CONSENT FORM
constanza rosemary, M.Sc. (A), n. d. psychospiritual therapist
naturotherapy registration #18-6339
infinite gratitude to the people of tiohtià:ke, hupacasath, and tseshaht for allowing me to live, play, and work on their land.
SAFETY & CONFIDENTIALITY
it is my responsibility to provide you with a safe and confidential space in which we can work together. confidentiality is one of the cornerstones of the therapeutic relationship. as such, any information exchanged during sessions will remain strictly confidential. there are 3 exceptions to this, including:
● if i have reason to believe that you are in clear and imminent danger of harming yourself or another person;
● if i learn that a minor is being harmed;
● if i am mandated to do so by a judge.
in these cases, and to the best of my ability, i will have a conversation with you before breaking our bond of confidence.
BENEFITS & RISKS OF THERAPY
although I expect that you will benefit from our work together, i cannot guarantee any specific results. the recipe to make the best out of therapy is very simple- the more time you spend reflecting, meditating, journaling, contemplating, integrating, practicing, and challenging yourself to grow, outside of therapy, the better results you will obtain. you get what you put in.
therapy may feel challenging and difficult at times. therapy and growth are not supposed to be comfortable or passive processes. sometimes we might revisit painful memories or uncomfortable feelings such as anger, sadness, guilt, grief, loss, resistance, frustration, and overwhelm. it is in the full surrender and loving acceptance of these memories/feelings that we allow for the transformation to happen.
therapy can be a wonderful process of exploration and discovery. that being said, 'talk therapy' has its limitations. i invite you to explore other healing modalities which might compliment our work together, such as somatic experiencing, hypnotherapy, energy work, psilocybin assisted therapy, EMDR, reiki, EFT, art therapy, amongst others, if you wish to do so.
THERAPEUTIC PROCESS
sessions are 50 minutes in length and are usually scheduled on a weekly basis, although it may sometimes be appropriate for sessions to be less frequent. therapy may be short or long term depending on your needs. together we will co-create a therapeutic rhythm and pacing that is catered to your own individual needs and resources.
during our sessions i:
-offer a non judgmental space fueled by unconditional love
-provide my clients with deep and undivided presence and witnessing
-ask questions to facilitate clarity and understanding
-reflect back to you what i am hearing in my own words
-bring awareness to certain limiting beliefs or narratives
-offer psychoeducation on the healing process and our innate power as humans
-hold you accountable to your own growth
-remind you of the power of your word, thoughts, and beliefs
-convey any message or downloads i might be intuitively called to share
-co-create a customized 'home-practice'
for therapy to be the most efficient, you need to be actively working on yourself on a day-to-day basis. thus, at the end of every session, we might agree on a home-practice, which is a customized exercise catered specifically to your own growth journey. your level of commitment to this practice will determine the level of success and inner peace/transformation you will experience in your life.
i ask that you have a 'therapy journal' or notepad to jot down some reflections or insights you might receive, be it within our sessions or outside of therapy. writing things down can give us clarity on what our wishes, goals, desires, priorities, challenges, & needs are, and can help us address them more effectively. you will also use this journal to take note of the home-practices, in order to keep track of what you're working on for self-accountability purposes.
even though I am a trained therapist, i remain a perfectly imperfect human, with talents and weaknesses, strengths and shortcomings. what this means is that at times i might fall short of your expectations, or say something that might not land well for you. this is an inevitable and healthy experience in ALL relationships. for example, it is normal to disagree with or be triggered by some of the therapist's reflections or remarks. that being said, if there are things that in your opinion you need more or less of, i encourage you to lovingly let me know so that i can grow into the best version of myself as a therapist, and ultimately, as a human.
should you wish to conclude or take a break from our therapeutic work, i invite you to please let me know, either during a session or via email, for the sake of respect and clear communication. :)
FEES & CANCELLATION POLICY
the general fee per session is $123. That being said, I also offer 3 other options to choose from.
1) the first one is the $111 option for people who need extra financial support (aka- don't have insurance, don't have steady income/work, are single parents, etc).
2) the second one is the $136 option for people who feel financially secure, abundant, and generous (aka. have insurance, have steady income/work, have no dependents/children, etc)
3) the third one is for clients who DO NOT wish to obtain a receipt have the option to pay by donation/gift economy, in which case the fee can be any amount desired (as low as $99). if this is the case for you, please let me know so that i can give you more details about this option.
you can choose any option that feels good to you. some people will pick one option and stick to it every session. some other people will pick different options from session to session, depending on their financial availability. you can choose whatever style and option works best for you, no questions asked.
fees are payable either via etransfer to therapy.constanza@gmail.com or via paypal (if you wish to pay through your credit card).
it is very important that payments are sent the day of the session for auditing and accounting purposes. i recommend sending the payment prior to our session to avoid forgetting afterwards. if you need to cancel an appointment, i request a minimum of 24 hours before the session. therapeutic availability can be scarce and as such it is important for me to know ahead of time if you're unable to attend our scheduled meeting. this 24-hour window allows me the time to offer the appointment slot to another client who might have requested it. failure to comply with the 24-hour cancellation policy results in a payable fee equivalent to 100% of the total session cost.
if you're late to the session (no worries, it happens!), please make sure to let me know at your earliest convenience. a brief email with the approximate time of delay will suffice. should I not hear from you, i will stay in the video call for a maximum 10 minutes, at which point i will end the call until i hear back from you.
once the session is completed and the payment is received, an online receipt will be sent to the client's email address on file. i offer receipts as a naturotherapist (#18-6339). it is the client's responsibility to inform themselves about insurance coverage and to take charge of that process.
SCHEDULING & COMMUNICATION
i see clients tuesdays and wednesdays at 1pm, 2pm, 5pm, and 6pm EST.
to book sessions please visit: https://tidycal.com/constanzarosemary. our sessions take place exclusively online, via google meets video service. please make sure you have a safe and private space with a solid internet connection. sessions are booked on a ''first come, first served'' basis, unless someone has reserved a weekly or biweekly spot. booking is left to each client's discretion.
communication happens via email (therapy.constanza@gmail.com). please do not text or call my phone number, unless you're unable to type and need to notify me that you're late for our session. should you need immediate assistance please contact your local health authorities and/or dial 911, at your discretion. i am not to be contacted during cases of emergency.
SIGNATURE
by my signature, i acknowledge that i have read and understand this therapy disclosure. i consent to therapy with constanza rosemary, according to the terms described here.