Service Agreement

About the Service

UPWARD Counselling and Psychological Services is dedicated to promoting the psychological wellbeing of its clients (ages 10+) via individual, group, couples, and family psychotherapy. Psychotherapy involves compassionate counselling for various problems, including (but not limited to) trauma, domestic violence, major life transitions (e.g. divorce, loss), interpersonal disputes, and other clinical issues (e.g. anxiety, depression). Psychotherapy sessions are conducted using a variety of approaches and interventions, including talk therapy, in- and out-of-session assignments, and assessments. Psychotherapy approaches, i.e. the lenses through which the presenting issues are framed and treated, include cognitive behavioural therapy, family systems therapies, psychodynamic therapy, acceptance and commitment therapy, and more. Approaches used are highly dependent on the client’s presenting concerns.

Fees, Attendance, and Cancellations

To get the most out of your psychotherapy sessions it is crucial for you to make every effort to attend regularly and be on time. If you are unable to attend due to an emergency or other unforeseeable circumstance, kindly contact the psychotherapist as soon as possible.  For cancellations made less than 24 hours in advance, you will be required to pay half of the session fee unless you and the psychotherapist come to an understanding that the situation was outside of your control. If you miss a session without contacting the psychotherapist, you will receive a call/message within 3 business days to reschedule your appointment. You will still be expected to pay half of the missed session fee. If the psychotherapist is unable to get into contact with you, she will wait to hear back from you concerning resuming sessions. In the event that the psychotherapist needs to cancel your session, you will be given as much notice as possible and other session arrangements will be made accordingly. The breakdown of session fees are as follows:

  • Individual Psychotherapy: $350 TTD (online)
  • Couples and Family Counselling: $450 TTD (online)
  • For in-person sessions, you can book an appointment with Reycine Mc Kenzie through Dolly and Associates in Woodbrook, Port of Spain. Session costs vary from $500 (individual) to $750 (family) for in-person appointments. Contact Dolly and Associates at 625-7107 or 627-1845 and request an appointment with Reycine Mc Kenzie.

UPWARD is currently unable to offer services on a sliding scale basis but we do take health insurance. If you wish for your sessions to be covered through insurance, you can pay for sessions upfront and request that the psychotherapist complete insurance forms which will be sent, along with digital receipts (which your insurance company will require), via email after your session. You can then claim back for sessions through your health insurance agency. Payment methods at UPWARD include online bank transfers and credit card payments. For online transfers, payments should be made the day before the session and a screenshot of payment should be sent via email to upwardtt@gmail.com or via WhatsApp to 1-868-287-7956. Online transfer details and credit card payment information will be included in the confirmation email for your appointments.

Employee Assistance Programme (EAP) Clients

EAP clients are those who have been directed to UPWARD for counselling via the Human Resources (HR) department at their organisation. Depending on your organisation’s EAP relationship with UPWARD, you will be entitled to a limited number of sessions (paid for by your company) which the psychotherapist will inform you of at the first session. Kindly note that failure to attend a scheduled session or cancelling a session less than 24 hours in advance will incur a deduction of one session from the allotted number (except in the case of obvious emergencies).

What to Expect

As some problems require only a brief intervention it may be determined at the first session that a one-off session is sufficient. One-off sessions will include a conversation about the presenting problem, the kind of support that will be most beneficial, and a brief psychotherapeutic intervention with potential referrals to other service providers or specialists, or other self-help resources. If you and/or the psychotherapist decide that more than a one-off session is required and you would like to continue working together, the psychotherapist will indicate how many sessions she recommends based on the diagnosis and severity of the presenting problem, and whether intervention from another specialist (e.g. psychiatrist) is required in addition to psychotherapy. Usually, the minimum number of sessions suggested is 6 to 8. The reasoning behind this is that the psychotherapeutic relationship is one built on trust, respect, and openness and these take time to establish. In order for a psychotherapeutic intervention to be successful and bring about significant, long-lasting change, the client and psychotherapist need time to build a good therapeutic relationship, get to the roots of the problem and work through them. Sessions last for 50-60 minutes and session frequency will be determined by the severity and immediacy of the presenting problem(s). Given the collaborative nature of clinical counselling, you and the psychotherapist will both decide which course of treatment and/or treatment activities will be most helpful to bring about the desired changes

