Aulneau Renewal Centre Terms of Service

i.                    Privacy and Use of Information

 Protection of Privacy

The information provided in the intake form and other feedback forms that may be used in the course of providing therapy, and information received while in therapy and after completing therapy at Aulneau Renewal Centre will be protected and kept in confidence by Aulneau Renewal Centre. Any information provided in any administrative function, will be compiled anonymously with others, so that individuals will not be identified or known by anyone reading the data.

More specifically, the information will be used to:

▪ Process the request for therapy
▪ Assist the therapist in providing services
▪ Enhancing outcome measures for funding and reports

The privacy of all personal information will be protected, as outlined by the Personal Health Information Act (PHIA).

ii.                 Terms of Engagement between Aulneau Renewal Centre and the Client(s):

The Aulneau Renewal Centre is committed to working in the best interest of the client. When the client is a child whose parents have separated or divorced, the focus will always be directed towards the needs of the child. Given the emotional/stressful nature of the separation/divorce process, one or both parents may feel the need to process their own issues or concerns about the other parent. However, to avoid drawing the focus from the child’s need, no time will be spent addressing the parents’ issues/concerns. The counsellor assigned to the child, may encourage parent(s) to seek out their own individual counselling.

ARC is aware that there are limited resources in the community which are equipped to address situations where clients are involved in high-conflict separation or divorce proceedings. Unfortunately, ARC is not equipped to fully support clients in all of the needs they may have in such situations. For this reason, ARC reserves the right to deny or terminate services where there are high-conflict divorce or separation legal proceedings underway.

It is important to note that the Aulneau Renewal Centre reserves the right to immediately cease services upon the determination that any client—active or referred—is actively involved in custody proceedings.

The Aulneau Renewal Centre also reserves the right to refuse services for or terminate services that involve legal proceedings.

Furthermore, this document confirms the following:

▪ That you have requested/consented to counselling and therapeutic services
▪ That you are prepared and committed to allow the Aulneau Renewal Centre to work alongside your child(ren) through any personal struggles and challenges they may face
▪ That you have advised us that you have completed court proceedings regarding separation/divorce and that no time will be spent discussing issues related to the past court proceedings;
▪ That you have been advised that we are prepared to provide the counselling and therapeutic services within our mandate;
▪ That you are prepared to take responsibility for bringing your child(ren) to their scheduled counselling sessions (during periods of care and control)
▪ That you have been advised and that you have agreed to fund the services as discussed with the intake worker
▪ That neither party shall make derogatory comments about the other while the child(ren) is/are present; and
▪ That you have agreed that these services are provided on the condition that:
▪ The counselling and therapeutic services are offered in confidence, in accordance with normally accepted legal standards;
▪ The therapists and counsellors providing the service will not be called by either party to testify in any Court Proceedings against the other.
▪ The therapists and counsellors providing the service will not provide reports for any court purpose or to any third party.

iii.               Electronic Communication Consent

For many people, electronic communication is an important part of life. This includes – but is not limited to – cell phones, texting, email, social media, and video chatting, as well as any other form of electronic communication. At Aulneau Renewal Centre, we want to make sure that we meet the needs of our clientele, and take cautionary means about privacy. Occasionally, counselling staff at Aulneau Renewal Centre may use electronic communication to arrange, cancel/confirm appointments, or provide clients with information about upcoming events or services. Staff and Therapists will not be able to contact you without your permission.

If you wish to contact us using electronic communications, please know that:

▪ We cannot guarantee the absolute privacy of electronic communication
▪ Email, cell phones, and other electronic means are not 100% secure or confidential
▪ Our scheduling program (Penelope) is web-based, and will send out email confirmations and reminders around scheduled appointments
▪ Electronic communication between client and therapist at Aulneau Renewal Centre may become part of the client file ▪ You can revoke your consent without penalty at any time.

iv.            Telecounselling Consent

Telecounselling Services:
I understand that the service provided is telecounselling, which is counselling delivered either by audio and/or video communication via the internet. Telecounselling can bring deeper insight and awareness, better ways of understanding and coping with problems, as well as improved relationships. I understand that telecounselling sometimes requires that I be willing to examine difficult topics or times in my life, to experience stronger than usual emotions, and to try out new and different behaviors.

Documentation and Access:
I understand that during the provision of telecounselling services my counsellor will need to securely collect and record personal information such as my name, address, and contact details as well as some on-going notes to document what happens during sessions.

My Identity and Contact Information:
In all communications with my counsellor I agree to honestly represent my identity and personal information. I also agree to regularly update my address, telephone number, and e-mail address, as well as any contact information for my emergency contacts. Failure to do so releases my counsellor from any and all ethical and/or legal obligation to warn of life-threatening situations.

