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Counselling Agreement (Example)
Who this is for
This agreement is between you (the client) and Suzanne Wood-Simmons (the counsellor).
We are agreeing on how we will work together in counselling.
About your counsellor
Suzanne is a trained counsellor and a member of BACP and NCPS. These are professional bodies that make sure counsellors work safely and ethically.
What counselling is
Counselling gives you a private and safe place to talk about what’s on your mind.
Suzanne will not judge you or tell you what to do. She may offer helpful suggestions.
You can always say if you don’t agree or want something different.
Your privacy (Confidentiality)
What you say in sessions is private.
Suzanne might talk to a supervisor (another counsellor) to make sure she is helping you well, but she won’t share your name or details.
Sometimes, Suzanne must tell someone else if:
- You say you are planning to hurt yourself or someone else.
- A child or vulnerable person is at risk.
- You mention serious crimes (like terrorism or drug trafficking).
She will tell you first, unless it is urgent.
She takes notes after sessions, but they are anonymous and stored safely for 7 years.
How much it costs
- £45 for online or phone sessions.
- £55 for sessions at your home.
- Sessions are 50 minutes long.
- Payment should be made in advance. Bank details will be provided to you privately.
If you are late or miss a session
If you are late, we still finish at the usual time.
If you don’t show up or cancel less than 24 hours before, you will still need to pay.
How to contact in between sessions
You can text or call 07827 467058. Suzanne will reply as soon as she can.
In a crisis, contact your GP, call 999, or speak to Samaritans.
Keeping things safe
You can share emotions, even hard ones, like anger.
But if there’s a risk of harm to you or Suzanne, the session will stop.
Our relationship
Suzanne is your counsellor. That means no other kind of relationship is allowed.
If you see each other outside, she will say hello only if you are okay with that.
Finishing counselling
You can stop counselling at any time.
If possible, talk about it first. This helps make a smooth ending.
Please read and sign
This agreement helps make sure we both understand how counselling works.
If there is anything you want to change or talk about, write it below.
CLIENT NAME: ________________________________
DATE: _________________________
COUNSELLOR: Suzanne Wood-Simmons
DATE: As confirmed by email
EMERGENCY CONTACT (with your permission or if you become very unwell): ________________________________
