Fillable Printable Counselling Contract Form and Instructions

Counselling Contract Form and Instructions

Counselling*Contract*Form:*

In the process of counselling we will engage in a form of psychological or

talking therapy that will offer you a chance to change how you feel and to live

better.

This is a contract between Gerard Murray, Counsellor and _______________

Address: ___________________________________________________

___________________________________________________

Telephone: ___________________________________________________

Email: ___________________________________________________

Occupation: ___________________________________________________

D.O.B: ___________________________________________________

GP Details:

Name: ___________________________________________________

Address: ___________________________________________________

Tel: ___________________________________________________

Frequency and duration of counselling

The duration of the therapeutic process will depend on the type of difficulty or

problem the client is facing. Some people prefer to work with an open

contract, whereas other people prefer to work with a fixed number of sessions

followed by a review. In all cases, every six sessions the counsellor and client

will review the therapeutic process together. This helps to assess whether the

client’s needs are being met and, this will also help (if required) to carry out

the necessary adjustments and/or establish new goals for the process.

We have agreed a minimum of _____ sessions to begin our work together.

Payment:

Based on your needs we have agreed a fee of £____ per hour for our

sessions.

Cancellation Policy

Cancellation of sessions with less than 48 hours notice will incur the full fee.

Gerard will always aim to give the client as much notice as possible of any

holidays, training workshops, conferences or illness that might prevent him

from being available at the time/day of the scheduled session. In such cases

the counsellor will always aim to offer an alternative arrangement.

Confidentiality

If you have referred yourself for counselling then no one apart from Gerard

Murray would know you have attended or what was discussed.

If you feel that someone may need to know information about your counselling

sessions then we ask you to make this clear to your Gerard at the beginning

of the sessions. For example, if you have been referred to us by another party

it may be in your interest for there to be some liaison.

As part of my professional standards, from time to time I may need to share

and discuss some of the information in our sessions with a qualifed

supervisor, always under a strict confidential and professional framework. The

client identity is always kept anonymous.

Where written confirmation may be required to be passed on to a third party,

this is restricted to a minimum. We are not able to provide in-depth reports on

the sessions or give opinions or diagnosis.

Exceptions

In certain circumstances, Gerard may have to make exceptions to the general

rules of confidentiality:

1. If we think there is a serious risk of harm to yourself or others.

2. Where we cannot contact you but suspect you are in danger. For

example, if you had not been seen for several days and colleagues and

friends felt concerned, we may disclose information without your

agreement.

3. Where there is a legal requirement to disclose information. This could

be because it has been ordered by a court, or because the law

requires, for example under the Terrorism Act 2000 or the Drug

Trafficking Offences Act 1986, for information to be passed on without

consent.

In the first and second of these cases, we would attempt to talk this through

with you beforehand if possible.

Notes and Record Keeping

Our policy is to keep minimum notes and records. The information we do

store includes:

• Personal information, such as your name, date of birth, address etc;

• Background information that might be relevant to the counselling

process;

• Your signed contract with us;

• Confidential case notes (describing the main focus of the session with

any important information);

• Information for service evaluation and statistical purposes.

You can request in writing to see the information held on you.

If you have any concerns about our policy on confidentiality and note-keeping,

you're welcome to discuss it fully with your counsellor.

Influence of alcohol or substances

Sessions will not take place if the client is under the influence of any misuse

of alcohol or substances.

Complaints:

Gerard is an Accredited Counsellor with the British Association for

Counselling and Psychotherapy (BACP). Any complaints about his work

should be made either through BACP on 01455 883300

PLEASE READ THIS CONTRACT CAREFULLY\

Check what we have agreed today. If you wish to negotiate any changes I will

be happy to do so before you sign.

This agreement is fully understood and agreed to and is signed as it stands

by:

Name: _____________________________, Client

Name: _____________________________, Client 2 (if needed)

Name: _____________________________, Counsellor Gerard Murray

Date: _____________________________