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GUIDELINES
PRACTICUM TRAINING
(AMCP5103)
&
INTERNSHIP
(AMCP5206)
MASTER OF COUNSELLING
Table of Content
Page No.
1.
Overview
2.
3.
4.
Responsibility of Students
5.
6.
7.
8.
9.
10.
11.
11
12.
13
13.
17
14.
22
15.
23
16.
Practicum Sites
24
17.
Related Forms:
31
34
35
Informed Consent
37
OVERVIEW
The Goal of Practicum Training and Internship
Practicum training and internship provide the application of theory and the development and
enhancement of skills for client assessment, planning, intervening and evaluating.
These experiences will provide opportunities for students to counsel clients who represent the
ethnic and demographic diversity of their community.
Hence, the goal of practicum training and internship is to provide hands-on counsellling
experiences under the supervision of qualified supervisors (registered counsellors).
These courses are necessary to prepare future counsellors to the real world and be able to
cope with and handle real life situations confidently and effectively.
This training component gives the learner the opportunity to integrate classroom learning,
personal skills, and prior experience into a therapeutic setting with on-site supervision.
The courses, AMCP5103 and AMCP5206 are totally based on the requirements, rules and
regulations determined by Lembaga Kaunselor Malaysia (LKM).
Internship (AMCP5206)
Internship students will accumulate a minimum of 504 internship hours of which 192
hours will be direct client contact hours and 312 hours for counselling related
activities or programmes and administrative works throughout a semester.
Internship (AMCP5206)
(5 hours X 3 sessions)
(5 hours X 5 sessions)
Practicum students are required to produce the following items as evidence of their Practicum
Training/Internship
Log book
Final Report
5 recorded audio or video counselling
session tapes
Log book
Final Report
7 recorded audio or video counselling
session tapes
Responsibility of Students
Students are responsible toward the following aspects:
Adhere to the Lembaga Kaunselor Malaysia Codes of Ethics and Standards of Practice
Submit the log book and final report to the Practicum/Internship Supervisor
Internship (AMCP5206)
work
work
on site visit
group
group
supervision
during
seminar
meetings
supervision
during
seminar
meetings
system
system
of
Applied
Social
Sciences
(FASS)
of
Applied
Social
Sciences
(FASS)
At least Master degree awarded from an accredited college or university prior to January 1,
2008, in counselling or related field designed to train the person to provide direct services to
individuals or groups in a counselling relationship in the resolution of personal-social
educational or occupational problems or related.
Site supervisor is responsibles for providing consistent (at least one hour per week) clinical
and administrative supervision to each practicum students.
Site supervisor serves as professional mentors to the practicum student. Site supervisors will
conduct consistent evaluations of students strengths and challenges.
The focus of individual supervision by onsite supervisors typically includes case review,
theoretical application, and counsellor self-awareness.
In collaboration with the practicum supervisor, the site supervisor will complete an evaluation
of the student's performance upon completion of the practicum course.
No specific requirement.
Internship (AMCP5206)
Must be registered counsellor with Lembaga
Kaunselor Malaysia (LKM).
Learning Opportunities
Along with identifying factors to consider in choosing practicum site, it is also essential to
consider the kinds of learning opportunities that will be able available to you.
It is especially important to clarify this before starting practicum/internship because they have
been issues on the lack of sufficiently interesting or challenging learning opportunities.
Clarifying from the outset what opportunities you desire and what the practicum/internship
can and will make available to you, can go a long way toward preventing disappointments.
Counselling/Treatment Approaches
This is to encourage students to be more open to different methods and to be able to learn
from another perspective.
Clients
The next factor to consider in selecting a placement is the type of clients served by the site.
Just as it is advisable for students to be exposed to a variety of treatment approaches,
experience with diverse client groups is also desirable.
However, it is desirable and a good idea to be flexible and open to different types of training
experiences and different client groups.
In addition, if students want to eventually work with a specific client group, it might be ideal to
find a placement with a site for that particular group.
Ethics
Each practicum/internship site has its own set of policies and procedures. It is students
responsibility to obtain and understand these policies.
Video and material from client files are never to be discussed or shown to anyone other than
the supervisor, instructor, or in class as directed by your instructor. Seek permission from the
site supervisor before discussing a case in class.
