Before we start, I would like you to read and sign this statement so that you understand some important details.
Fees
The first session is free of charge.
My standard rate for therapy is €65 per session, €55 for students, €70 for supervision. These rates are negotiable depending on financial circumstances
Confidentiality
Confidentiality is one of the most important aspects of counseling. It is essential in establishing a trusting relationship with your therapist so that you feel safe when talking about personal and sensitive issues. Everything you say to your therapist remains confidential.
The only instances where there are limits to confidentiality are when someone is identified as being either at risk of harm to themselves or at risk of harming others. If there is a perceived risk of harm to a child or if there is a disclosure of historic abuse where the alleged perpetrator may currently have access to vulnerable children, I am required to notify the Child and Family agency.
No action is taken without talking through the process with the client.
Supervision
All accredited counsellors/psychotherapists attend their own professional supervision. Although cases are reviewed in supervision, care is taken to maintain the client’s anonymity.
Written records
With your signed consent I keep two forms of Information: Contact information and therapy process information.
- Contact information includes your name, contact details, your doctors contact details (with your permission to contact) possibly next of kin contact details in case of emergency (with your permission)
- Therapy process information would be the content of clinical notes following each therapy session, these are kept anonymous and usually very brief.
Where do I keep this information?
I keep your contact information separate from the clinical notes (therapy process information) in two separate locked cabinets (not on computer) so your personal data cannot be linked to the clinical notes. For convenience I will have your phone number on my phone but it is password protected. If you have contacted me by email and contract to attend therapy I will, with your consent, keep your email address in a password protected contacts list, (not identifying you as a client). If you make an enquiry and choose not to proceed with therapy I will delete any contact details
- If you engage in Art Therapy your art-work is classified as therapy process. You may choose to take your art work away with you, you may choose to dispose of it, or you may choose to leave it with me for the duration of therapy, in which case I keep it in a locked cabinet in my office. If you choose to leave your art-work with me subsequent to the therapy sessions I will dispose of it securely unless we contract for me to retain the art work for a specific purpose
Why do I require this information?
The maintenance of this information is necessary as part of my professional duty of care to facilitate the therapy process. The basis for this under GDPR is classified as “Processing necessary for the purposes of preventative or occupational medicine”
How long do I keep this information?
No longer than is strictly necessary. If there are no issues which may lead to legal proceedings to necessitate the retention of notes (in which case I retain notes for seven years), I shred them after three years after completion of therapy, or earlier if the client requires them to be erased after ending therapy.
I do not write reports for the legal profession, nor do I provide access to written notes unless legally impelled to do so.
Your Rights
If at any time you are concerned about what information I am keeping or that it may be incorrect, you have the right to see it and have it corrected. If you are not happy with how I deal with your data or how I respond to your request for access, you may refer to the Data Protection Commission
Appointments
I need to be given 48 hours notice by telephone if you are unable to attend a scheduled appointment. Sometimes this is not possible, but I need to charge for any session cancelled with less than 48 hours notice
I have read and understand this form
Signature:____________________________________________________Date:______________________
Online therapy
If you wish to engage in video sessions for online therapy:
- You need to have sufficient technology/equipment in your house.
- Have checked that all connections are secure (an ethernet cable provides a stronger connection than wi-fi).
- Ensure that other devices in your household are not using internet bandwidth which could cause the connection to be disrupted.
- Have a back up plan in case of technological glitches, such as a fully charged phone, so we could continue the session by phone if need be.
- You need to have a private space where you will not be interrupted during the session.
- There should be no recording of the sessions
Privacy
- Check that others can not see your screen.
- Check that you can not be easily overheard or interrupted
- If possible use a headset or earbuds with internal microphone
At present I am using Doxy.me for online sessions as it is a system designed for health professionals who require a high level of security. The system destroys data from sessions immediately after the session. According to Doxy.me
“All data is encrypted, your sessions are anonymous, and none of your information is stored. Doxy.me adheres to HIPAA, PIPEDA, and GDPR data privacy requirements.”
You need to agree by email to confirm that you understand the risks around a video counselling session.
I would suggest that you read the reviews of Doxy.me so you can see how these risks may be minimised by using this platform
Signing below serves as this confirmation
Signature: Date:
Liam Plant 