Working Agreement

First Name

Last Name

Known as

Date of birth

Address

Address Line 1

Address Line 2

City

PostCode

Phone number

What is your preferred mode of communication?

Phone

Text

What is your availability for communication?

Name of GP and Medical Centre

Emergency name and contact information

Mental health medication and dosage

Employment / occupation

Are you working with any other therapists at this time?

Are you currently involved in any legal proceedings? (There may be implications for counselling regarding court orders for session notes.)

Are you adopted? (There may be legal implications for our therapeutic work together.)

What are your presenting issues?

Why are you seeking therapy at this time?

What would you like to get out of therapy?

Have you before had counselling / psychotherapy? If yes, what was helpful / unhelpful in your experience?

How did you become aware of my professional services?

Working Agreement

The Working Agreement between us

My commitment to you
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As a caregiver cradles a new-born child in their arms, I commit to offer you a therapeutic relationship in which you are therapeutically held and cherished.

As a child explores the world with wonder, I commit to be curious with you trusting that through my stance of curiosity you will be offered different ways of being in the world.

As the most trustworthy in our lives are often those who challenge us the most, I commit to be ready to challenge you through gentleness within your capacity to receive it.

As our greatest supporters in life celebrate us for being ourselves, I commit to be a cheerleader who trusts in your inner resources.

As an inspirational leader embodies compassion, I commit to model and promote self-compassion in our work together.

As friends delight in company one with another, I commit to honour the place of humour and playfulness as essential to wellbeing.

As partners choose to collaborate as they journey through life, I commit to be a co-creator with you as the therapeutic relationship develops between us.

Our commitment to sessions
--------------------------------
If you can't attend a session, at the earliest opportunity, please let me know by phone call, do leave a voice message if I am unable to answer your call, or by text: 07534 599 233.

My time and your time are valuable. Cancellations will need to be made at least 48 hours in advance. If you fail to notify me 48 hours prior to your appointment that you are not attending you will be charged the full session fee of £60.

I commit to give you as much notice as possible regarding any absence on my part.

If you fail to attend two consecutive sessions without notice, no further appointments will be offered.

A session usually lasts for the duration of 50-60 minutes.

The Therapy Process 
-----------------------
I will explain the therapeutic process and my personal approach during the initial sessions, and as is therapeutically purposeful during further sessions. In particular, it is helpful to understand that therapy is not advice giving. The therapist may be likened to a mirror who reflects back to the client themselves in their life. Through this the client gains new awareness and is equipped with a range of perspectives and choices in their life.  A therapist can make ‘invitations’ to a client who is free to ignore them, or act on them.

I am trained as a ‘relational integrative’ therapist. ‘Relational’ means that I recognise the power in therapy resides in the relationship co-created between the client and therapist. ‘Integrative’ means that I work with several theoretical approaches (Cognitive Behavioural Therapy - CBT, Psychodynamic and Humanistic) so between us we can find a way of working together which meets your needs and aims.

Commitment between sessions
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Preparation for a session will look different for different clients depending on their place in the therapeutic process. To help you get the most out of your sessions, pay attention to what it is you want to get from your sessions. Some clients find it helpful to name this in terms of their aims, or goals. For others, they cannot name what they need from counselling, but they know they need help.

A session is one hour of your life in a week which comprises 167 other hours. It will be important for you to discover how you reflect on each session, this may include journaling, jotting notes (digital, or hard copy), or making visual representations which may include drawing. Creating intentional reflection time during your day and week can enhance the impact of your sessions.

Paying attention to your ‘take-away’ from each session, and how to sit with it during your week, is a habit to cultivate. This may involve putting into practice things you have discovered, or rehearsed, during your session.

This contract limits our contact between sessions solely for the purposes of planning between us. Communication between us will be limited to the ‘administration’ of arrangements for sessions, we can agree your preferred mode of communication for this – phone call, text, or email.

This contract does not provide the client with a ‘crisis service’. If you urgently need help, or support, outside our arranged session times please reach out to crisis service providers, which include:

Samaritans: Tel. 116 123 (free from any phone, open 24 hours)

24/7 NHS Mental health response line: Tel. 0800 038 5300 (free) 24 hours a day
For support and advice.

Shout: 24/7 text service, free on all major mobile networks, for anyone in crisis anytime, anywhere. It’s a place to go if you’re struggling to cope and you need immediate help. Text: 85258

Medication and Health
--------------------------
Please let me know if you are taking any medication. Some medication may affect the therapy process.

If you are receiving any other form of therapy, please let me know. It is unadvisable to be receiving more than one type of counselling, or psychotherapy at the same time; unless you are participating in Couples Counselling.

Let me know if you have previously had any therapy and what that was helpful, and unhelpful, to you. This can assist in developing the therapeutic relationship between us.

Therapy will not take place if you appear to be under the influence of drugs, or alcohol.

Confidentiality 
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Your sessions are confidential but with limitations.

I work within the British Association for Counselling and Psychotherapy (BACP) Ethical Framework for good practice and seek to offer the highest level of confidentiality consistent with the Law and BACP codes.

An important part of the code of ethics is that counsellors have a supervisor with whom they discuss their work. The focus of supervision is to help a counsellor look after the best interests of their clients. I may, from time to time, use examples of my casework in which the identity of the client will be anonymised. The therapist – supervisor relationship is confidential.

Exceptionally, I will involve outside agencies when harm to a client, or others, is considered a serious risk. In these circumstances, if possible, I will first discuss the situation with you and then agree a course of action. If necessary, you may be asked to sign a ‘client information release consent form'.

There are circumstances, however, where the law requires me to break confidentiality without informing you, or gaining your consent. These relate to the Terrorism Act (2000), the Children Act (1989/2004), the Drug Trafficking Offences Act (1986- amended by Criminal Justice Act 1993), and court orders.

If you have any concerns, or queries, about these limitations to confidentiality you can discuss them with me at any time.

Note Taking 
--------------
Factual notes are made regarding each session. The notes are always securely kept and are destroyed three years after the last session. It is the client's right to ask to see their notes. My privacy policy can be viewed in full here: https://markgr.co.uk/privacy-policy/

I am registered with the Information Commissioner's Office as a data controller and operate within the General Data Protection Regulation. My registration number is: ZB338288. You have rights under data protection law. For further information about your rights please contact www.ico.org.uk

Outside of your Psychotherapy Sessions 
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Due to the nature of therapy, it is important that we have no other relationship during the period we are working together.

If we happen to ‘bump into each other' between sessions, I will follow your lead in acknowledging each other or not, as I understand that you may not wish to explain to the people you are with how we know each other.

Working with international clients
--------------------------------------
I am based in the UK. Our work is under UK jurisdiction and governed by UK law.

Payment
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You can pay via bank transfer:

Mark Greenaway-Robbins | Starling Bank | 60-83-71 | 17329626

Payment is made no less than 48 hours in advance of your session. Your booked session will not take place unless payment has been received 48 hours in advance of the start time of the session.

£60 per 50-60 minute session: face to face, online, phone, walk & talk

Fees are reviewed every April. At any time during a year three months’ notice will be given of any change in fees.

The Agreement 
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This Working Agreement is voluntary, and you can end this agreement at any time.

I retain the right to terminate this Working Agreement at my discretion.

I confirm I have read, understand and accept the working agreement, and my details will be stored to confirm acceptance.

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