Information about clients is never requested or released without the clients specific written
consent, a copy of which must be kept in the client's file. In the case of child clients, a parent
or guardian must authorise such action. An exception to this rule is made when it is
suspected that the client may be harm to self or others. The decision to breech the client's
confidentiality is never to be made by the Practicum/Internship supervisor.
Clients need to be advised of these limits to confidentiality during the intake interview. Clients
who are at risk of harm to self or others are not appropriate for practicum and need to be
referred to more advanced practitioners.
Informed Consent
Before initiating a counselling relationship, students must first inform clients of any limits to
confidentiality, status as a counsellor-in-training, and any site specific information provided by
site supervisor.
Students must also secure clients permission to tape the counselling sessions.
Professional Behaviour
This includes being punctual, dressing appropriately and presenting oneself professionally as
it reflects that counsellor-in-training and the counselling profession.
ii.
iii. Individual on site visits will be conducted by Practicum/Internship supervisor (1 time visit for
Practicum) and (1 time visits for Internship).
Counselling Supervisions
To prepare student for supervisory sessions (individual and group), review videotapes and
sessions, and identify specific supervisory needs prior to your supervision sessions.
The site supervisor or practicum/internship supervisor may ask student to bring counselling
files and videotapes to supervision sessions.
Meet with the site supervisor prior to see clients to set up goals and structure.
Practicum/Internship supervisor should lead student to reflection, help to determine the ways
student need to improve, and find the types of learning experiences student need to be the
best possible counsellor for clients with a variety of needs.
Log book
A log book is a record of activities, experiences, reactions and thoughts consistent with the
emphasis on active learning at the counselling sites. It may also include a reflection of the
experiences in order to better understand such things on emotional reactions, thoughts about
clients and impression on treatment.
Progress notes
Progress notes provide a means for monitoring a clients progress throughout treatment or
counseling.
Progress notes are also used to examine a clients progress toward treatment/counselling
goals, the development of new issues and goals, and the modification of the initial
treatment/counseling plan. In supervision, these notes provide a means for the supervisor to
track and monitor the progress of the client and the supervisee.
Progress notes should be brief, concise, and should be written as soon as possible following
the counseling session.
Progress notes should only include relevant information, and do avoid labeling, judging or
using terminology that may be stigmatising to the client.
Session objectives and therapeutic interventions should relate to the overall treatment or
counseling plan for the client. Progress notes should include specific client information and
may be supported by behavioural observations, assessment measures, client statements,
and other observations by the counsellor.
Progress notes also allow student to monitor changes that may result in a modification of the
treatment or counselling plan for a client.
2. Submit the form to the Executive, Faculty of Applied Social Sciences (FASS) via email at
bismi@oum.edu.my at least 3 months before undergoing the Practicum Training/Internship at
the respective organisation.
3. Student can suggest not more than 3 organisations for the counselling placement in his or her
application form (AMCP-1) and do state the main/priority organisation.
4. Student must contact the proposed site supervisor / organisation and make preliminary
arrangement for the placement before completing this application form. Student must keep
another copy of AMCP-1 for his or her own record/reference.
5. After the approval from Programme Coordinator, FASS will prepare the application letter for
undergoing the Practicum Training/Internship to the respective organisations. Student will be
contacted after the letter is ready.
6. After getting the approval from the respective organisations, student has to submit AMCP-L1
to FASS.
8. Student must come for face-to-face classes/seminar three times per semester for Practicum
Training & five times per semester for Internship. These seminars are important
for
10. Practicum/Internship supervisor has to key-in students marks in the OMES system and then
submit students reports to FASS not late than 1 week after receiving the reports from
students.
** Important Notes:
Students can get all related forms for Practicum/Internship in their student portal.
MyVLE E-servicePostgraduatePracticum or Internship
o
Informed Consent
10
Students are encouraged to approach the respective organisations and site supervisors three
months before undergo the Practicum/Internship. There are a couple of ways to find a
Practicum/Internship sites.
o
Each site has information on what the site offers. But please be informed that, some
organisations/institutions as in the list provided may no longer available to offer students
for counselling practices.
If the sites list is not fit students interests, they can suggest to FASS other counselling
organisations/institutions in AMCP-1 form.
Remarks
email to bismi@oum.edu.my
11
SUBMISSION OF REPORTS
Student must submit the reports
not late than 1 week after the
final examination to his or her
Practicum/Internship supervisor.
12
1.
Name of Course/Module:
Practicum
2.
