Counselling Agreement

Counselling Agreement


‘Philippi ‘ Philippi Guernsey LBG whose address is St Andrew’s Barn, Rue des Morts, St Andrew Guernsey; and
‘Client’ (name and address)

I confirm that I have read and agree the following terms and conditions, (which are incorporated in this Agreement) and which have been designed to provide me with a professional and confidential counselling service.

I agree that if I am unable to keep an appointment, I will give you as much notice as possible, ideally not being less than 24 hours before the appointment. I understand that you will do your best to avoid altering my appointments.

I accept that if I miss 2 consecutive appointments without contacting you with a valid reason, you are entitled to give my appointment times to someone else. This includes the offer of taking up and starting counselling.

Signed client:
Signed manager:


Terms and Conditions


  1. Confidentiality

All sessions will be conducted in strictest confidence and this confidence will be maintained and applied to all records, except in the following circumstances:

  1. Where you, the client, give consent for the confidence to be broken.
  2. Where the counsellor is compelled to do so by an Order of a Court.
  3. Where the counsellor reasonably considers that the information is of such gravity that confidentiality cannot be maintained e.g. drug trafficking, money laundering or terrorism
  4. Where the counsellor reasonably considers that there is a risk of serious harm to yourself or others.


  1. Counselling Plan

Sessions will last fifty minutes. After the Initial Consultation with the manager or her deputy, you will be allocated to a counsellor, when an appointment becomes available, who will arrange a convenient time to meet.  The number and frequency of sessions will be discussed and mutually agreed by you and the counsellor.  There will be a regular review of the counselling sessions and objectives. Unfortunately, due to the high demand for counselling, there may be a waiting list. Therefore, please let us know if you decide to make alternative arrangements.



  1. Disclosure of your personal information / Data Protection
  1. A copy of the brief notes made from the Initial Consultation (see overleaf) will be forwarded to the counsellor together with a copy of the signed Counselling Agreement.
  1. In accordance with the Counselling Code of Ethics, your counsellor is required by their professional body to undertake supervision.Although client issues are discussed within supervision, confidentiality is maintained, and your identity will not be revealed.
  1. In order to provide you with the highest level of care and ensure that the counsellor is working within the Association of Christian Counsellors’ (ACC) or the British Association for Counselling and Psychotherapy (BACP) Code of Ethics and Practice, there may be times when it is appropriate to audio record a counselling session for the supervisor. This will be only considered if it is thought to be in your best interests.Your written permission will be obtained first.
  1. Furthermore, the manager (or deputy) of the service may need to access your information in connection with the management of the counselling services and/or their professional responsibilities.
  1. You are asked to sign the Data Protection consent below.
  1. Cancellations

If you are unable to keep an appointment, please give us as much notice as possible, ideally not less than 24 hours before the appointment. We will let you know as soon as possible if we have to alter an appointment. We will do our best to avoid this. Due to the growing waiting list, if you miss two appointments without contacting us with a valid reason, we may consider allocating your appointment time to another client. This includes the offer of taking up and starting counselling.

  1. Payment

We expect clients to pay a contribution for each session, usually a minimum of £10 up to £40, or more. However, please discuss this with us, in relation to your individual circumstances. These contributions are essential to help us to maintain the service.

  1. Useful websites

Whilst waiting for an appointment, you might like to look up a few websites.,,  and www.mindfulselfcompassion.orgare helpful sources of information.

  1. Complaints

If you are not satisfied at any time with your counselling and feel unable to resolve this with your counsellor, please telephone the manager via 07781 130 523.