Use of Technology and Limits of Communication:
Any communication by unsecured means (i.e., non-encrypted email, text messaging, instant messaging, etc.) will only be used for scheduling or for clarifying questions related to the services being provided. If I send any messages involving personal information to my counsellor without encryption, I agree to waive my privilege to confidentiality. In addition, I must assume full responsibility for the risks inherent in insecure Internet transmissions, including any losses or damages. I also agree not to post transcripts or any other recording of my counselling sessions online or to distribute them in any way. I have read and understood the section below on confidentiality. Finally, I understand my counselor will not accept requests to participate in any online social networks, discussion forums, or blogs with current or past clients.

Telecounselling Precautions:
I understand that telecounselling and face-to-face counselling involve important differences that limit the responsibilities assumed by my counsellor. Unlike in face-to-face counselling, my counsellor cannot guarantee the same degree of confidentiality since telecounselling partially takes place in a space outside of my counsellor’s control (i.e., the internet and my physical location). Because telecounselling takes place at a distance and possibly across jurisdictions my counsellor cannot reliably intervene in situations that may involve risk to my emotional or physical well-being (e.g., if I am in crisis, suicidal, or require hospitalization). This means I agree to take full responsibility for making the following treatment decisions:

• Whether and where I decide to initiate the teleconference
• Whether and how I will protect the confidentiality of my conversation from my side of the teleconference
• Planning in advance what I will do if I become in need of emergency emotional support, including knowing how to contact my local crisis or emergency hot-line. If in crisis or need immediate assistance I can contact:
• Police emergency 911 – non-emergency 204-986-6222
• Mobile Crisis Team at 204-940-1781
• WRHA Crisis Stabilization Unit 204-940-3633
• Klinic Crisis Line 204-786-8686 or 1-888-322-3019
• E-Counselling (Text-Based Messaging) Counselling will take place via audio and video connection only. Text based communication will not be used for counselling; however, it can be used as a support for arranging the logistics of counselling.

Fees are to be paid via contacting Aulneau Renewal. One of our receptionists will call you up to ½ hour before the appt to collect payment over the phone.

Emergency Contact Information:
In case of emergency or clear imminent harm to myself or another person, my counsellor is legally and ethically bound to contact the appropriate authority. My counsellor has my permission to contact my family doctor, a friend/family member, or appropriate authority, in such cases. I understand that my counsellor will not agree to provide counselling unless this form is agreed to in full. I also understand that falsification of this information releases my counsellor from all legal responsibility and repercussions related to notifying appropriate authorities in the case of an emergency.

Importance of the Agreement The following statements are intended to explain confidentiality as it applies to discussions between counsellor and client. The common limits placed on the confidentiality of disclosures made to a counsellor by professional ethics and legal systems are also described. This information is important to you, so please read it carefully and make sure you understand it. In the first meeting your counsellor will ask you to confirm that you have read this section on confidentiality, that you understand it, and that you agree to its conditions. Without this agreement counselling cannot ethically proceed, so make sure that you really do understand it and that you are comfortable with it.

Confidentiality Agreement:
In general, your identity as a client, as well as the disclosures that you make in the course of your services are private and protected. If you would ever like your information shared with a third party, you will be asked to sign an agreement waiving your right to confidentiality.

Unintentional Breaches of Confidentiality:
Telecounselling has certain aspects to it which present challenges to confidentiality that do not exist in conventional, face-to-face counselling. There are breaches of confidentiality that a conventional counsellor has control over that a telecounsellor does not and you need to be aware of areas where your confidentiality might unknowingly be breached.

Any e-mail that you send from conventional online e-mail services like Hotmail, Gmail, Yahoo or other similar agencies are not secure. These organizations reserve the right search the content of your letters. Similarly, private non-web-based e-mail messages (such as ones you may send from a program on your own computer, such as Eudora, Outlook Express or the Macintosh Mail program) may be intercepted by others once sent. Finally, if you are using a work provided e-mail your employer almost always has the right to access the information in e-mails that you send. In many locations those messages are considered to be the property of the employer. In order to overcome this breach of security you might consider setting up an online, encrypted and secure e-mail address that you use for sending and
receiving messages from your counsellor. You might try which is free, secure and easy to use, but there are many other similar services available like Hushmail which has a small monthly fee. Any message that you send from a non-encrypted source represents a possible breach of security that Aulneau cannot secure.