Benefits & Risks Associated with Therapy

Psychotherapy, when done well, can have significant benefits. It allows you to explore your feelings, behaviours, and thoughts, restore interpersonal relationships, come up with solutions to difficult issues, enhance awareness and insight, and bring about other positive life changes. However, difficult topics also arise that can lead to discomfort and strong feelings (such as intense anger, fear and sadness) and may not be resolved at the end of every session. Hence, an important part of psychotherapy is learning how to sit with heavy feelings outside of the psychotherapy room, process why these emotions and thoughts are coming up, and be ready to discuss these issues at the next session. During psychotherapy you will also be challenged to engage in activities that may fall outside of your comfort zone or encouraged to make changes in aspects of your life that may be negatively impacting you. The main goal of psychotherapy is to improve psychological wellness and bring about mental healing. This requires the client’s openness, honesty, and active involvement in the psychotherapy relationship.

Confidentiality and Record Keeping

Due to the personal nature of the information you disclose during psychotherapy sessions, UPWARD values your privacy and makes every effort to keep your information confidential. For example, UPWARD keeps softcopies of client personal records, including psychotherapy notes and reports in a secure database. The psychotherapist also de-identifies client files using a 5-digit numerical identifier and hardcopy documents are kept in a locked file cabinet. Everything said between you and the psychotherapist is kept within the confines of the psychotherapy space; however, there are certain occasions in which UPWARD is mandated, ethically and/or legally, to disclose information to a third party. These circumstances include:

  • Risk of harm to self. This encompasses situations in which the client has expressly indicated that he/she is engaging in or has intent to engage in life-threatening, self-injurious behaviours such as serious cutting, burning, and other self-harm or suicidal gestures. In this situation, the therapist has the right to use her clinical judgement to contact the appropriate caregiver, next of kin, identified emergency contact, and/or psychiatric or emergency service in order to ensure the client’s safety.
  • Grave disability: It may become apparent to therapist that the client is experiencing severe psychosis (e.g. hallucinations, delusions), is highly intoxicated (by some drug or substance) or delirious, or has some other grave condition that prevents him/her from taking care of his/her basic needs. In this case, the therapist will contact the appropriate caregiver, next of kin, identified emergency contact, and/or psychiatric or emergency service in order to ensure the client’s safety.
  • Risk of harm to others: During the course of psychotherapy the client may express the desire and/or intention to physically harm a named individual OR the therapist may have reasonable grounds to believe, based on what the client has shared, that he/she plans to seriously harm a certain person. In either of these situations, the therapist reserves the right to notify the police and the named individual (if that information is available) to ensure that person’s safety.
  • Abuse of vulnerable persons: If during the course of treatment the client names a child or vulnerable adult that is being abused or neglected, the therapist is ethically obligated to notify the relevant authorities in order to protect that child or vulnerable person. For child abuse, a report will be made to the Children’s Authority of Trinidad and Tobago after sufficient information is gathered from the client, such as the names of the child(ren) and parent(s) involved. For elder abuse, a report will be made to the Division of Aging.
  • Employee Assistance Programme (EAP) managerial referrals: For clients who are referred for psychotherapy via managerial referrals for specific problems related to their performance at work, their companies usually require feedback via a letter or formal report regarding the client’s progress in therapy. Managerial referrals usually entail problems such as testing positive for drugs at work, receiving a very low score on your performance appraisal, or other specific on-the-job problems for which the company mandates psychotherapy. If the client is mandated to attend therapy for such a reason, the therapist will be providing general feedback to the organisation about the client’s progress and recommendations for moving forward. On the other hand, if an EAP client is referred for therapy via HR (and not specifically via managerial referral), no such reports to the organisation are required.
  • Request to release information: If your information must be shared with a third party as per your request, legal mandates, or stated policies at UPWARD, you will be given a Release-of-Information (ROI) form in which you will detail the information that UPWARD is allowed to share. At UPWARD, clients are also asked to complete ROI forms for other service providers whom may be treating you for related problems (e.g. a psychiatrist or general practitioner) and for loved ones with whom you may want UPWARD to coordinate your care. Such releases are necessary to make sure that UPWARD is providing you with comprehensive, top quality and well-coordinated care.
  • Research: Client data may be used to compile statistics (anonymously) to monitor trends in the work at UPWARD. If client data is used for research purposes you will receive confidentiality protections under the laws of T&T.
  • Legal mandates: You may become involved in legal proceedings such as a custody case or lawsuit and believe that your therapist at UPWARD can provide expert witness on your case, whether via written report or oral testimony. However, due to the confidential and sensitive nature of the information clients disclose in the therapy setting, UPWARD reserves the right to refuse your or your attorney’s request to appear in court or disclose information in your client record unless a judge or court issues an order. If a court order is issued, UPWARD is legally bound to abide by the directives of the court order and will have you sign a Release of Information form agreeing to the information to be shared with the court. If UPWARD is unable to reach you to sign the Release or you choose not to sign it of your own volition, UPWARD will still be required to appear in court/submit the information requested. Only the minimum necessary information will be provided to the court.
  • Supervision and consulting: In order to provide the best possible care, the therapist may consult with other clinicians and/or professionals in the field. These consultations are for professional purposes and clients’ identifying information will be kept confidential.
  • Additional concerns with doing online counselling at UPWARD:
    • Privacy Limits: Because online counselling sessions will not take place at UPWARD’s office space but, instead, remotely via telecommunications technologies, the potential exists for others to overhear what is being shared during your sessions. As such, the therapist will take the necessary precautions to ensure privacy, including using headphones and a private area out of earshot of others. UPWARD asks that you take the same precautions and encourages you to participate in online counselling sessions only while in a room outside of earshot of others. If this is unavoidable, we ask that you be mindful of the associated privacy limitations.
    • Risk of Hackers: UPWARD is legally obligated to protect clients’ mental health information. Therefore, UPWARD keeps de-identified softcopies of client personal records, psychotherapy notes and reports in a secure storage. Hardcopies of client files are kept in a locked file cabinet and client files are kept for seven years post-termination of treatment after which they will be securely disposed. These security measures ensure an extra layer of protection against unauthorized persons gaining access to client information. However, in using online platforms like Zoom for Healthcare, there is the risk of unauthorized access by hackers. The same can be said for client information stored in encrypted databases and softcopy files shared via other electronic media such as e-mail and text messages. UPWARD cannot guarantee confidentiality with e-mail and text messages, so the therapist will not discuss any clinical information with you via these methods and we prefer you do not either. While UPWARD will take precautions to protect clients’ information on our end (by using the most updated encryption methods, for example), we ask that you take the necessary steps to secure your communications, such as password protecting the device you use for online counselling sessions and using only secure networks

Boundaries

It is important for the psychotherapist and client to have mutual respect, trust, and confidence in each other. In order to foster these virtues and minimize misunderstandings in the psychotherapy relationship, UPWARD would like you to be aware of the following potentially awkward situations:

  • Meeting in a social setting. Aligned with respecting your right to privacy, if the psychotherapist sees you in a social setting she will not initiate contact. However, if you do approach her she will follow your lead on the conversation.
  • Social media. In an attempt to respect the boundaries of what you share about yourself in psychotherapy, the psychotherapist will not use any social media, search engines, or any other means to find out further personal information about you. UPWARD requests that you give mutual regard to the psychotherapist in this manner.
  • Complaints. In the case that you are dissatisfied with the services at UPWARD you are encouraged to address these concerns with the psychotherapist directly in order to resolve these issues. If after speaking with the psychotherapist you are still dissatisfied with your service and would like to make a formal complaint, you can send an e-mail to the Trinidad and Tobago Association of Psychologists with whom the psychotherapist is registered. Their e-mail address is at secretary@psychologytt.org. Nonetheless, you have the right to withdraw from treatment at any time, refuse a particular type of treatment, request other treatment options, or ask to redirect treatment.
  • Multiple roles. Trinidad and Tobago has a relatively small population so it is likely that the psychotherapist and client will have an additional connection outside of the psychotherapy relationship, whether directly or via a third party. As such, you and the psychotherapist will have a conversation at the outset as to how you plan to maintain strict boundaries in this area and isolate the psychotherapy relationship from the influence of outside connections.