Course Code:
AMCP5103
3.
4.
5.
6.
Face to Face
L = Lecture
T = Tutorial
P = Practical
O= Others
7.
Credit Value:
3
8.
13
9.
Learning outcomes:
a. Learners have experience working as a counsellor in an agency setting
under the dual guidance of an on-site practitioner and a university-based
clinical supervisor
b. Learners are able do the intake and screening process, individual
evaluations, participate in interdisciplinary staff conferences and
professional meetings
c. Learners are able to evaluate individual, write reports and practice shortterm counselling and consultation under the supervision of the clinician.
d. Learners are able to resolve professional and ethical issues related to the
practice of counselling.
e. Learners are able to integrate classroom learning, personal skills, and
prior experience into a new therapeutic setting.
10.
Transferable Skills:
Counselling skills, individual evaluation skills, consultation skills, problem
solving skills
11.
12.
Synopsis:
The course involves 240 clock hours in a setting where students will provide 96
hours face-to-face counselling. 144 hours for counselling related activities and
administrative counselling works. During the practicum, students will engage in
clinical experiences appropriate for their level of professional training. This
training component gives the learner the opportunity to integrate classroom
learning, personal skills, and prior experience into a new therapeutic setting with
on-site supervision.
Mode of Delivery:
Discussion with practicum supervisor
14.
Log book-15%
14
15.
16.
17.
SLT
1. Getting started
1.1.
1.2.
1.3.
12
2. Microcounselling Supervision
3.
2.1.
2.2.
12
Microcounselling supervision
3.1.
3.2.
12
4. Microcounselling Supervision
4.1.
4.2.
12
5. Microcounselling Supervision
5.1.
5.2.
Administrative Skills
12
6. Microcounselling Supervision
6.1.
6.2.
12
7. Microcounselling Supervision
7.1.
7.2.
12
8. Microcounseling Supervision
8.1.
8.2.
15
12
9. Microcounselling Supervision
9.1.
9.2.
12
10.2.
Psychoeducational Approach
12
Total
18.
120
16
2.
3.
4.
5.
6.
Face to Face
Time (SLT)
L = Lecture
Learning
L
T = Tutorial
P = Practical
O= Others
7.
Credit Value: 6
8.
9.
Learning outcomes:
a. Being able to understand and cope with real situation in counselling and
psychotherapy;
b. Being able to conduct individual counseling with confidence and
effectively;
c. Being able to conduct group counselling with confidence and effectively;
d. Having the ability to cope and handle problems at the intership site; and
e. Having the empathy and undertanding of the clients needs.
17
10.
Transferable Skills:
a.
12.
Synopsis:
Learners are required to undertake this 4 months internship experience with the
any one options of the following; community setting, e.g in a school, college or
university, prison, drug rehabilitation centre, the religious department or any
non-government organisation. Learners are required to conduct individual and
group counselling as well as other activities related to guidance and counselling
at the internship site. They are also expected to participate in some other related
activities conducted by the site supervisors. As a part of the internship, learners
have to prepare a report which would then be presented at the seminar. Site
visits will be done by the course supervisors.
13.
Mode of Delivery:
Discussion with internship supervisor.
14.
15.
18
16.
17.
SLT
1. Internship
1.1 Individual and group counselling
12
12
12
12
12
19
12
7. Internship
7.1 Individual and group counselling
12
12
20
120
18.
B., &
OHanlon,
B.
2002.
Counseling
and
therapy.