Conversational privacy:
In conventional counselling it is the responsibility of the counsellor to ensure that no one can overhear the counselling conversation. During telecounselling your counsellor will ensure that no one will be able to hear their end of the conversation. However, Aulneau cannot assure the privacy of your location. If you are somewhere where a family member, co-worker or even a stranger might be able to hear or see you, then your conversation cannot be kept secure. Aulneau strongly encourages you to find a private location to have our conversation. Aulneau also cannot ensure that your computer is free of malicious software that might record the conversation. If you have any concerns about this, you should have your computer examined by a qualified IT professional. This is important not only for confidentiality, but for the process of counselling. It is very difficult to be attentive and focused on the process if there are constant interruptions, or if you feel others can see or hear you (and therefore possibly judge you). For this reason, and for your sake, your counsellor will refuse to begin or might possibly end a counselling session if they realize that you are not in a private location. Internet cafe’s, a common room in your workstation, a public library terminal, or your own computer in an open living area of your house with others around you are not appropriate areas for counselling. Similarly, it is important that we create a counselling environment free of interruptions. Please do not schedule sessions while you are ‘on call’. We must be sure that the therapy hour will be uninterrupted.

Limits on Confidentiality:
There are certain situations which can arise in which disclosures made cannot be kept strictly private due to professional ethics or law. The following information describes these situations.

1. If you indicate that you are in serious and immediate risk of harming yourself or someone else. The most typical situation would be when the threat of suicide is such that your counsellor cannot be assured of your safety once you leave the session. It is important to note that this does not apply to talking about thoughts of harming yourself that you may be experiencing. Many people who are feeling discouraged and hopeless think about harming themselves, and it is very important to talk openly about this in psychotherapy. Talking about suicide or other thoughts of self-harm would not automatically lead to a breach confidentiality. However, in the event that you intended to act on your thought to kill or harm yourself, your counsellor would be required to act to protect you even if that involved breaching confidentiality. Your life is more important than your right to privacy! In the event that you reveal a serious intention to harm someone else, your counsellor would be required to take the same action to protect that person as they would to prevent you from harming yourself.
2. If you indicate that you are involved in the abuse of a minor child, an elderly adult, or a disabled person. In these cases, your counsellor is ethically and legally required to file a report about these activities with the appropriate authorities in your location. Once filed, your counsellor would be unable to safeguard the privacy of the information that those authorities would then have.
3. If your counsellor is ordered to release information by subpoena. If you should become involved in a court proceeding, the court may use the power of subpoena to gain access to information that you have shared your counsellor. Although it is Aulneau’s policy to limit my involvement in legal proceedings as much as possible, under court order your counsellor/Aulneau may be required by law to provide written or verbal testimony to the court.

Assurance of Intent:
Be assured that your right to confidentiality is very important to Aulneau. In the unlikely event that your Confidentiality must be breached; your counsellor will make every effort to use care and discretion while meeting their legal and ethical obligations.

v.               Aulneau Renewal Centre Consultation and Recording Permission (MIG)


I (we) understand that my (our) therapist will discuss my (our) therapy interviews with his/her clinical manager and/or therapy team, that information provided about myself (ourselves) will be handled professionally and confidentially, and that these discussions will be for my (our) benefit.


I (we) understand that during Modified Interaction Guidance therapy, my (our) therapy will be subject to direct observation. Audio and/or video footage from these recordings will be used only by my (our) therapist, and his/her supervision team & students where appropriate.


vi.                  Consent to Participate

 Counselling at the Aulneau Renewal Centre involves taking part in a process of addressing personal challenges with a professionally trained counsellor, in order to achieve more fulfilling individual lives, or couple/family relationships. This process of change will be unique to your particular situation. It will consist of:

  • Clearly defining problem areas
  • Establishing therapeutic goals
  • Determining an intervention plan
  • Participating in an evaluation

Successful counselling and problem resolution requires your active participation, as well as a serious commitment; therefore it should not be entered into lightly.

Prior to agreeing to this process, individuals have a right to ask the counsellor about their qualifications, background, and orientation. In addition to a qualified counsellor, the match between client and counsellor will influence the outcomes of counselling. Clients are encouraged to voice any concerns to ensure services are best suited to their, needs. To best deliver therapeutic assistance to children, individuals, couples and families we have developed certain policies and procedures. They are as follows:

1. APPOINTMENT SCHEDULING: Clients are asked to attend each session as scheduled. The sessions are 50 minutes in length. Should it become necessary to cancel an appointment, we require a minimum of 24 hours’ notice; otherwise there will be a no-show fee of $25.00 charged to the client account. Please note that after two consecutive cancellations, the file will be reviewed and either closed, or placed back onto the waitlist. The sliding scale program is based on a maximum of 12 sessions, after which your file will be closed and you will be required to reapply for more services. Upon the discretion of your counsellor, you may be permitted to access more than 12-sessions, but no more than 24-sessions per service contract. We require a minimum of 6-months break between open service contracts.

