Individual Counselling Contract

Counselling Contract for Individual Counselling

This contract sets out the working agreement between you (the client) and me (the counsellor). Please read it carefully and ask any questions before signing.

1. Confidentiality

Everything you share in counselling is treated as confidential. Confidentiality is a cornerstone of counselling and helps create a safe and trusting space for our work together.

Counselling Records

Session notes are brief, factual records made by the counsellor for professional purposes. These notes:

• Use      your initials only and refer to you as “the client”
• Are      stored securely in accordance with data protection legislation
• Are      retained for 5 years after counselling ends, in line with professional and      insurance requirements
• Are      securely destroyed (shredded or permanently deleted) after this period

Personal Details

Your name, contact details, emergency contact, and GP details are stored securely and separately from session notes. These details are retained for 5 years after counselling ends for legal, ethical, and insurance purposes, then securely destroyed.

If I become incapacitated or unable to practise, a therapeutic will arrangement is in place. In this situation, my nominated professional may access your contact details only in order to inform you and, if appropriate, support you to arrange alternative therapy.

Supervision

I attend regular clinical supervision in line with professional requirements. Client work is discussed anonymously, and no identifying details are shared.

2. Limits of Confidentiality

Confidentiality may only be broken when there is a legal or ethical obligation to do so. This includes situations where:

• There      is a serious and imminent risk of harm to yourself or another person
• There      is a safeguarding concern involving a child or vulnerable adult
• Disclosure      is required by law (for example, under terrorism or money laundering      legislation where there is reasonable suspicion)
• A      court orders disclosure of information

Where possible, I will discuss any need to break confidentiality with you beforehand. Any disclosure will be limited to the minimum necessary information.

Disclosure may involve:

• Contacting      your GP or local crisis team
• Contacting      emergency services or other relevant authorities

3. Data Protection & GDPR

I am registered with the Information Commissioner’s Office (ICO) and comply with the UK General Data Protection Regulation (UK GDPR) and the Data Protection Act 2018.

I am the data controller for your personal data. The lawful basis for processing your data is legitimate interest and contractual necessity, in order to provide counselling services safely and ethically.

You have the right to:

• Access      your personal data
• Request      correction of inaccurate data
• Request      erasure of data (where legally permissible)
• Restrict      or object to processing
• Lodge      a complaint with the Information Commissioner’s Office (ICO)

4. Online Counselling & Confidentiality

Online counselling sessions take place via Zoom. While I take reasonable steps to ensure confidentiality from my location, I cannot guarantee confidentiality from your location. It is your responsibility to ensure that you have:

• A      private, quiet space
• Freedom      from interruption
• Appropriate      use of headphones if needed

Online counselling is not suitable for emergency situations. You will be asked to provide emergency contact details before starting therapy. If you are in immediate danger, please contact emergency services or your local crisis team.

5. Appointments & Timekeeping

• Counselling      sessions are 50 minutes long
• Birth      debrief sessions are 60 minutes long
• Please      arrive on time
• If  you arrive late, the session will still end at the scheduled time

Appointments are usually scheduled back-to-back with a short gap between sessions for administration. If you arrive more than 10 minutes late, the session will be cancelled and the full fee will still apply.

6. Cancellations & Missed Appointments

• At least 24 hours’ notice is required to cancel or rearrange a session
• Cancellations with less than 24 hours’ notice will be charged at the full session fee
• Missed appointments without notice will be charged in full
• Session cancelled with at least 24 hours’ notice may be credited forward to the      following month

7. Fees & Payment

Payment is required prior to the session or within 2 hours after the session ends.

Payment details:

• Bank:      Mettle
• Account      Name: Counsellor Midwife
• Sort      Code: 04-03-33
• Account      Number: 36194532
• Reference:      Your initials

8. Fees

Counselling

• Full      price: £50 per 50-minute session
• Concessions*:      £45 per 50-minute session

*Concessions apply to students, clients claiming benefits, and OAPs.

Birth Debrief

• £60      for a 60-minute session
• £90      for a 90 minute session 

Rewind Therapy

• £180      (payment required prior to Session 1)
• Payment      plans available on request

The Rewind package includes:

• Session      1 (30–60 minutes): history taking, understanding your goals, deep      relaxation, and an audio recording for daily practice
• Session      2 (60–120 minutes): reflection, deep relaxation, 3-stage rewind process,      and future scene setting
• Session      3 (30–60 minutes): reflection, deep relaxation, future scene setting, and      session recording
• A   personalised script based on Session 1
• A  specially curated aromatherapy candle to support relaxation
• A   6-week follow-up check-in by phone or Zoom

Rewind therapy is a therapeutic intervention and is not a medical treatment.

9. Birth Debriefs

Birth debriefs are one-off sessions offering a supportive space to reflect on and process your birth experience.

Further sessions may be discussed if you feel additional support would be helpful, but there is no obligation to continue beyond the debrief session.

10. Face-to-Face Counselling Location

Face-to-face sessions are held at:

Ladybridge Connect
Off Meadway Road
Cheadle Hulme
Cheadle
SK8 5NZ

There is ample parking available. If I am with another client, please wait in the seating area near the entrance or the café area. If the door is locked, please wait and I will come to greet you at your appointment time.

11. Voluntary Participation

Counselling is voluntary. You are free to end counselling at any time.

12. Concerns or Complaints

If you have any concerns about our work together, I encourage you to raise them with me so we can try to resolve them informally.

If you remain dissatisfied, you may make a formal complaint to the British Association for Counselling and Psychotherapy (BACP). Details of their complaints procedure are available on the BACP website.

13. Agreement

Please sign and date below to confirm that you have read, understood, and agree to the terms of this counselling contract.

Client Name:

Signed: _______________________________

Date: _________________________________

Counsellor:

Samantha Phillis
MBACP (Registered Member), NMC

MSc | BSc | BMidwif | BA (Psychology) | Dip Couns
Certificate in CBT | Diploma in Hypnobirthing

Counsellor Midwife

Email: counsellor@therapistmidwife.co.uk
Website: counsellormidwife.co.uk

Phone: 07736035033