Psychotherapy with Dependants

When working with a child, adolescent, or dependent adult client it is his/her primary adult caregiver that is the consenting client. The consenting client is the primary adult caregiver that is consenting to services at UPWARD on the client’s behalf. As such, the consenting client is entitled to have open and clear communication about the dependant’s treatment, including, but not limited to: the psychotherapist’s impressions of the presenting problem(s), what is generally discussed in session, and documentation of treatment progress. While the aforementioned is true, there needs to be a level of trust and privacy established between the psychotherapist and the dependant client so he/she can open up and explore his/her issues. Such confidence cannot be established unless the dependant has the assurance that the caregiver(s) will not know every detail of what is discussed in the psychotherapy sessions. This is particularly true for adolescents who are undergoing a transition from greater reliance on and closeness with parents to more independence and autonomy. Adolescents are also undergoing a time of exploration and discovery, a lot of which is within the boundaries of normal adolescent experience but in some instances may require caregiver intervention. Therefore, it is crucial for the primary caregiver(s) and psychotherapist to discuss early on what their expectations and standards are for acceptable behaviour. What UPWARD will provide is general information about how treatment is going, areas of concern and imminent risk, and other issues that may be impacting the dependant’s ability to function optimally that are within the caregiver(s)’ sphere of influence/control. UPWARD will also let you know whether other specialized services are necessary and present you with a treatment summary at termination of treatment (if requested). Everything else that UPWARD shares with the caregiver(s) regarding the dependant’s treatment will be with the dependant’s explicit consent and in his/her best interest.

There may disagreement between the caregiver(s) and psychotherapist regarding the dependant’s treatment. In such instances, the psychotherapist will be open to listening to the caregiver(s)’s concerns and sharing her stance on the helpfulness and effectiveness of the suggested interventions. If an agreement cannot be reached, the caregiver is free to do what he/she believes is in the dependant’s best interest, including terminating treatment at UPWARD. UPWARD asks that if you wish to prematurely end treatment that you allow the psychotherapist to have a final session with the dependant in order to gain closure on both sides. The psychotherapist may request to have a collateral session with the caregiver(s) only in order to discuss specifics of the dependant’s treatment, offer advice or foster parenting/caretaking skills that can increase the dependant’s psychological wellness. UPWARD will notify the caregiver(s) if such a session is needed. In addition, UPWARD requests that, in the case that there are legal proceedings involving the relationship between caregivers and/or a child custody case, neither caregiver will try to gain the upper hand over the other by asking the psychotherapist to testify on his/her behalf or present treatment documentation based on the psychotherapist’s involvement with the dependant.

Contact

Clinic hours at UPWARD are 3-7pm Tues-Thurs and 1:30pm-5pm Sat, except on public holidays (office is closed). Clinical Psychotherapist, Reycine Mc Kenzie, can be reached at 1-868-287-7956 via WhatsApp, text message, or phone call. WhatsApp is the quickest form of communication. However, if she is not immediately reachable, please leave a message or email (upawrdtt@gmail.com) and she will get back to you as soon as possible. In the event of a clinical emergency, immediate crisis, or life-threatening situation, please contact one of the following emergency numbers:

  • Police: 999
  • Ambulance: 811
  • Suicide Hotline: 800-5588 (toll free)
  • St. Ann’s Psychiatric Hospital: 624-1151 (ext. 5)
  • Mental Health Unit, Eric Williams Medical Sciences Complex: 624-3232 (ext. 2542)
  • San Fernando General Hospital, Ward One: 652-3581 (ext. 3221)