Client- Therapist Relationship
An effective client-therapist relationship is critical to ensure that your therapy works.
It is important that you feel comfortable with your therapist. I help with this by establishing trusting rapport where you feel able to freely discuss your issues and concerns. This is achieved through attentiveness, caring and sensitivity to this very personal process.
Confidentiality must be assured so that any subject may be explored and discussed.
Therapy is an interactive process and you share responsibility for this process as well as the content.
It is often helpful to establish goals so that your expectations and issues may be clear and focused. Answering the questions, “What do I want to be like?” and “What would I like to achieve through this process?” may help you with this.
Personal histories can often provide valuable information in order to identify links between past experiences and current problems.
Self-destructive beliefs and values are explored and challenged.
Self-empowerment is one of the goals of therapy. Philosophers have said, “It is better to learn how to fish than to be given a fish”.
"I believe that people can create positive change in their lives. I promote and support these changes through a multi-disciplined, empathetic approach to psychotherapy.
People often enter therapy seeking relief from a current crisis. They may recognize the need for change and at the same time feel resistant to the unfamiliarity that change can bring.
I bring a variety of modalities and training in psychotherapy, counselling, mediation, and life skills to help you access your own innate growth process.”
Leland F. Clipperton
Therapy Contract Form
Prior to attending your first appointment, it is helpful if you can copy and paste the following form into your word processing program, complete the form bring the completed form with you.
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Counselling & Mediation Services
Leland Clipperton, H.S.C.
Phone: (905) 510-9117
(705) 443-8290
Email: leland@CounsellingandMediation.com
Therapy Contract
Name:
Address:
Postal Code:
Phone No.: [Home]
[Business]
Email Address:
Date of Birth: Referred by:
You have made the first step to your ongoing change process. This has, no doubt, been a challenging decision to make. Therapy can be hard work. Much of the process involves sharing your personal thoughts and feelings.
Your commitment to undertake therapy at this time in your life will be best served if you give this time the greatest value you can. There is a direct relationship between successful outcome of therapy and how strong your belief in the process is. In other words, the more value and positive belief you place on your therapy, the greater your success will be.
Therapy can often feel difficult and you will likely have times when you will feel that something or someone seems to take priority over your scheduled sessions. This may also be an ideal opportunity for your own personal growth. It is often more valuable to work through this conflict you may experience while in a supportive environment.
Most clients whom attend regular weekly sessions find it easier to book the same time and day. ie. Wednesdays at 10:00. Sessions are 55 minutes in duration. Regular and timely attendance at all sessions is expected. You must provide at least five business days notice in advance of your scheduled session when you know you will be unable to attend. This is to give others the opportunity to utilize your scheduled time period. If appropriate notice is not received, you will be charged for the missed session.
The current fees are $100.00 per session for counselling, $130.00 for couples sessions, and $160.00 for mediation; all one hour sessions Payment in cash is required at each session. Fees are not covered by O.H.I.P. Please check with your individual insurance company for possible extended health plan coverage. Employee assistance program coverage may also be available.
I have read and understand the above. Signed:
Date:
Describe where you live.
How long have you lived there?
What do you like about where you live?
What don’t you like about where you live?
Who do you live with?
What is like at your residence i.e. what typical challenges occur?
Describe your work (or school ) experience.
What motivated you to come to counselling?
What needs to occur to improve your life?
What are your strengths?
What are your weaknesses?
Describe the problems you are currently experiencing.
What are the consequences of the current problems you experience?
What do you typically find rewarding i.e. people, places, things, food, activities?
What do you find unpleasant i.e people, places, things, food, activities?
What is your medical history?
Describe your family’s medical history.
Describe any recent traumas or changes.
Have you been in therapy before? If yes, please provide details.
Members of family (including spouse, parents, children, siblings, etc.)?
Name Age Relationship
Please describe any recurring thoughts or dreams you may have.
How would you describe yourself?
What will you be like when your therapy is completed?