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                                                               Therapy with Patsy
Please read this agreement carefully and raise any queries with me. If you agree to these terms, please sign both copies, returning one copy to me while keeping the other for your records. Signing this agreement means that you give your informed consent to counselling with me.
The following terms will apply to your on-going therapy:
  1. Sessions are on the same day and time each week, each session lasts 50 minutes. I may occasionally need to make changes to my schedule, I aim to give you as much notice as possible, and to keep changes to a minimum.
  2. Please give me at least 48 hours’ notice when you need to cancel a session, otherwise I need to charge the full rate for the missed session. If you are more than 15 minutes late to your appointment, the session will not commence.
  3. I may take up to 10 weeks break per year for professional development and holidays, and I aim to inform you well in advance. Please provide me with as much notice as possible of your planned breaks. I’m able to hold your space for two weeks, for any planned breaks, beyond this I’d need to charge full session fee to keep the space.
  4. The fee for each session is £60 and payment is due on the day of the session. You are welcome to pay in cash or via bank transfer. Fees will be reviewed annually, and at least 8 weeks’ notice of an increase will be given. Refund does not apply. Future sessions are booked on the basis that payments are up to date.
  5. I am a qualified and registered counsellor, and I abide by the code of ethics set out by my membership of the National Counselling and Psychotherapy Society (NCPS). For more information on their code of ethics and practice, please visit the following website:
  6. If you think my work with you is in any way unethical, you have the right to make a complaint to the above membership body.
  7. You are welcome to contact me by text or email outside of our planned sessions to make and change appointments. I am the only person who has access to my phone and emails, so our correspondence remains confidential. I usually respond within 24 hours, unless it’s the weekend or I’m on holiday.
  8. I do not accept invitations on personal social media. I have professional social media accounts and you are welcome to follow me on those. I will never read your social media profiles.
  9. I will terminate the session, and charge for it, if you attend your appointment under the influence of drugs or alcohol, or if I perceive my physical or psychological wellbeing to be under threat.
  10. Please ask about anything you’d like clarified about the practice or our work together, it’s important to let me know if there is anything about our work that you are unhappy with. We will review our work together after the first 4-6 sessions to establish whether we feel we are a good fit for working together, and we will review your therapeutic progress throughout our sessions.
  11. If you choose to stop working together, I ask to have at least one sessions’ notice. Endings are an important part of therapy and I strongly encourage taking time to explore the meaning of our ending and reflect on the work that we have done together.
  12. In extreme cases, such as conflict of interest, therapy might be inappropriate and brought to an end.
The contents of our sessions are strictly confidential and will only be discussed within my clinical supervision. Supervision is part of my ethical practice, and my supervisor is bound by the same confidentiality agreement.
If we see each other outside of our sessions, I will not acknowledge you unless you acknowledge me first. This is to maintain your confidentiality. We may find that we are part of similar communities, in which case it is important for us to establish boundaries which allow both of us to feel safe and comfortable when attending events. This may take the form of on-going negotiation rather than a set of hard and fast rules.
The circumstances that require the breach of confidentiality are:
  1. If I am sufficiently concerned that you may harm yourself or a third party.
  2. If there are children or vulnerable adults at significant risk of harm (current sexual, physical, psychological or financial abuse)
  3. Acts of terrorism
  4. Drug or people trafficking
  5. Money laundering
  6. If I am ordered by a court to give evidence under oath
General Data Protection Regulation
I am registered with the Information Commissioner (registered number: ZA661610). Any personal information I hold about you (name, address etc) is stored in a locked filing box and only I have access to it. All your details are kept confidential, and I don’t share any of your details with third parties. You have the right to request your personal information to be corrected or erased at any time.
I may write brief notes about what we discuss in sessions. Your notes are kept electronically and only I have access to them. I’m required to keep all the information I hold about you, including your notes, for seven years after the end of therapy. After seven years, I will erase all of your data.
For more information on the Information Commissioner and the GDPR, please visit:
My professional counselling work is subject to English Law within the Exclusive Jurisdiction of the Courts of England and Wales only.
Client Name:                    
                                                        Patsy Gough
Client Signature:
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