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Counselling Agreement

Version 1.0 – July 2026

Review Date: July 2027

21. Client Information
Date of Birth
Day
Month
Year
Emergency Contact
Presenting Concerns
Previous Counselling
Medical Information

Please provide details of any relevant physical or mental health conditions, current medication or psychiatric history.

Risk Information
Have you experienced or do you currently experience:
22. Consent to Contact GP

I give permission for Wendy Mayfield to contact my GP only where clinically or ethically necessary, for example where there are serious concerns regarding my safety or wellbeing, and wherever possible this will first be discussed with me.

Please tick one option
Yes
No
23. Client Declaration

I confirm that:

  • I have read and understood this Counselling Agreement and Privacy Notice.

  • I have had the opportunity to ask questions.

  • I understand the limits of confidentiality.

  • I understand the cancellation policy.

  • I understand how my personal information will be stored and used.

  • I consent to participate in counselling under the terms described in this agreement.

Client Signature
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Date
Day
Month
Year
Counsellor Signature

Wendy Mayfield MBACP, MA, HND, Dip. Couples Counselling, MACCPH

Signature: W.Mayfield

Date
Day
Month
Year

Contact Details

Wendy Mayfield MBACP

Professional Email:

wendymayfield60@icloud.com

Telephone:

07734 774725

Wendy Mayfield MBACP, MA, HND, Dip. Couples Counselling, MACCPH

Registered Member, British Association for Counselling and Psychotherapy(BACP)

Membership Number: 381018

I work in accordance with the BACP Ethical Framework for the Counselling Professions and the BACP Guidance on Working Online

Further information about the BACP can be found at:

https://www.bacp.co.uk​​

Welcome

Thank you for choosing to work with me.

Beginning counselling can feel like a significant step and it is important that you understand how i work, what you can expect from me, and what i ask of you in return.

This agreement explains how counselling will be provided, how your personal information is handled, what you can expect from me, and what I ask of you in return

This agreement explains how counselling will be provided, how your personal information is handled, the limits of confidentiality, and your rights as a client. It is intended to help us establish a safe, respectful and collaborative therapeutic relationship from the outset.

Please take time to read this document carefully before your first session. If anything is unclear, I encourage you to ask questions so that you feel fully informed before we begin working together.

1. My Approach

As an integrative Counsellor, i draw upon a range of recognised therapuetic approaches to meet your individual needs. Every person experiences life differently, and I believe counselling should reflect your unique experiences, values, strengths and goals.

Although I integrate different therapeutic models where appropriate, my work is firmly grounded in the Person-Centred Approach, which values empathy, genuineness and unconditional positive regard. I believe that people have the capacity for growth and change when they are offered a safe, accepting and non-judgemental therapeutic relationship.

My role is not to tell you what decisions to make, but to work alongside you, helping you gain greater understanding of yourself, your relationships and the challenges you may be experiencing.

Counselling may involve exploring difficult emotions and experiences. At times this can feel uncomfortable, but many clients find that working through these experiences within a supportive relationship leads to increased self-awareness, resilience and emotional wellbeing

2. What is Counselling?

Counselling provides a confidential space where you can explore thoughts, feelings, behaviours and experiences without fear of judgement.

People seek counselling for many different reasons, including:

  • Anxiety

  • Depression

  • Stress

  • Bereavement

  • Relationship difficulties

  • Trauma

  • Low self-esteem

  • Work-related issues

  • Family concerns

  • Life transitions

  • Personal growth

Counselling is a collaborative process rather than advice-giving. While I may occasionally offer information, psychoeducation or observations where appropriate, I will not tell you what choices you should make. Instead, I aim to support you in developing greater understanding, confidence and autonomy.

Our work will proceed at a pace that feels manageable for you.

3. How Counselling is Delivered

I offer counselling in the following ways:

  • Face-to-face

  • Online video counselling

Online sessions are available using secure platforms such as Zoom, Microsoft Teams.

Each counselling session lasts 50 minutes.

We usually begin with six sessions, after which we will review how the work is progressing and discuss whether further sessions would be beneficial.

Appointments are normally offered on the same day and time each week wherever possible.

I aim to respond to emails within one working day during my normal working hours.

Please note that email is intended for arranging appointments or brief administrative matters and is not suitable for therapeutic work.

4. Fees and Cancellation Policy

The current counselling fee will be agreed before therapy begins.

Payment should be made before or on the day of each session using the agreed payment method.

If you need to cancel or rearrange an appointment, please provide at least 48 hours' notice.

Appointments cancelled with less than 48 hours' notice will normally be charged in full unless exceptional circumstances apply.

If I need to cancel a session, I will provide as much notice as possible and offer an alternative appointment where available.

