Parent/Guardian contract agreement for
Please take some time to carefully read through the contents of this contract for in-person counselling. If you agree to the terms and conditions that this contract holds, please sign the contract and submit the contract agreement below.
The following outlines the terms of the contract for counselling between:
Peter Golder (Counsellor) on behalf of Acorn Counselling Therapy and the (Client) that signs and completes details on this document.
Confidentiality is a means of providing the person in your care with safety, privacy and autonomy. As part of my (Peter Golder) professional development and ethical working, I attend regular clinical supervision where my work is discussed. When doing this I will not share yours or the young person in your care's identity or any other details which could identify you both.
In the event that I believe it would be helpful to communicate with other professionals, I will speak to my client first, to make them aware of this and get their consent. The exception of this would be if they told me something that they or another had done or were intending to do, and this action was something I was legally or ethically obliged to disclose. In the unlikely event that this happens, I would inform them that I was going to discuss this with other professionals and would do so, with or without their consent.
Sessions last for 50 minutes and will usually be at the same time and day each week. We will agree on there frequency between us on an ongoing basis. In some circumstances, with mutual consent, it may be that my client and I choose to plan one of their sessions on another day of the week and at another time, in order to provide a flexible service when needed.
If they are late for a session for any reason, please let me know as soon as you can. If they are late for their session, the session cannot be extended.
If they arrive to a session and their behaviour has been affected in any way due to substances use e.g. alcohol / drugs, I may decide not to proceed with the session, this will be at my discretion and the session will remain chargeable.
Payment for sessions
Fees are £55 per session. Payment for sessions will be made before the session or on the same day as the session by bank transfer. Please note that your name may appear on Acorn Counselling Therapy bank statements. The statements will be seen by myself, Counsellor and Giancarlo Squillaci, business manager of Acorn Counselling Therapy.
The bank details to make the payments are;
Account in the name of - Acorn Counselling Therapy
Sort code. 40-25-03 Account no. 01695428
Cancelled and missed sessions
I will give them as much notice as possible if I need to cancel their session for any reason.
I require at least 48 hours’ notice if they have to cancel a session. If they cannot give 48 hours then the session will still need to be paid for, unless we have previously agreed otherwise. To cancel a session you or them can email, call or text me directly.
I request that no part of our conversations are shared on social media by yourself, the young person who is my client or someone else of yours or their choosing
I request that you or anyone else that you know, do not search any personal profile on social media of a member of Acorn Counselling Therapy or send a message by social media to a personal social media account of a member of Acorn Counselling Therapy. You may however search and look at Acorn Counselling Therapy's facebook page or other Acorn Counselling Therapy social media.
If any of these requests are not met, I reserve the right to withdraw the offer of counselling
Certification of counsellor
I am a qualified counsellor and registered member with the National Counselling Society (NCS) and United Kingdom Association of Transactional Analysis (UKATA) and as such abide to their Code of Ethics and Professional Guidelines (a copy of which are available from their respective websites).
Termination of Counselling
There may be times during counselling that the young person in your care feels distressed and feels that counselling is not helping them. This is not an uncommon experience part way through counselling. If they feel they would like to stop counselling at any time, please talk this through with me first. This will give us all the opportunity to understand more fully what is distressing them, enabling us to find a way to resolve the distress that they may be feeling. With this in mind I ask that they give two clear sessions notice of ending therapy.