CLIENT INFORMATION SHEET AND CONTRACT
AIM OF COUNSELLING & PSYCHOTHERAPY
The aim of therapy is to provide you, the client, with a confidential, predictable and safe space to explore personal and relational issues, or whatever else you feel is important to talk about. It's important to understand that no therapist can fix your problems for you, and that the work with any issues you discuss will ultimately have to be done by you. You're paying for expertise and insight, and Daniel will be making suggestions and giving you information. The more you take what is discussed in your sessions, think about it, apply it, and work on it between sessions, the more you will get out of coming to see Daniel.
FREQUENCY & LENGTH OF SESSIONS
Therapy tends to be weekly. Particularly in the early stages of therapy many people find it hard to maintain the “momentum” of change outside of sessions and hence frequent sessions help keep things on track. However, how often you come is of course affected by practical matters such as your ability to make time, the cost, travel etc.
Sessions run for 50 minutes.
PAYMENT
The fee is $180 per session (excluding 15% GST). Daniel will email you an invoice after the session, and payment is due 24 hours before your next session. If you wish to pay by cash, you can do that at the end of the session.
CANCELLATION
If you get sick, or need to change or cancel your appointment, please contact Daniel at least 24 hours before your appointment. If you cancel or change your appointment after this, there is a $80 cancellation fee, and if you cancel less than two hours before, you will be charged the full fee. If you miss your appointment, you will still be charged the full fee as Daniel will wait for you in case you show up. If you're late for your appointment you'll still need to finish on time to be fair to the next client.
This policy is in place so that if you cancel or change your appointment, Daniel can still offer your allocated time to someone else who might need it.
CONFIDENITALITY & LIMITS TO CONFIDENTIALITY
In most cases, the fact that you are seeing Daniel, and anything you might tell him, is confidential and he will not share this with anyone else without your permission. There are some exceptions to this policy:
If you or someone else are at risk of serious harm, which Daniel could prevent by breaking confidentiality, then he will act to prevent that harm. He will normally discuss this with you first however, unless there is an emergency or doing so would increase the risk of harm.
With your express permission, Daniel can liaise with other health professionals involved in your care to assist you in receiving the best possible care. If you've been referred to Daniel, he will normally ask your permission to liaise with the referrer, usually just to acknowledge the referral.
Daniel does not release therapy files to clients for use in court proceedings unless ordered to do so. This is not their intended use and they are too open to misinterpretation.
Like all psychologists, Daniel receives regular professional supervision from senior colleagues and peers on a regular basis. Supervision provides a check on the quality and safety of Daniel's work, and a means to develop his knowledge and skills. Though the focus is primarily on Daniel and how he works, he also talks about his clients in supervision. He does however, do his best to avoid saying anything that might identify the client.
THERAPY NOTES & FILES
Daniel keeps a record of each session on file while he is working with you. He keeps these notes securely after therapy in case you should choose to return at any point.
CONTACT OUTSIDE OF THERAPY
If Daniel meets you accidentally in public, he will wait for you to make the first approach. It's perfectly ok to ignore him if you'd like.
EXTRA SUPPORT & CRISIS SITUATIONS
Daniel can only offer very limited support outside of session times, but he is willing to make extra appointments as his schedule allows. You can phone or email Daniel, but you need to remember that he won't be able to talk for long, you might get his voicemail, and it might take him a while to get back to you. In a crisis, you need to contact public crisis services such as Lifeline (0800 543 354), or 111 if you need acute help.
KEEPING ROLES SEPARATE
Daniel also works for Hawke's Bay DHB, but this role is kept completely separate from his role as a private psychologist. He cannot access your DHB notes, nor access DHB resources or services for you.
DECLARATION
I have read and understand the above information, including the information about confidentiality and the limits to confidentiality.
I have read, understand and agree to follow Daniel's policy on fee payment and cancellation/changing of appointments.
I understand what is expected of me during therapy, and that if I do not follow these expectations it may reduce the effectiveness of therapy.
I have had the chance to ask any questions/discuss anything I want.
I understand that taking part in counselling and psychotherapy is my own choice, and I can withdraw at any time.
SIGN: ______________________________________________
PRINT NAME: ______________________________________________
DATE: _______________________