Narratively Speaking Therapeutic Services - Therapeutic Agreement

I ask everyone to read, and sign, a therapeutic agreement for any work we agree to, this is so that you know what is being offered, and we can think carefully about how best we can work together. This document can be adjusted as needed, but here is the basic version:

Ethical Framework

I/We agree to attend individual/group counselling/psychotherapy/supervision/spiritual accompaniment sessions with Susan Dale who is an accredited member of BACP (British Association of Counselling and Psychotherapy www.bacp.co.uk ).   All sessions will comply with BACP Ethical Framework for the Counselling Professions (a full copy of this document can be found on: http://www.bacp.co.uk/ethics/EFfCP.php). This framework commits Susan Dale to:

1. Putting you as a client/supervisee/accompanee first by

1. making you her primary concern while she is working with you.

2. Working to professional standards by:

1. working within her competence
2. keeping her skills and knowledge up to date
3. collaborating with colleagues to improve the quality of what is being offered to you (and other clients)
4. ensuring that her wellbeing is sufficient to sustain the quality of the work
5. keeping accurate and appropriate records

3. Show respect by:

1. valuing you as a unique person
2. protecting your confidentiality and privacy
3. agreeing with you on how we will work together
4. working in partnership with you

4. Building an appropriate relationship with you by:

1. communicating clearly what you have a right to expect from her
2. communicating any benefits, costs and commitments that you may reasonably expect
3. respecting the boundaries between her work with you and what lies outside that work
4. not exploiting or abusing you
5. listening out for how you experience your working together

5. Maintaining integrity by:

1. being honest about the work
2. communicating her qualifications, experience and working methods accurately
3. working ethically and with careful consideration of the law

6. Demonstrating accountability and candour by:

1. being willing to discuss with you any known risks involved in the work and how best to work towards your desired outcomes
2. ensuring that you are promptly informed about anything important that has gone wrong in our work together, whether or not you are aware of it, and quickly taking action to limit or   repair any harm as far as possible
3. reviewing her work with you in supervision
4. monitoring how you experience our work together and the effects of her work with you.

If you have any concerns about your work together and feel unable to speak with Susan Dale directly, or you would like more details in respect of counselling and psychotherapy, you can contact BACP Ask Kathleen Service in confidence on: http://www.bacpregister.co.uk/public/

Practical Arrangements

I/We have agreed to a pay Susan Dale  £    per hour for sessions and understand that if I cancel pre-booked sessions with less than 24 hours notice I may be charged for those missed sessions. Regular monthly statements will be given to you showing monies paid.

I/We have agreed to meet for_________sessions of counselling/psychotherapy/supervision/spiritual accompaniment at a pre-arranged venue/ online via suitably encrypted and secure online platform/ telephone. 

I/We understand that Susan Dale will (wherever possible) give you adequate notice of any breaks or possible ending of the therapeutic agreement.

Confidentiality

I/We recognise that the content of counselling/supervision/spiritual accompaniment sessions will remain confidential unless Susan Dale considers that there is a serious risk of harm to either you, or others, or when she is ordered to give information by a court of law.

In any of these circumstances she will make every effort to discuss her concerns with you so that you can decide together how to keep you, or others safe, but occasionally in exceptional circumstances this may not be possible, and she will need to contact:

• the emergency services (for example a medical emergency such as a heart attack)
• the police or other relevant agency where I have a statutory  duty to report (for example in the case of terrorism or major criminal activity)
• your GP (for example if I considered that you were at high risk of self-harm, or you may wish me to write to them confirming you are working with me)
• her insurers (Susan Dale carries both public liability and professional indemnity insurance for all of her work - you can ask to see the documentation).

Please give your GP details and/or a contact for someone known to you that Susan Dale can contact in an emergency of the kind shown above:

I/We agree not to record or post details of online therapy sessions on social media without the permission of Susan Dale

Record Keeping

I/We understand that Susan Dale keeps minimal records of our work together (in accordance with Data Protection Act).

This includes a record of your name and preferred contact details, the details shown on this agreement, and brief case notes (stored separately from your name and contact details) which contain the date you came, any specific goals, issues or any particular decisions made. For example supervision case notes may look like this:

18-12-15        001     Agreed work together: Outcome: monthly 1.5hr meetings in Kentisbeare

18-1-16          001     Discussion: Client work School

12-1-16          001     Outcome: Further training CYP safeguarding

12-2-16          001     Discussion: Client A risk of harm – 001 will monitor and carry out risk assessment  

You are welcome to view or retain a copy of this record if you require it. Susan Dale will not give these records (unless compelled to do so by a court of law or as outlined above in the case of risk of significant harm) to any other agency or person, and will store them electronically (in accordance with data protection – see: https://ico.org.uk/for-organisations/guide-to-data-protection/ 

Susan Dale keeps similar notes for her own supervision sessions and your reference (but not your name) may appear on this record with any agreed actions for Susan Dale. 

Cancelling therapeutic agreement

I/We understand that we can cancel the therapeutic agreement at any time but I/we will endeavour to give 24 hours notice.

Signed

Signed                                                               Susan Dale

Date

Name:

Address:

D.O.B.

Telephone No:

Email:

GP (or other)