Agreement

Counselling Psychotherapy Agreement

Thank you so much for booking your first session with me! I am excited to support you on your journey. Before we begin, I kindly ask that you read, fill out and sign the agreement form. This is an important step to ensure that I can provide you with the best possible care.

Details, Competence, Qualifications

  • I, Silvie Broukova, trading as Brouk Ltd., confirm I am an Accredited Member of the National Counselling and Psychotherapy Society. Membership number: NCS2002121.
  • I’m trained in CBT/REBT Therapy.
  • I confirm I have Professional Civil Liability Insurance arranged through Towergate Insurance Brokers.
  • I will be assessing clients and deciding if I am able to take the work on; if not, I will suggest the client contact IAPT or their GP.

Commitment to the Process

Having made the decision to attend counselling or therapy, it is important that you attend regularly. This ensures that the process of healing or overcoming an issue is effectively undertaken. Too many gaps between appointments usually slow down progress. It is also essential to discuss your therapeutic needs and maintain a personal commitment to your emotional, behavioural, and psychological changes.

Confidentiality and Privacy

The law protects the relationship between a client and a counsellor or psychotherapist. Information cannot be disclosed without written permission.

  • Most client information is recorded in paper form and will not be shared with third parties without the client’s written permission. If a client is referred by a Consultant Psychiatrist or a Medical Professional, a progress report may be provided, as they are also bound by GDPR law.
  • Data collected includes: Name, Address, Date of Birth, Profession, Telephone Number, Medical and Psychiatric Information, Previous Therapies, Problem/s, Goals, Priority Problem, Emotional Assessment of Problem, Specific Trigger Events Assessment of Beliefs, Financial Details (e.g., Debit or Credit Card Number), Agreed Homework.
  • Clinical supervision is a requirement by accrediting bodies such as the National Counselling Society, BACP, BABCP, etc. Client work may be discussed anonymously with a Professional Clinical Supervisor, who is also bound by law to maintain confidentiality.
  • Only relevant information is taken, and these notes are held securely. Electronic systems holding client information are password-protected.
  • Client notes are kept for 5 years and then safely destroyed.
  • Any financial details are destroyed when therapy ends.
  • It would be helpful to have a next of kin or close contact for emergencies. Providing this information grants permission for the therapist to contact them if deemed essential.

Clients Have the Right to:

  • Be informed
  • Access their data
  • Rectification
  • Erasure
  • Restrict processing
  • Data portability
  • Object
  • Not be subject to automated decision-making

Exceptions to Confidentiality

  • Supervision: Regular, ongoing supervision is required by most professional bodies, focusing on the therapist’s work without revealing client identities.
  • Risk of Harm to Self: If a client expresses suicidal thoughts and intent, confidentiality may be broken as per organisational policies.
  • Risk of Harm to Others: While there is no legal obligation to report abuse, safeguarding is an ethical responsibility. Confidentiality may need to be breached if there is an increased risk to a child or vulnerable person.

Confidentiality for Online Bookings

  • When attending online counselling, please book appointments during times you are unlikely to be disturbed and ensure therapy occurs in a confidential space.
  • The confidentiality of our appointments must be maintained, and sessions should not be recorded. By signing this agreement, you agree to this.

Session Bookings, Times, and Frequency

  • Each session lasts 55 minutes.
  • All Online sessions will be held via Google Meets.
  • In-person sessions are held at: 36 St Mary at Hill, London EC3R 8DU.
  • Appointments can be booked via the website www.silviebrouk.com or by email.

Fees and Options

  • Initial Online Session (30 min) – Free
  • Therapy Session Online – £70
  • Biweekly Online Session Package (2 sessions/month) – £130
  • Four Weekly Online Sessions Package – £220
  • Single In-person Therapy Session – £95
  • 5 In-person Sessions Package – £450
  • 10 In-person Sessions Package – £850

I offer a limited number of lower-cost sessions for individuals on reduced income; please ask for details.

  • Cancellations made outside of 24 hours will be charged at the full rate of the session. No-shows will also incur the full session fee.

Payment

Payment must be made 24 hours before a session by card at www.silviebrouk.com or via electronic transfer to:

Account Name: Brouk Ltd, Sort Code: 04-06-05, Account Number: 25071919.

Cancellation Policy

  • Cancellations made outside of 24 hours will be charged at the full rate of the session. Fees will still be required unless there is an emergency.
  • No-shows will incur the full session fee.

Endings (Termination)

You will generally know when you are ready to finish counselling/psychotherapy, and we will agree on how to prepare for this. If you feel the desire to end therapy, please discuss it to explore further instead of terminating suddenly, which may prevent resolving important issues.

I will not terminate our contract without warning, except in exceptional circumstances, which we will discuss together.

Ethics and Code of Conduct

I am an accredited member of the Addiction Counsellors of Ireland and adhere to the ethical framework for good practice in Counselling and Psychotherapy established by these organisations. Further information is available on their websites.

    Client's details

    Designated Person or Next of Kin Contact



    I agree to undertake Counselling/therapy in accordance with the terms outlined above in this agreement.


    FREE INITIAL PHONE CONSULTATION

    This will allow us to get to know each other. During the initial consultation we will discuss your current situation, define the goals and choose the right therapy for you. Please use the form to book your free initial phone consultation or to contact me. Thank you and I look forward to meeting you.

    With regards to costs, please contact me so that we can agree something and discuss the possibilities.