5. Artificial Intelligence (AI)

Some clients choose to use Artificial Intelligence (AI) tools or applications that provide emotional support or therapy-like conversations. These tools are entirely separate from the counselling that I provide.

AI cannot replace a therapeutic relationship with a qualified counsellor. AI systems do not hold professional responsibility for your care, cannot consistently assess risk or crisis, and may sometimes provide inaccurate, incomplete or misleading information.

Different AI providers have different privacy policies. Information you share with AI tools may be stored, retained or processed according to the provider's terms and may not be protected by the same standards of confidentiality that apply within professional counselling.

My clinical decisions are based on professional judgement, ethical practice, supervision and continuing professional development. I do not rely on AI to make clinical decisions about your care.

If you choose to use AI as part of your personal reflection or wellbeing, you are welcome to bring this into our counselling sessions. Together we can explore how it is helping you, whether it raises any concerns, and how it fits alongside our therapeutic work.

6. Face-to-Face and Online Counselling

I offer counselling both online and face to face, depending on your preferences and circumstances.

For face-to-face counselling, I will provide directions to my practice location together with payment information before your first appointment.

For online counselling, you are responsible for ensuring you have:

  • A reliable internet connection.

  • A device capable of video or telephone calls.

  • A private space where you are unlikely to be interrupted.

  • Enough time before and after your session to settle yourself emotionally.

Where possible, please use headphones to increase privacy and confidentiality.

If you are attending online sessions from home, please consider whether anyone else may be able to overhear our conversation.

7. Confidentiality

Everything you share within counselling is treated with the utmost respect and confidentiality.

Your counselling records are stored securely using password-protected electronic systems and, where applicable, securely stored paper records.

I regularly attend professional supervision, as required by the BACP Ethical Framework. During supervision, client information is discussed anonymously, and every effort is made to protect your identity.

There are, however, important legal and ethical limits to confidentiality.

Confidentiality may need to be broken if:

  • there is a serious risk of harm to yourself;

  • there is a serious risk of harm to another person;

  • there are safeguarding concerns involving a child or vulnerable adult;

  • I am legally required to disclose information relating to terrorism, money laundering or other serious criminal activity;

  • a court orders the disclosure of information.

Wherever possible, I will discuss any proposed disclosure with you before sharing information, unless doing so would increase the risk of harm or is prohibited by law.

8. Safeguarding

Safeguarding is an important part of professional counselling practice.

If I become concerned that you, another adult, or a child may be at significant risk of harm, I have an ethical and legal duty to consider appropriate action to help protect those involved.

Where it is safe and appropriate to do so, I will discuss these concerns with you before contacting another professional or organisation.

My aim is always to work collaboratively with you whenever possible.

9. Professional Boundaries

Maintaining clear professional boundaries helps create a safe and effective therapeutic relationship.

For this reason:

  • Counselling sessions will begin and end at the agreed times.

  • Contact between sessions should be limited to arranging or changing appointments unless otherwise agreed.

  • I do not provide counselling through text messages, email or social media.

  • I do not accept friend or follow requests from current or former clients on personal social media accounts.

  • Gifts are accepted only in exceptional circumstances and at my professional discretion.

  • If we happen to meet outside the counselling setting, I will not acknowledge you unless you choose to acknowledge me first. This is to protect your confidentiality.

These boundaries help maintain a professional therapeutic relationship and protect both you and me throughout our work together.

10. Professional Supervision

To ensure that I provide safe, ethical and effective counselling, I attend regular clinical supervision in accordance with the BACP Ethical Framework for the Counselling Professions.

Supervision is a professional requirement that supports counsellors in reflecting on their work, maintaining professional standards and ensuring the best possible care for clients.

Any information discussed during supervision is anonymised wherever possible. Your identity will not be disclosed unless there is a legal or safeguarding reason to do so.

11. Record Keeping

I keep brief, factual counselling notes to support continuity of care and to meet my professional and insurance requirements.

These notes may include:

  • Your name and contact details.

  • Appointment dates and attendance.

  • Brief summaries of each counselling session.

  • Risk assessments, where appropriate.

  • Any agreed actions or referrals.

Records are stored securely using password-protected electronic systems and/or locked storage where paper records are used.

Records are retained for five years following the end of counselling and are then confidentially destroyed, unless I am legally required to retain them for longer.

12. Data Protection and Privacy

I am committed to protecting your personal information and handling it lawfully, fairly and transparently.

I comply with:

  • The UK General Data Protection Regulation (UK GDPR).

  • The Data Protection Act 2018.

  • Other applicable UK data protection legislation.

The personal information I collect is used solely for the purpose of providing counselling and managing my professional practice.

This may include:

  • Contact information.

  • Appointment records.

  • Counselling notes.

  • Correspondence relating to your therapy.