2. CONFIDENTIALITY: According to professional ethics and federal and provincial laws, all counselling sessions are strictly confidential. However, there are certain limitations to confidentiality. Examples include:

  • A court-ordered release of information
  • When a child is being harmed
  • Or when a client is considering harming self or others

When the counselling services are being funded by Child and Family Services, Aulneau Renewal Centre counselors will on occasion share relevant information with and/or write reports for social workers, if applicable. They may also on occasion consult with each other and/or a clinical manager.

3. STUDENT PLACEMENT- Aulneau Renewal Centre is committed to lifelong learning and is a placement site for many students. Students are supervised with mentors and receive clinical consultation. Different students have different roles. At times, you may have a student counsellor or may be asked to have a student observe. For observation purposes, therapists will ask if the client is comfortable. This may be done in person or through an observation mirror. If you have any concerns, please let your therapist know.
Please Note that the student clinicians may be required to record their sessions for review by their supervisors.

4. CLIENT SATISFACTION: Clients are asked if Aulneau Renewal Centre is able to contact them at 6 and 12-month intervals, in order to collect anonymous feedback in regard to services received at Aulneau Renewal Centre. Participation is not mandatory.

5. SUPERVISION OF UNATTENDED CHILDREN: While at the Centre children under the age of 12 must be supervised by an adult. Please note that children must be supervised at all times while in the waiting area. We are unable to provide supervision.

6. FEES: Fees are to be paid at the beginning each appointment. No further appointments will be made until all outstanding fees are paid in full. We accept cash, Visa, MasterCard, and debit. If an outstanding balance exists on an account, a payment plan may be put in place where the balance cannot be paid in full. If financial circumstances change during the time you are a client with our centre, we must be informed in order to reassess fees. Please note that clients will be asked for proof of current income (Notice of Assessment), in order for us to accurately assess your fees.

Please note that the Aulneau Renewal Centre reserves the right to reassess fees at any time. If you have any questions about this process, please contact for more information about our fee assessment schedule.

7. TERMINATIONS: Clients have the right to terminate counselling at any time. However, we encourage discussion with the therapist so that sufficient closure can take place. Please note that, due to Aulneau’s limitations regarding legal involvement, we cannot provide services to individuals actively involved in legal proceedings. In the event that a client is found to be involved in such circumstances, services will be terminated. Once legal proceedings are completed, services can be resumed.

Just as our clients reserve the right to terminate services, the Aulneau Renewal Centre (ARC) also reserves the right to terminate or deny services. There may be many reasons why ARC determines that we will need to deny or terminate services. In general, ARC strives to ensure that all of our services are professional and an appropriate fit for the needs of our clients. In situations where our ethics may be compromised–or where clients’ needs extend beyond the services we are equipped to offer–we will refer to other agencies who are better equipped to support your needs.

Please note that the Aulneau Renewal Centre is committed to a positive environment in which all employees and clients are treated with compassion, respect and dignity. Abuse and harassment in any form (verbal, emotional, physical or sexual) will not be tolerated and may result in a termination of services. We reserve the right to refuse services.

8. INACTIVITY CLAUSE: In an effort to reduce the wait times for services, Aulneau cannot keep client files in an open status indefinitely. For this reason, if we do not receive any communication from—or have any appointments scheduled and attended by—clients for a maximum of three months, we will have to assume that there is no longer an interest in accessing services and will subsequently close the file. If you have an open file, and you anticipate needing to take a break from services exceeding our three month maximum, please consult with your counsellor or our reception staff. We reserve the right to close client files without notice where there has been inactivity without any communication from the client for three months.

9. CRISIS SERVICES: Emergency services are not provided by Aulneau Renewal Centre. If you are in need of immediate assistance, the following are some resources available:

  • Klinic Crisis Line at 786.8686
  • Crisis Stabilization Centre at 940.1781
  • Youth Crisis Stabilization System at 949.4777
  • Manitoba Suicide Line at 877.435.7170

vii.               Confidentiality & Your Rights


Aulneau Renewal Centre respects your right to privacy and will ask only for information that is relevant to the therapy. We require your consent to obtain this information. Our policies and procedures for the collection, use, and disclosure of your personal information, conform to the Personal Health Information Act (PHIA).

