Counselling Agreement
Charlotte Bond Counsellor/Psychotherapist MBACP
Barnfield,
Bratton Fleming,
Barnstaple,
EX31 4RT
T: 07595532316. E: 1to1charliebond@gmail.com
Welcome to One to One Counselling; the intention of our time working together is to offer you a regular space to give attention to issues you are facing in your life. There is no fixed length to the number of sessions you may require, we will review regularly, and you can discuss ending sessions at any point. The following agreement is designed to offer reassurance and clarity about what we can both expect of sessions. We will discuss our mutual expectations at your first session.
Counselling Agreement
This is a mutual agreement negotiated between the Counsellor and the Client prior to the commencement of counselling. It outlines the responsibilities of the Counsellor towards the Client, and also the Client's responsibilities in the counselling relationship.
This contract is between Charlotte Bond, (The Counsellor) One to One Counselling (1to1)
and _______________________________________ (The Client)
Address:
Email:
Telephone:
Date of birth:
G.P. and Surgery:
Emergency contact:
Tel:
The Counsellor:
As your counsellor I adhere to the BACP (British Association for Counsellors and Psychotherapists) Code of Ethics for Professional Counsellors. A full copy of these can be made available or the BACP Ethical Framework can be found on my website
Insurance: I carry my own professional liability insurance, with Holistic Services Insurance ID: HIS83117 and I hold an up-to-date DBS check.
Confidentiality: This is a very important aspect of the counselling relationship. Everything that is discussed with your Counsellor in the counselling session is kept in the strictest confidence.
As a member of the BACP, I am required to have regular supervision and will need to discuss sessions with my Supervisor from time to time. However, I will not disclose your name or anything that would enable you to be identified.
Any information that a Supervisor receives is also treated as confidential and subject to the same ethical criteria as counselling. If you are being treated by your Doctor for your mental health, it is important that you inform him or her about your Counsellor, and vice versa.
As your Counsellor I will not confer with your Doctor without your knowledge and permission.
If there is convincing evidence that you intend to harm yourself or others, I will need to break confidentiality by informing your Doctor or other appropriate third party. Wherever possible, and if it is considered appropriate, you will be informed of this.
As your Counsellor, I may keep brief notes after a session, which will be securely stored. Counselling is for individuals only; no other person will be permitted in the counselling room at any time or for any reason.
This is for your benefit, to offer the best opportunity to voice your concerns and experiences. For the same reason, if you choose to meet for sessions on Zoom please ensure that you are in a confidential space and that no one is going to enter the space during the session. As your counsellor I may not be aware if someone has entered the room out of camera view, and so may not be able to protect your confidentiality. Being interrupted or overheard may prevent you from fully participating openly in the counselling session.
Contact: Please use my mobile phone or email as a means of contact for arranging and re-scheduling appointments etc. This should only be used for this purpose, I would request that contact is made during office hours only.
Please be specific which telephone number you wish me to use for contact and indicate whether it is acceptable to leave a message.
Should you feel you need urgent support between sessions, please contact your GP or one of the following organisations for help:
www.mind.org.uk, www.mentalhealth.org.uk, www.samaritans.org.uk (Telephone: 08457 909090), www.depressionalliance.org/, www.depressionanon.co.uk
Sessions: Sessions last for 55 minutes. We will meet once a week/fortnight as agreed, on the same time and day each week. The whole session time belongs to you, whether you choose to attend or not, and as your Counsellor I will be present for the entire time of the session. If you arrive/log on part way through your allotted time, I will see you for the remainder of the time.
If your circumstances change and the session time is no longer suitable, I will do my best to accommodate this and offer you an alternative regular time. If I am unable to offer an alternative time you will be required to pay for the scheduled session.
Cancellation and Holidays: If you are unable to attend a session, provided you give plenty of notice (and not less than 48 hours), I will do my best to accommodate this and offer you an alternative time or date. However, if I am unable to accommodate this, the full fee will be charged for the missed session. Cancellation of an appointment or failure to attend for an appointment will incur the full fee.
