• Unexpected technical disruptions or power shortages interrupting flow of the therapeutic interaction can reduce full benefit to the client. Misunderstandings can more easily occur, especially when care is delivered in an asynchronous manner.
•  As well such interruptions might shorten the time available for therapy within the 50-minute session.  If the client is in crisis, a technical interruption would prevent the potential support and interventions of the therapist. 
• In the case of physical emergency, the therapist cannot intervene immediately in person but must notify appropriate emergency personnel resulting in a delay in direct response.

• The use of electronic therapy allows access to therapy from despite distance, thus providing the client with psychological treatment and the opportunity to improve mental wellbeing.
• Teletherapy permits the client to be treated from any location at a mutually agreeable time.

• The use of online video or phone technology to conduct therapy is limited in its capacity to transmit the full range of non-verbal cues and communication normally part of in-person interactions between therapist and client. Teletherapy may not yield the same results or be as complete as face to face therapy.
• Electronic communication is not as direct as in-person psychotherapy and may increase a sense of disconnection, emotional distance or elevated scrutiny for some people. Teletherapy may not yield the same results or be as complete as face to face therapy.
• Generally, the results of therapy cannot be guaranteed or assured.

• In the event of a technological disruption while using videoconferencing, we will continue the session on audio phone. Should we be unable to use either because of a power shortage, we will make arrangements at the earliest possible opportunity on email or text to reconvene at a mutually acceptable time.

Steps to be taken in the event of client in crisis or physical emergency:

• I will obtain emergency numbers of local authorities to be contacted in case of a physical emergency. The client agrees to inform me of changes in phone numbers and address to permit access by emergency personnel.The following crisis helplines and local distress centres may be used by the client if there is a technological disruption during a session when the client is in crisis:
  Crisis Hotline: 1-800-448-3000
  Suicide & Distress Centre (Toronto) 416-408-HELP (4357)
  Gerstein Centre (Toronto) 416-929-5200
  Lesbian, Gay, Bi Youth Hotline 1-800-268-9688
  Assaulted Women’s Helpline 416-863-0511, 1-866-863-0511
  Parent Help Line” 1-888-603-9100

Therapist Responsibility and Limits of Confidentiality

Normally, Shauna Cake may only disclose personal health information with the consent of the client or his/her/their authorized representative. However, there are a limited number of circumstances where disclosure of personal health information is required without consent.

1. Where Shauna believes on reasonable grounds that disclosure is necessary to eliminate or reduce significant, imminent risk of serious bodily harm (includes physical or psychological harm) to you or anyone else, e.g. suicide, homicide.
2. Where disclosure is required under the Child and Family Services Act, for example, where I have reasonable grounds to suspect that a child is in need of protection due to physical harm, neglect or sexual abuse by a person having charge of the child.
3. Where necessary for particular legal proceedings (e.g. when I am subpoenaed).
   To facilitate an investigation or inspection if authorized by warrant or by any provincial or federal law.
4. For the purpose of contacting a relative, friend or potential substitute decision-maker of the individual, if the individual is injured, incapacitated or ill and unable to give consent personally.

Teletherapy, because of the complexities and abnormalities of the Internet, carries the risk of potential release of private information. The video conferencing system used is an encrypted electronic platform that has been chosen because of a greater capacity to ensure confidentiality. However, despite these efforts, confidentiality in online psychotherapy cannot be guaranteed.

Client Responsibility to Privacy and Confidentiality

• The client understands that there is the risk of being overheard by anyone near you if you do not place yourself in a private area that is not subject to unauthorized intrusion.
• You are responsible for information security on your computer.
• Email is not a secure method of communication and should only be used to arrange appointments, not to transmit any personal information. If necessary, the client is encouraged to use an encrypted email service such as ProtonMail.

Payment will be made through e-transfer just prior to each appointment at the agreed rate. In the case of a cancellation, the client must give 48 hours notice or a cancelation fee is required.