, Canada, the act of psychotherapy is not protected in Norway, and is considered an alternative healthcare practice. My license does not allow for me to utilize my Canadian title in Norway, as it is outside of my jurisdiction of practice. When practicing in Norway with those who live in Norway, I simply use the title of psykoterapeut. 

Confidentiality and Record-Keeping: 

Personal information gathered in the course of counselling will be used in accordance with the purposes outlined in the paragraph above and will not be disclosed except in cases of the exceptions outlined below. Confidentiality is a key to the effectiveness of the psychotherapy process, so the personal information you share in counselling will be kept confidential. Confidentiality continues after the end of the counselling relationship and all staff interacted with

There are, however, some exceptions to the counsellor's duty of confidentiality, in particular:

(a) If it is their opinion that a child or vulnerable adult is, or may be, at risk of abuse or neglect, or in need of protection;

(b) If it is their opinion that you or another person is at clear risk of imminent harm;

Occasionally, cases are discussed in a supervisory capacity. While clinicians may disclose information for the purpose of a professional consultation, your identity will remain confidential. For the educational purposes, your session may be recorded, which will be outlined first by your clinician and verbal consent always requested. No identifying information would be included, and confidentiality still strictly enforced.

If I see you in person outside of the therapeutic hour or session and outside of the therapeutic environment by coincidence, I will not acknowledge your presence or greet you. This is simply to protect your privacy and confidentiality.

If you have any questions or concerns about the clinician's personal information policies and procedures apply, please ask.

Fees and Payment 
Payment is accepted by Vipps or credit card and is required by the end of the session. If you intend to pay by credit card, I ask that you please provide the details of a credit card to have on file. The credit card will be charged at the end of your session by your therapist, creating ease on both ends of the payment process. If you prefer to pay via Vipps, payment is due by the end of the psychotherapy session. We still ask that you have a credit card on file in case payment is not received on time, and the credit card will be charged. 

Administrative Fees 
Should you need forms or paperwork to be filled out or completed by me outside of our allotted session time, you will be billed an administrative fee of or 190 NOK per form or to a maximum of 2 pages. For longer forms, the hourly rate will apply. 

Session Length 
All session lengths are written in the description on my booking webpage, and when booked for each individuals. Administrative queries around scheduling and payment are part of the session time. 

Please arrive on time for the session. A therapeutic hour will run for 1 hour, regardless of a late start due to your delayed arrival. If the session is delayed due to my actions, then it will either be extended, or the fees will be adjusted on a pro rata basis for the session. If I choose to extend an hour-long session with your permission, then you will not be charged for the added time. 

Cancellations 
Your appointment time is reserved just for you. A late cancellation or missed visit leaves a hole in the therapists’ day that could have been filled by another patient. As such, we require 48 hours notice for any cancellations or changes to your appointment. If you are running late, please reach out and let us know by phone or email (awensingpsychotherapy@gmail.com). Patients who provide less than 48 hours notice, or miss their appointment, will be charged a cancellation fee of 50% of their session cost. If you are running late, please reach out and let us know.
Clients who provide less than 24 hours' notice, or miss their appointment without notice, will be charged a cancellation fee of 100% of their session cost.

In Case of Emergency and/or Crisis
As a psychotherapist, I do not provide crisis or emergency services. In the case of emergency, please dial your local emergency telephone number, contact your General Practitioner or Medical Doctor, or go to the Emergency Department of a hospital. 

Personal Responsibility 
The Client acknowledges that responsibility for personal actions in or outside the clinic is not altered by virtue of receiving therapeutic services. The Client agrees to hold their therapist free of all liability and responsibility for any actions or results or adverse situations created as a direct or indirect result of actions taken by the Client during or after the termination of therapy. 

Email Communication 
Email is not a safe platform for sharing sensitive information, so I ask that we reserve email for booking, payment or logistical questions. We will keep therapeutic updates within the session time. Please be advised that anything you send via email may be read by Alexia, although it will be kept confidential. 

Alexia’s email address: awensingpsychotherapy@gmail.com 

Termination 
This agreement may be terminated at any time by the client. The psychotherapist reserves the right to terminate services should the needs of the clients be outside of the therapist's scope of competency, but referrals more suited for the client's clinical needs will be provided.

Consent to Receive Psychotherapy 
By signing below, you as the client acknowledge that you have read and understood the above information, and give permission and consent to Alexia Wensing, to provide psychotherapy consultation and/or treatment to you.