If I need to cancel: I will give you as much notice as possible if I am unable to make a session due to annual leave or training and will endeavour to offer an alternative where appropriate. In the event where I will need to miss your session because of illness, I will give you as much notice as possible, and will try to offer you an alternative time, as soon as possible. Sessions missed due to my unavailability are obviously not charged for.
Fees: I offer a sliding scale of fees from £50 - £70 per 55 minute session. Payment within this scale is left to the discretion of the client dependent upon their individual financial circumstances. Payment is due at the session in cash or paid by BACS prior to the session.
Covid Compliance: Whilst many of the covid restrictions have now been relaxed, I would ask that you call to cancel your appointment if you are displaying Covid-19 symptoms or have recently spent time in close proximity to someone who has tested positive for Covid-19. I will do the same, this way we protect each other and my other clients. You will not be charged for a session missed because of Covid-19.
Duration of Counselling: It is recommended that you have a few sessions to gain confidence in the counselling relationship, before reviewing whether to continue. However, you are in control of this process and can choose to end counselling at any time.
Endings: You will normally know when you are ready to finish counselling and you can address this issue with me within a session. I ask that you give at least one weeks’ notice before finishing so that you can have the chance to discuss your decision, but there will be no pressure on you to continue with counselling.
Face-to-Face contact outside sessions: Should you happen to meet me outside of your session please be aware I will not acknowledge you, unless you choose to acknowledge me. This is to protect your privacy and maintain confidentiality. This is especially important if you are with other people. If you acknowledge me openly, then I will respond in an appropriate, professional manner. Should you find yourself in a situation where you and I are part of the same group, either social or professional, where appropriate, and possible, I will withdraw.
Facebook, Twitter, Linked in and all social media: Please do not invite me to join you on any social media. I am not permitted to do so under the strict Codes of Ethics, and refusal can cause offense where none is intended.
Expectations: We will not be able to work together if you are under the influence of alcohol or other mind-altering substances during a session. If this is found to be the case, I will end the session and you will be charged at the normal rate.
Data Protection Statement:
To assist me in working effectively with you, One to One Counselling (1to1) keeps brief confidential records about all clients. These records are kept securely and are only seen by the counsellor. The records held by 1to1 are subject to the Data Protection Act 1998 which gives clients the right to access personal data held about them.
Some of this data may be classified as sensitive personal data which includes but is not limited to information concerning gender, sexuality, racial or ethnic origin, political opinions, religious beliefs, physical or mental health, relationships, sexual life, criminal proceedings and convictions.
I can only use your sensitive personal data with your consent which I ask you to give by signing this form. Both personal and sensitive personal data is used by me only, to provide the best possible service to you and to ensure that I continue to offer the highest possible standards in delivery of care to all clients. As required by BACP and Holistic Services Insurers.
Personal records are kept for the period of seven years after which time they may be destroyed in accordance with guidelines on the destruction of sensitive information. Under the Data Protection Act 1998 clients have the right to make a subject access request in respect of personal information held by One to One Counselling. (1to1)
Should you wish to make a subject access request please follow the information on my priivacy policy. My full privacy policy can be found on my website
PLEASE READ THIS CONTRACT CAREFULLY Check what you and I have agreed today. If you wish to negotiate any changes, I will be happy to do so before you sign.
- I understand my right to access personal data held about me by 1to1.
- I consent to 1to1 storing my personal and sensitive data in accordance with the Data Protection Act 1998 for the purposes of delivering counselling to me and for management of the quality of the service that 1to1 delivers.
- This agreement is fully understood and agreed to and is signed as it stands by:
Signed: ________________________Client Name: __________________
Signed: ________________________ Therapist Charlotte Bond
Date: _________________________________
Further negotiations during counselling can be recorded here:-