21
Sample
Preparation for Time Allocation (Practicum AMCP5103)
Date
Counselling
Activities
Administrative
Meetings
works
1
13/1-19/1
7 hours
5 hours
4.3 hours
20/1-26/1
7 hours
5 hours
4.3 hours
27/1-2/2
7 hours
5 hours
4.3 hours
3/2-9/2
7 hours
5 hours
4.3 hours
10/2-16/2
7 hours
5 hours
4.3 hours
17/2-23/2
7 hours
5 hours
4.3 hours
24/2-2/3
7 hours
5 hours
4.3 hours
3/3-9/3
7 hours
5 hours
4.3 hours
10/3-16/3
7 hours
5 hours
4.3 hours
10
17/3-23/3
7 hours
5 hours
4.3 hours
11
24/3-30/3
7 hours
5 hours
4.3 hours
12
31/3-6/4
7 hours
5 hours
4.3 hours
13
7/4-13/4
7 hours
5 hours
4.3 hours
14
14/4-20/4
7 hours
5 hours
4.3 hours
15
21/4
5 hours
5 hours
5 hours
96 hours
70 hours
59 hours
15 hours
= 240 hours
22
Sample
Preparation for Time Allocation (Internship AMCP5206)
Direct contact hours for counselling (individual or group counselling)= 192 hours
= 12.8 hours per week
Week
Date
Counselling
Activities
Administrative
Meetings
works
1
13/1-19/1
12.8 hours
10 hours
9.13 hours
5 hours
20/1-26/1
12.8 hours
10 hours
9.13 hours
27/1-2/2
12.8 hours
10 hours
9.13 hours
3/2-9/2
12.8 hours
10 hours
9.13 hours
10/2-16/2
12.8 hours
10 hours
9.13 hours
17/2-23/2
12.8 hours
10 hours
9.13 hours
24/2-2/3
12.8 hours
10 hours
9.13 hours
3/3-9/3
12.8 hours
10 hours
9.13 hours
10/3-16/3
12.8 hours
10 hours
9.13 hours
10
17/3-23/3
12.8 hours
10 hours
9.13 hours
11
24/3-30/3
12.8 hours
10 hours
9.13 hours
12
31/3-6/4
12.8 hours
10 hours
9.13 hours
13
7/4-13/4
12.8 hours
10 hours
9.13 hours
14
14/4-20/4
12.8 hours
10 hours
9.13 hours
15
21/4
12.8 hours
10 hours
9.13 hours
5 hours
192 hours
150 hours
137 hours
25 hours
5 hours
5 hours
5 hours
= 504 hours
23
PRACTICUM SITES
Students are encouraged to approach the respective organisations and site supervisors three
months before undergo the Practicum/Internship. There are a couple of ways to find a
Practicum/Internship sites.
o
Each site has information on what the site offers. But please be informed that, some
organisations/institutions as in the list provided may no longer available to offer students
for counselling practices.
If the sites list is not fit students interests, they can suggest to FASS other counselling
organisations/institutions in AMCP-1 form.
No.
1.
Sites
Site Name:
Agensi Antidadah Kebangsaan.
Site Address:
Kementerian Dalam Negeri.
Jalan Maktab Perguruan Islam
43000 Kajang, Selangor
Web Address:
http://www.adk.gov.my
Contact No:
Tel: 03 - 8911 2200 Fax: 03 - 8926 2055
Email: webmaster@adk.gov.my
Brief description:
Provides individual and group counselling for drug addicts.
2.
Site Name:
Unit Kaunseling, Jabatan Pembangunan Wanita
Site Address:
Aras 23 - 25
No.55, Persiaran Perdana,
Presint 4, 62100 Putrajaya, Wilayah Persekutuan Putrajaya, MALAYSIA.
Web Address:
http://www.jpw.gov.my/
Contact Person:
i. Counsellor- 03-83231000
Brief description:
Provides individual and group counselling for family and women.
24
3.
Site Name:
PENGASIH Malaysia
Site Address:
3201 Jalan Syers, Off Langgak Tunku,
50480 Bukit Tunku, Kuala Lumpur,
Malaysia
Contact Persons:
i. Roslan bin Yahya 03-6201 3179
ii. Azura Zulkarnain- 03-6201 0287
Web Address:
http://pengasih.net/v2/
Brief description:
Provides individual and group counselling for drug addicts.
1.
Site Name:
Protect And Save The Children Association of Selangor and Kuala Lumpur
Site Address:
No. 5, Jalan 7/14,
Section 7,
46050, Petaling Jaya, Selangor, Malaysia.
Web Address:
http://www.psthechildren.org.my/
Contact Number:
i. 03- 7957 4344
ii. 03- 7956 4355
Brief description: Provides individual and group counselling for children and family.
2.
Site Name:
Jabatan Kebajikan Masyarakat
Site Address:
Jabatan Kebajikan Masyarakat
Aras 6, 9-18
No 55, Persiaran Perdana,
Presint 4,
62100 Putrajaya
Contact Number:
Telefon :
03-8000 8000
Faks :
03-8323 2045
Emel :
info@jkm.gov.my
Web Address:
http://www.jkm.gov.my
Brief description:
Provides individual and group counselling for all level of society.
25
6.
