Client Consent Form

Code of Ethics

Your student counsellor will work in accordance with the ethical guidelines of the National Counselling Society and is governed by the NCS’ code of conduct to practice.

Terms and Conditions

1. I have agreed with Izabela Burge to meet for sessions based on Izabela Burge being a counselling student in training. We have spoken over the phone for an initial consultation and have agreed to meet during ongoing sessions via phone or video link. Each session will be for 50 minutes maximum. We will review progress and feedback at end of each meeting.
2. I have been advised that I can terminate any or all sessions if needed, as and when desired. I also agree to participate in each and all sessions to my best abilities.
3. I understand that confidentiality regarding any sessions will be respected between Izabela Burge and myself.

Confidentiality

All of our interactions including but not limited to, telephone calls, emails, video conference calls (such as Zoom or Teams,) letters and all other forms of communication including our face to face therapy sessions together, will remain strictly confidential.

When attending sessions over the telephone or video link, I will ensure I am in a safe and confidential space. I understand that information disclosed will be held in the strictest of confidence and not shared with anyone without permission. However, there are boundries and limits to confidentiality and my student therapist may need to disclose information to an appropriate professional person or authority if there is a concern for my own or another person’s safety, including any children and vulnerable adults.  Examples of when certain information that you disclouse and where confidentiality will need to be breached /broken is when:

• You, tell me that you intend to harm yourself, like committing suicide, or harm others such as planning to injure or kill someone.
• If you tell me about any knowlege or involvement in abuse or abusive behaviours that may lead to harm or neglect to children or vulnerable adults.
• Of any knowlege or involvement in acts of terrorism, drug trafficking, people trafficking or money laundering.

In such cases, I will be obliged to report this to the appropriate authorities or by subpoena.

I will inform my student therapist if I feel my difficulties worsen, or if I have any concerns about being able to keep myself safe between sessions. If I need support between sessions, I can contact the Samaritans (116 123), Mental Health Matters (0800 107 0160, 24 hours a day, 7 days a week) or text Shout to 85258.I am also able to request an emergency appointment with my GP or attend A&E at any time if I need immediate help to keep myself safe. I accept that I cannot seek therapeutic advice or crisis support from my student therapist via email, text or telephone.

Supervision

As part of good professional practice, all student counsellors are guided by supervision with their tutors and as professionals, all therapists meet regularly with supervisors. In cases of student counsellors, a supervisor is a tutor, to whom the therapist will discuss volunteering sessions. The aim of supervision is for educational and professional development purposes and supporting effective therapy and learning. All supervisors are bound by a code of practice and limits of confidentiality. Shared information in supervision will not disclose personal information.

Attendance

I recognise that there is a service given on a voluntary basis, and that regular attendance is needed for maximum benefit. I accept that my sessions will probably be discontinued if I miss an appointment without letting my student therapist know. If a cancellation is unavoidable, I will give as much notice as possible so the appointment can be rescheduled. If I cancel two appointments, the therapy sessions will probably be discontinued.

I will do my best to inform my student therapist if I know that I cannot attend or I am going to be late for a session. I will do this via an email to ib@mending-minds.com. I understand that if I attend late, sessions will still finish at the usual time. If I arrive more than 15 minutes late, we agree to cancel the session.

Commitment and Integrity

The student therapist’s commitment is to act as a trainee counsellor, and use best endeavours to help guide you through the therapy process to the best of their knowledge and skills. Should any conflicts arise, your therapist will seek help from a supervisor at the first instance. With their guidance, they will try to resolve any problems, keeping your information secure, safe, and confidential.

Your student therapist will keep you informed about your progress throughout and will let you know if at any point, they feel that their involvement is unlikely to make a positive difference in your life, and may propose bringing the sessions to an end.

Safe & Effective Sessions

I accept that my student therapist will not be able to work with me if I use verbal abuse or physical violence during a session. When connecting via telephone or video link, I agree to keep background distractions to a minimum and agree to not multitask on other tasks during my session. I agree that we will review our work together to decide if it is effective.

Availability

Our sessions will be done on the dates and times we have agree upon. This may take place at my student therapist’s office, at my home or over the internet using a communication platform such as Zoom, Teams, Skype or similar. Sessions outside working hours will need to be agreed on. 

Disclaimer

All student therapy sessions are conducted on a voluntary basis, meaning that no monies, fees or goods will be exchange. Please also note that as a student therapist, they make no guarantees that your sessions will reach a successful conclusion.

Contacting Student Counsellor

You may contact Izabela Burge on mobile number 07799 953347 or email at izabela@casaburge.com or ib@mending-minds.com. If it is not possible to leave a voice mail on my phone, please email or send a text message and I will get back to you as soon as I can.