The Personal Health Information Act (PHIA) provides access to information and protection of privacy rights concerning personal health information. PHIA allows individuals to examine and receive a copy of their own personal health information from a trustee holding this information. PHIA imposes obligations on trustees for the protection of personal health information, specifically its collection, use, disclosure and security.

PHIA applies to trustees who maintain (have custody or control of) personal health information. Trustees are:

  • all public bodies that fall under FIPPA
  • health professionals licensed or registered to provide health care or health professionals (such as doctors, nurses, physiotherapists, psychologists, etc.);
  • health care facilities (such as hospitals, personal care homes, psychiatric facilities, medical clinics, laboratories, and community health centres or other health care facilities designated in the regulations)
  • health services agencies providing health care under an agreement with another trustee (such as the Victorian Order of Nurses and We Care).

Personal health information is information about an identifiable individual that relates to an individual’s health and health care history including genetic information, the provision of health care to the individual, or payment for health care provided to the individual. This includes such things as your Personal Health Information Number (PHIN) assigned by Manitoba Health, as well as any identifying information collected in the course of providing health care services.

For more information about PHIA, please check the following websites:


Limits of Confidentiality

 It is important that you understand the confidential nature of your relationship with your therapist. Information that you disclose about your situation will be treated as confidential. No one at Aulneau Renewal Centre will release your name, or information about you, or your counselling, to anyone outside of the agency without your informed, voluntary, and written consent, except as outlined below:

  1. If we obtain information which leads us to suspect that a child (18 and under) is at risk for, or has been, physically abused, sexually abused, emotionally abused, or neglected, we are legally obliged to make a report to Child and Family Services.
  2. If you inform us about any intent to commit an act which could result in the injury or death of you or another/others, we are legally obliged to contact the police or emergency services.
  3. If a counsellor has concerns that you are a danger to yourself, she/he will discuss with you any plan that they may need to take on your behalf (e.g. call a family member or family physician). However, in situations where your counsellor is unable to discuss this with you, they may need to proceed without your consent to fulfill their obligation to ensure your safety.
  4. If we are ordered by a court subpoena to release information to a third party, such as a lawyer, we will need to follow protocol.
  5. In order to ensure accountable, ethical, and effective clinical service your therapist may consult with a Clinical Consultant, and/or colleagues, for clinical consultation. Identifying information will be kept to a minimum during any such clinical consultation.
  6. If you are a CFS client attending therapy, CFS does ask for reports on a regular basis. This is to ensure that goals for treatment are being met and to ensure CFS to continue to support the family.


Release of Information

If you need your therapist to release information to a third party, such as a, doctor, or lawyer, you must provide us with informed, written, and voluntary consent. A form must be completed before any release of information.


viii.             Client Bill of Rights


As a client of Aulneau Renewal Centre, you have the right to…

  • Refuse to attend therapy, but we ask that you inform Aulneau Renewal Centre if you no longer want to attend. If you have scheduled an appointment and do not provide 24 hours notice, you must pay for the session. However any appointments cancelled before this time frame will not result in any payment. Please advise reception or the therapist if you wish for us to close your file.
  • End therapy at any time, for any reason, unless you have been mandated to attend. Again, please advise the therapist and reception that you will no longer be attending therapy.
  • Decline to work with a particular therapist if you do not feel comfortable with them, or the therapist’s office.
  • Request to work with a therapist of a particular gender.
  • Have the content of your sessions kept strictly confidential and any exceptions to confidentiality should be explained to you before therapy
  • Ask the therapist questions about their training and approach
  • Refuse to answer any question the therapist asks that you are not comfortable answering
  • Provide the therapist with feedback about your session
  • Ask the therapist questions and/or request clarification at any point
  • Have all fees and policies explained to you prior to starting the therapy process
  • Be spared from questions that solely benefit the therapist, for example, if you have expertise in an area or have a particular skill set which is not related to your reasons for attending therapy
  • Bring a support person with you to your sessions or to refuse another person’s attendance, if requested
  • Work with a therapist that you do not know personally as it may be a conflict of interest.
  • Have a therapist who respects your ethnicity, race, sexual orientation, gender identity, relationship status, age and religion
  • Have therapy in a physically safe environment.
  • Have professional boundaries respected; your therapist does not initiate social contact with you outside the therapist relationship at all
  • Access your file. There is a process to request access to the information in your file. We require a completed document permitting your request to access your file. Fees for this request vary, and are assessed upon request. please make this request through the intake coordinator:
  • Not have information about you released without your signed consent
  • Request information about your progress or planning around your therapy

For information about the aforementioned Terms of Service, please contact