Site Name:
Yayasan Salam Malaysia
Site Address:
No 22 Jalan Changgai (6/22), 46000 Petaling Jaya, Selangor, Malaysia (Next to Assunta
School)
Web Address:
http://www.salam.org.my
Contact Number:
03- 7958 4021
Brief description:
Provides all types of counselling include, family, women, children, teenagers, drug addicts,
school students and counselling related programmes.
7.
Site Name:
Careers, Industrial Relationships and Student Information System, Student Affairs
Site Address:
Level 1, Block D
Kompleks Perdanasiswa
University Malaya
50603 Kuala Lumpur
Site Address:
Web Address:
www.um.edu.my
Contact Person:
i. Mrs. Halimaton Attan, Head Assistant Registrar- 03-7967 3322
ii. Ms. Nor Nismawati Mokhtar, Counsellor- 03-7967 3335
iii. Ms. Maznah Azis, Counsellor- 03-7967 3342
Brief description:
Provides individual and group counselling for career related skills to the future graduates of
University of Malaya such as in making career decisions, work finding process, and training
or skills that are able to aid future graduates in the preparatory process to face the working
world.
8.
Site Name:
Malaysia Mental Health Association
Site Address:
No. 8 Jalan 4/33 off Jalan Othman,
46000 Petaling Jaya, Selangor
Website:
http://www.bhd.bz/mentalhealth
Contact Number:
03 - 7782 5499
Email:
mmha@streamyx.com
26
Brief Description:
Advocacy, free counselling, subsidised day care rehab, support groups, family, vocational
training & job placement.
9.
Site Name:
AGAPE Counselling Centre Malaysia
Site Address:
56B Jln PJS 1/46, Taman Petaling Utama,
46150 Petaling Jaya
Website:
http://www.agape.org.my/
Contact Number:
03-7785 5955/689
Email:
agapemal@yahoo.com
Brief Description:
Subsidised counselling services, play therapy, family, training for counsellors
10.
Site Name:
Befrienders
Site Address:
95 Jalan Templer
46000, Petaling Jaya
Website:
http://www.befrienders.org.my/
Contact Number:
03-79568144 or 03-79568145
Email:
sam@befrienders.org.my
Brief Description:
The Befrienders reaches out to the community, particularly to groups at high risk to suicide
to provide, on-site emotional support, talks, workshop sessions and seminars on counselling
skills, suicide prevention, capacity building and mental health awareness.
Working Hours:
24 hours
11.
Site Name:
Counselling Unit, Buddhist Gem Fellowship
Site Address:
60A, Jln 19/3 46300, Petaling Jaya
Website:
http://bgf.buddhism.org/graphics/
27
Contact Number:
03-7954 8750/8753
Email:
buddhistgemfellowship-owner@yahoogroups.com
Brief Description:
Training for paracounsellors, Telephone Counselling, Face-to-face Counselling, Counselling
Training Program, Regular Sharing Sessions for the Helpers, Visits to childrens welfare
homes, Assisting homes for the aged
Working Hours:
Tuesday-Saturday (7.00am-9.30pm)
12.
Site Name:
DBKL Counselling Service
Site Address:
Tingkat 1, Menara DBKL, Jln Raja Laut, 50350, KL
Website:
http://kaunselordbkl.blogspot.com/
Contact Number:
03-2694 7912/7657
03-2617 9905 (Fax)
1-800-88-2600
Brief Description:
Telephone Counselling, Face-to-face Counselling, Counselling
Working Hours:
Monday-Friday (9.00am-5.00pm)
13.
Site Name:
Pelita, YBAM Psychological Guidance Unit
Site Address:
9, Jln SS25/24, Tmn Mayang, 47301, Petaling Jaya
Website:
http://www.mybuddhist.net/
Contact Number:
03-7805 3030
Brief Description:
Training for paracounsellors & Counselling services
Working Hours:
Saturday (3.00pm-6.00pm)
14.
Site Name:
Life Line Association Malaysia
Site Address:
28
Site Name:
Calvary Life Ministries
Site Address:
20-2, 1st Floor, Jln PJU 8/5G, Bdr Damansara Perdana, 47820, Petaling Jaya
Website:
http://www.clm.org.my/
Contact Number:
03-7710 3360
Email:
clm@clm.org.my
Brief Description:
All types of counselling services.
Working Hours:
Tuesday, Friday & Saturday: 9.00am-5.00pm
Wednesday & Thursday: 9.00am-9.00pm
29
RELATED FORMS
Informed Consent
30
TO BE COMPLETED BY STUDENT
Name
: _____________________________________________________________
Programme
: _____________________________________________________________
Centre
: _____________________________________________________________
IC/Passport Number
Intake
Postal Address
: ____________________________________________________________
__________________________________
Poscode:_______________
Telephone (House)
: ________________
Telephone (Office)
: _________________
Handphone
: ________________
Fax
: ____________________________________________________________
: __________________
b. Internship (AMCP5206)
A total of 504 clock hours of supervised experience must be documented to satisfy
the requirements of this practicum. At least 312 hours must involve direct client
counselling.
MAY
SEPT
Year ____________
Instructions:
Contact proposed site supervisor and make preliminary arrangements for your placement
before completing this application.
Completed application form must be submitted to the Executive at Faculty of Applied Social
Sciences (FASS) or email to bismil@oum.edu.my
31
Students may not begin Practicum/Internship placements until their application from the
respective organisations have been approved.
Placement
Student can proposed not more than 3 organisations.
Email Address:
Contact Number:
Email address:
Contact Number:
Email address:
Contact Number:
Concisely list/describe the proposed activities, duties and responsibilities in which you will engage in
during this Practicum/Internship:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Explain why you have chosen this particular site/supervisor and how placement at this site will be
beneficial to you:
_________________________________________________________________________________
32
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
What is your expected work schedule (days per week/hours per day) at this site?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
PART B
............................................................................
..................................
Date
33
___________________________________________________
Matric No.
___________________________________________________
Semester:
___________________________________________________
Locati
on
Date
Time
JKM
21/9/12
2.00pm3.00pm
3.00pm4.00pm
4.00pm6.00pm
22/9/12
23/9/12
24/9/12
9.00am10.30am
10.30am1.00pm
1.00pm3.00pm
5.00pm7.30pm
7.30am9.00am
9.00am11.00am
11.00am12.15noo
n
Administrative
works (4.3
hours per
week)
Jacy
Depression
Sara
Conflict with
children
2 hours
1.5 hour
2.5 hours
1 hour
2.5 hours
1.5 hour
2 hours
1.15 hour
4.3 hours
Total hours this page: 16.3 hours
7 hours
34
5 hours
Client Code:
Date:
Counsellor-in-Training:
Session Number:
Session Objective (s): (In brief format, describe the specific session objective(s). These objectives
should relate to the goals and objectives in your treatment/counselling plan)
Therapeutic Intervention(s): (This session should discuss the specific therapeutic techniques, skills,
or activities you used in the session to assist the client in working through the session objective(s))
35
Evaluation(This section should provide an overview of the session in relation to the objective(s)
established for this session. This may include consideration of client progress, evaluation of your role
as counsellor, critical issues that arose, client-counsellor dynamics, and issues that may have led to
a revision of the original session objectives or treatment/counselling plan.
Plan(s) for Next Session: (This should include consideration of overall objectives and what occured
in the previous session.
36
INFORMED CONSENT
I would like to take this opportunity to welcome you to counseling and provide you with some
information that you may find valuable. I am currently a counsellor-in-training at Open University
Malaysia.
Our relationship, although psychologically personal at times, should be regarded as strictly
profesional in nature. We will meet ____ a week for approximately one hour. Since we will have
limited amount of time to work together, our highest priority will be on the short-term golas we work
together to establish. As your counselor, I would like to request that you be willing to work with me
towards the goals you set for yourself.
I am ethically bound to keep confidential anything you say in our counseling sessions, with the
following exceptions:
(a) If I determine that you are a danger to yourself or others, or if someone else is harming you;
(b) If I am ordered to do so by a court of law;
(c) If you direct me to disclose information to another; and
(d) For consultation purposes.
In order for me to provide you with the best care possible, I will regularly audio and/or video tape our
sessions and consult with my supervisor. Your identity will be protected in these circumstances.
If at any time you are dissatisfied with my services, please do not hesitate to let me know. If we
cannot come to an understanding and resolution, it is my duty to refer you to another care provider. If
you have any questions now or in the future, please feel free to ask at any time. Please indicate your
understanding and consent by signing below.
Signature of Counsellor:
___________________________________
37
Date:_____________
Date:_____________