  • Payment records where applicable.

Your information will never be sold or shared for marketing purposes.

Personal information will only be shared where:

  • you have given your consent;

  • I am legally required to do so;

  • there is a serious safeguarding concern;

  • disclosure is necessary to protect someone from serious harm.

You have the right to:

  • request access to your personal information;

  • request correction of inaccurate information;

  • request restriction of processing in certain circumstances;

  • request erasure where legally applicable;

  • withdraw consent where processing is based upon consent;

  • make a complaint regarding the handling of your personal information.

Some information may need to be retained where professional, legal or insurance obligations require this.

13. Data Protection Complaints

If you have any concerns about how your personal information has been handled, I encourage you to raise these concerns with me first.

Please submit your concern in writing by email.

I will:

  • acknowledge receipt of your complaint within 30 days;

  • investigate your concerns fairly and objectively;

  • keep you informed if further enquiries are required;

  • provide a written outcome without unnecessary delay.

You also have the right to complain directly to the Information Commissioner's Office (ICO) if you believe your personal information has not been handled in accordance with data protection law.

Website: www.ico.org.uk

14. Recording Sessions

To protect confidentiality and maintain the integrity of the therapeutic relationship, counselling sessions must not be audio or video recorded by either party without prior written agreement.

If recordings are agreed for training, accessibility or another specific purpose, the arrangements will be discussed fully beforehand and your informed consent obtained.

15. Technology Difficulties

Although every effort is made to provide uninterrupted online counselling, technical difficulties can occasionally occur.

If our connection is interrupted during an online session:

  • I will attempt to reconnect immediately.

  • If we are unable to reconnect within approximately 10 minutes, I will contact you using the telephone number you have provided.

  • Together we will decide whether to continue by telephone, reconnect online or rearrange the appointment.

If technical difficulties significantly reduce the quality of the session, we may agree to reschedule where appropriate.

16. Professional Insurance

I maintain professional indemnity and public liability insurance appropriate to my counselling practice.

Insurance Provider

Holistic Insurance Services
181a Watling Street West
Towcester
Northants NN12 6BX

Telephone: 0345 222 2236 / 01327 354249

Email: info@holisticinsurance.co.uk

17. Emergencies and Crisis Support

Counselling is not an emergency or crisis service.

If you believe you are at immediate risk of harming yourself or another person, please do not wait for your next counselling appointment.

Instead, seek immediate assistance by:

  • Calling 999 if there is an immediate danger.

  • Attending your nearest Accident and Emergency Department (A&E).

  • Contacting NHS 111 (including the Mental Health option where available).

  • Contacting your local Mental Health Crisis Team.

  • Contacting Samaritans on 116 123, available free, 24 hours a day, 365 days a year.

If I become concerned about your immediate safety and am unable to contact you, I may contact your emergency contact or emergency services where I believe this is necessary to protect life or prevent serious harm.

18. Ending Counselling

Either you or I may decide to end counselling at any time.

Whenever possible, I encourage us to discuss ending therapy together so that we can reflect on the work completed, acknowledge your progress and consider any future support you may need.

Where appropriate, we may agree to use the final session as an opportunity to review your counselling journey and bring our work to a thoughtful and respectful conclusion.

Should I become unable to continue providing counselling due to illness, retirement or other unforeseen circumstances, I will endeavour to provide as much notice as possible and, where appropriate, discuss alternative sources of support.

19. Complaints Procedure

I hope that you will feel able to discuss any concerns with me directly so that we can try to resolve them together.

If you remain dissatisfied, you may make a formal complaint in writing.

If your complaint relates to my professional conduct and cannot be resolved directly, you may also contact the British Association for Counselling and Psychotherapy (BACP) for information about their Professional Conduct Procedure.

20. Equality, Diversity and Inclusion

I am committed to providing counselling that is inclusive, respectful and free from discrimination.

I welcome clients from all backgrounds and seek to create a therapeutic environment where diversity is valued and respected.

I will not discriminate on the grounds of age, disability, gender identity, race, religion or belief, sex, sexual orientation, relationship status, pregnancy or maternity, or any other characteristic protected by law.

If you have any accessibility requirements or adjustments that would support your counselling, please let me know and I will make every reasonable effort to accommodate your needs.

20. Equality, Diversity and Inclusion

I am committed to providing counselling that is inclusive, respectful and free from discrimination.

I welcome clients from all backgrounds and seek to create a therapeutic environment where diversity is valued and respected.

I will not discriminate on the grounds of age, disability, gender identity, race, religion or belief, sex, sexual orientation, relationship status, pregnancy or maternity, or any other characteristic protected by law.

If you have any accessibility requirements or adjustments that would support your counselling, please let me know and I will make every reasonable effort to accommodate your needs.

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