On this page I set out my 'terms and conditions' for our counselling sessions. 

• Please read as everything here forms the basis of our work together. 

• Some parts can be changed, some parts cannot under any circumstances be altered. 

• The purpose of this statement is to create Informed Consent.

PLEASE READ EACH ITEM AND CHOOSE YES OR NO: 

1. ______ I understand that Ms Josephine Smith is a counsellor and mediator - her qualifications are: 

• Pearson Level 5 Diploma in therapeutic counselling. 

• Change Birmingham Brief Therapy Diploma in solution focused therapy.

• The Interpersonal Mediation Practitioner’s Certificate.

2.  ______ I understand that Ms Josephine Smith does not provide 24-hour crisis counselling. Should I experience an emergency necessitating immediate mental health attention, I will immediately call 999 or go to an accident and emergency hospital department. or seek help from another organisation such as:

A. Samaritans. To talk about anything that is upsetting you, you can contact Samaritans 24 hours a day, 365 days a year. You can call 116 123 (free from any phone)

B. SANEline. If you're experiencing a mental health problem or supporting someone else, you can call SANEline on 0300 304 7000 (4.30pm–10.30pm every day).

C. National Suicide Prevention Helpline UK. Offers a supportive listening service to anyone with thoughts of suicide. You can call the National Suicide Prevention Helpline UK on 0800 689 5652 (6pm to midnight every day).

3.  ______ I understand that a counselling session is approximately 50 minuites duration. Appointments usually happen on the same day and time. The number of sessions can be agreed on (a set number) or open ( number of sessions added or decreased.) 

 4. ______ I understand our contact will be limited to arranging counselling sessions, and that our relationship is a professional relationship rather than a social one.

5. ______ I understand that, at any time, I may initiate a discussion of possible positive or negative effects of entering into the counselling relationship and that specific results are not guaranteed although benefits are expected from counselling. 

6. ______ I understand that counselling can improve as well as upset the equilibrium in any person or family. Counselling is a personal exploration and may lead to changes in my life perspectives and decisions. These changes could be temporarily distressing. 

7. ______ I understand that I am in control of the counselling relationship and may choose at any time to end our therapeutic relationship. If at any time I am dissatisfied with Ms Josephine Smith’s services as a therapist, I have a right to let her know. If I do not feel that Ms Josephine Smith may resolve my complaint, I may file a formal complaint through contact with the BACP.

8.  ______ I understand that our paths may cross in social situations but that our therapeutic relationship comes first, along with protection of my confidentiality, and that Ms Josephine Smith does not initiate the greetings. 

9. ______ I understand that Josephine Smith does not diagnose, or specialise in any psychological conditions. I understand that she never makes any diagnosis, or records any  information about my state of mind or personal circumstances (*unless there is a risk to life. See paragraph 17.) If I would like a diagnosis, or letter describing my state of mind, I will ask my GP to refer me to a psychologist or a psychiatrist.

10. ______ I understand that the rate for individual counselling sessions is £50.0 for up to a 50 minute session.

11. ______ I understand that all fees for counselling are due two days before each session. And I will receive a confirmation of my appointment by email.

 12. ______ I understand that if I do not pay for my session at least two days before the appointment date, the session is cancelled.

13. ______ I understand that I am responsible for missing any appointments that are not cancelled at least 48 hours prior to my appointment time and my session fee is not refundable. 

14. ______ I understand that if I do not cancel my appointment 48 hours ahead of time, the session fee of £50 is non-refundable. 

15. ______ I understand that if I do not show up for an appointment and I wish to continue therapy it is my responsibility to make another appointment.

16. ______ I understand that my records and all of our communications become part of the clinical record. And that I have a right to see all notes Ms Josephine Smith has about me. Adult client records are disposed of seven years after a client has stopped receiving services.

17.  ______ I understand that I have the right to record my sessions, and I am solely responsible for maintaining the privacy of the recordings.

18. ______ I understand that while most of our communication is confidential there are, however, circumstances when disclosure can occur without my prior consent. The following are typical, but not exhaustive, examples of situations and circumstances under which information may be disclosed without prior consent: 

1. As part of my ethical practice I have supervision from a more experienced therapist with whom I discuss my work. I never disclose my client’s name, and do not mention age or gender, so that the identity of my client is protected.

2. If you are a danger to yourself or someone else, I will seek advice and may need to break the confidentiality of our session. 

3. In situations of suspected child, spouse, or elder abuse, it is my duty to notify medical, legal, or other authorities. 

4. If you tell me that you are money laundering, trafficking drugs, or involved in terrorism it is against the law for me not to inform the police.

5. If you are involved in legal action/proceedings, your records may be subject to a summons or lawful directive from a court.