Agreement for working together

& informed consent – Jenny Katz MSW, RSW


Beginnings are important because I believe we plant the seeds for what is to come at the start. I strive to be honest and transparent in the work and I do this imperfectly. My hope is that we can establish a connection where you will feel comfortable enough to let me know when you want to change directions, or if you have a concern. I am passionate in my learning about life and am honoured to be a part of your journey. Our work together is completely voluntary and I aim to create an atmosphere of collaboration.

Please read through this agreement and during our next session, ask me any questions that will ensure you understand it. If there is anything that you would like me to consider adding to our agreement – let’s talk about it.

I am registered with the Ontario College of Social Workers and Social Service Workers and a member of the Ontario Association of Social Workers. More information about many of the topics covered on this page can be found on their websites.

Your record and confidentiality

I write notes during or after sessions. I do this for many reasons including:

  • To identify goals
  • To assess what direction to go in
  • Narrative therapy
  • Adjunct techniques
  • Reviewing the work we’ve done if there’s been a lapse in sessions
  • Sometimes having written something down comes in handy later and we can’t anticipate how…

You are entitled to know what I’ve written and I am happy to share this with you anytime including during a session. Just ask. If taking notes is making you uncomfortable, please let me know so we can talk about it.

Any other information that I have about you for example, your name and the date of sessions, and records of other points of contact, are to meet legal and regulatory requirements, as well as for scheduling and billing purposes.

Confidentiality and Exceptions

I keep information about you confidential and I keep your records in a locked filing cabinet. If you request that I share information about you with an institution or person, I require your explicit consent.

There are important exceptions to what I can keep confidential and they are:

  • If I learn about a child under 16yrs who is in need of protection, i.e. has been, is being, or at risk of being harmed, I have a duty to report this to the children’s aid society
  • If I learn you are about to seriously hurt yourself or harm another
  • If I am required to by law or court order
  • If I learn the name of a worker registered with the Ontario College of Social Workers and Social Service Workers (OCSWSSW) has sexually abused a client then I must report them to OCSWSSW
  • If I must defend myself against a complaint filed with the OCSWSSW 

Emails and texts

Please know that when you email me or text me that this information is not completely secure. I have pass-codes on my devices and I do use Hushmail which offers encryption options for secure email communication.  Texts are recorded on 3rd party servers therefore please do not to include personal content in them for this reason. If you do share with me personal information over text, I will include references to it in your record.

Telephone and video sessions

During phone sessions, the phone is broadcasting a signal that could potentially be picked up by another phone or listening device nearby and is therefore not considered entirely secure. Voicemails are stored by phone companies and are therefore also not considered secure. If we are doing video sessions, I use Zoom which has recently increased its security features.


If there is 3rd party billing then confidentiality will need to be discussed, as different providers require different information. I will not share any information with a 3rd party without your consent. If you pay me through e-transfer or cheque, there is a chance that the credit union or bank staff who may see these transactions could guess that you are a client if they are aware that I offer counselling services.


It’s important to me that I keep learning and developing my skills. It’s also important for me to have support in doing this work. In order to fulfill these needs I engage in peer supervision. This means that there are other practitioners that I talk to about some of the issues that come up in the work that I do. In these conversations I do not disclose identifying information about you and sometimes I will change some aspect of your identity to further protect your privacy.

Small community clause

If we live in, and/or belong to, the same community/area then please go here to read the ‘small community clause’ and copy the consent statement to add to the statement at the end of this page.

Nature of the service

In my website I refer to my work as counselling and coaching because I believe these terms are more accessible to people seeking the kind of help I provide.

The counselling and coaching services I provide are often psychotherapy services as defined by the Ontario College of Social Workers and Social Service Workers (OCSWSSW) Code of Ethics and Standards of Practice 2nd Edition.

 “Psychotherapy services are defined as any form of treatment for psycho-social or emotional difficulties, behavioural maladaptations and/or other problems that are assumed to be of an emotional nature, in which a social worker establishes a professional relationship with a client for the purposes of promoting positive personal growth and development.”

I provide psychotherapy services integrated with other approaches including adjunct techniques. I also provide coaching which tends to be more present and future focused whereas psychotherapy tends to address the past and the present.  Both the psychotherapy and coaching services I provide fit the above OCSWSSW definition of psychotherapy services. These approaches to helping may overlap in our work together. For more about this please see and


Risks and Benefits

The potential risks to psychotherapy and coaching and the adjunct techniques I use include the possibility that difficult feelings will surface and you may even feel ‘worse’ for a time. Many people experience fatigue after some of the work and this could last for varying amounts of time.  Feeling ‘worse’ and/or experiencing fatigue is a normal part of the process but it can be hard.   In addition to this, as you begin to change your life and the way you understand yourself, relationships change too. You may be saying ‘no’ more often or changing other aspects of how you are in the world. This change may cause people in your life to react and/or protest. Things can get pretty stirred up and this can also cause fatigue, sadness, anger, fear and other reactions/emotions. All of this is part of the process. Benefits can include increased energy, reduced stress, deepened understanding of, and compassion for oneself, improved relationships with self and others, clarity of and movement toward achieving goals.

Therapeutic techniques beyond conventional social work practice (adjunct techniques)

Some of the modalities I use may currently considered to be outside of conventional social work practice. These modalities include somatic-based practices, relaxation and visualization techniques as well as ‘tapping’ or Emotional Freedom Techniques (EFT).  We will talk about your comfort level with various modalities on an ongoing basis.

Appointments and cancellations

Please give me at least 24hrs notice if you are cancelling an appointment. If you cancel an appointment with less than 24hrs notice then you will be charged a cancellation fee of $35.

If you decide to end our work together and have an unused portion of a purchased package you will be reimbursed for the unused portion and the sessions you did have will be charged the single session fee of $130/session.


You can decide to end our work together at any time and without any explanation.

You may choose to end our work together for many reasons including – that our work together is complete for now and the goals that were identified have been achieved, or I may no longer be the right person to help you and/or you need a different kind of help than I am able to provide. If this last point is the case then I would be happy to try and help you find the right person.

That said, talking about endings and striving for a good ending can be a healing process especially because many people have experienced painful endings.

Please know that I am always open to talking about endings including whether or not it would be best continue the work together, what may be in the way of continuing or ending the work together, what would be a good way to end, when would it be helpful for an ending process, etc.


Statement of Consent

Please ask me any questions you have related to this document so that you understand it. After you have received all explanations and clarifications you need, copy and paste the statement below into an email and send it to me. I will also ask for your verbal informed consent during our next session.


I have read the information contained on the page: and any questions I have related to its contents have been answered to my satisfaction.  I understand my rights, the limits to confidentiality, and the risks and benefits.

I understand that participation in psychotherapy/counselling/coaching services is completely voluntary and I can end these services at any time. This email serves as my informed consent.

If we belong to or live in the same community, please paste the ‘small community clause’ informed consent statement here.

your name:


Date of Birth: