Catherine Burnard Counselling & Psychotherapy
Counselling contract
I am a British Association for Counselling and Psychotherapy (BACP) registered counsellor. I have a BA (Hons) Degree in Humanistic Counselling and Postgraduate Diploma in Counselling.
Confidentiality:
The therapeutic relationship is non-judgemental and takes place in a safe environment. Confidentiality is fundamental to the therapeutic relationship. I will always agree to uphold confidentiality unless you disclose information to me regarding risk or serious harm to self or others. In the rare decision to break confidentiality, I would discuss any action, normally this would involve sharing information with your GP or social services if appropriate.
There are some legal exceptions where I am legally bound to break confidentiality:
• Any information on acts of terrorism.
• Money laundering concerned with drug trafficking.
Supervision:
Under the BACP guidelines I undertake regular clinical supervision, I take great care to preserve my client’s anonymity and any notes my supervisor takes will be stored appropriately.
Counselling sessions:
All counselling sessions are held on a weekly basis, unless otherwise agreed. Face -Face, online and telephone counselling sessions will last 50 minutes, walk & Talk sessions may run over slightly depending on-walking speed, terrain and the weather.
Free consultation:
I offer a free of charge telephone consultation, this gives us the opportunity to get to know each other and decide if and how we can work therapeutically together, and for me to answer any questions you may have.
Fees:
Individual counselling:
My fee for individual counselling is £50.00 per session.
Couples counselling:
My fee for couples counselling is £65.00 per session.
Payment:
Therapy sessions are paid for in advance by bank transfer (24 hours before the session commences). If payment is not received prior to the arranged counselling session, the session will not take place.
Cash is accepted for face-to-face clients.
Cancellation:
If you need to cancel a session and you cancel within 24 hours there will be no charge. If adequate notice is not received, I require payment for the session. However, I understand life can be unpredictable and genuine emergencies can be accommodated. If I need to cancel a session, I will contact you via our normal means of contact as early as possible.
To gain the most from counselling it is important to that you attend every week as far as possible.
All appointments are booked in advance and will be the same time and day each week unless otherwise agreed.
Crisis:
In case of crisis, I would advise you contact the Samaritans 24 hour support line (116 123).
Storing information GDPR:
The EU GDPR came into effect on 25th May 2018
It was put in place to ensure the data is always kept secure and safe to protect your confidentiality.
What data do I keep?
I keep a base line data. This includes your name, address, email address, landline, mobile number, an emergency contact number. GP surgery and any medical diagnosis and a list of medication you are currently taking
Storage:
I write case notes. These and all of the above information are kept in a locked filling cabinet.
I will never disclose or share any of the above data without your express permission or unless subpoenaed. This is very unlikely, however, for this reason I always keep client notes very short and factual.
I am obliged to keep your records on file for a period of 7 years after the last therapeutic session.
Deleting data:
When data is no longer required (legal storage period has expired) I permanently destroy the data.
By signing this contract, you agree to the terms and conditions above and agree that you have given your personal data voluntarily and that you understand I will keep the information stored in a locked cabinet.
Name/s………………………………………………………………………
I/We agree to the terms and conditions laid out in this contract.
Client’s Signature/s:
Counsellors Signature:
Date:
Personal information
Clients name……………………………………………………………………
Date of birth…………………………………………………………………….
Preferred gender………………………………………………………………..
Address………………………………………………………………………….
……………………………………………………………………………………
Email address…………………………………………………………………...
Contact telephone numbers…………………………………………………...
……………………………………………………………………………………
Emergency contact name and number……………………………………….
……………………………………………………………………………………
GP Surgery/ contact number………………………………………………….
……………………………………………………………………………………
Medical history………………………………………………………………….
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
Medication
§
§
§
§
§
§
Please tick where you heard about Catherine Burnard Counselling & Psychotherapy
· Counsellors directory
· Psychology today
· Website
· Word of mouth
· Other, please state: