Informed Consent for Individual and Couple Counselling
This agreement outlines some important aspects of my counselling practice. If you are satisfied with the information below, please sign this consent form. We will discuss it together and you can ask me about any item in the agreement.
The purpose of our work together is to help you manage or resolve issues in your life that you choose to bring to the sessions. The aim of our work is to assist you in growing and developing yourself. I do not make decisions for you unless in my professional opinion you are in danger as discussed in the confidentiality section.
This process is client focused, in that you can introduce any issue you would like to work on at any time in the therapy. I will then explore with you how we might best approach this. I have a number of approaches and techniques I can use dependent upon what we agree will work best for you at that time. The work is very much tailored to you as an individual. You can ask to discuss the theory and techniques we are using at any time.
We will establish the goals for your therapy and I will regularly monitor the progress and give feedback to you. During the therapeutic process your goals can alter or could be modified.
The frequency of the sessions are discussed in the first session. It is recommended to meet weekly or biweekly in order to achieve progress. However if this seems too much or too infrequent for you, we can adjust it to your needs. Preferably you will have a regular time for your session.
The length of the sessions are individualised. Most of the individual sessions last for 60 minutes, however I offer 75 minute sessions if it seems more beneficial for your progress. It is your choice which length session you choose. For couple therapy the session’s duration vary between 60-90 minute, depending on the couple’s preference and the nature of the work. I discuss the preferences with each couple.
The length of the therapeutic process is dependent on the issues needing attention. I can always give you my thoughts on how long we might need to work together, but in the end the number of sessions you have with me is always your decision. We will discuss this in therapy.
It would be good if you raise your thoughts if you are thinking about finishing and that we have a last session for closing. I will also advise you if in my opinion it is time to meet less frequently or if it is beneficial for you to close or pause the therapy.
60 minute individual session: $135
75 minute individual session: $165
60 minute couple session: $155
75 minute couple session: $190
90 minute couple session: $220
Payment is due in either cash or bank transfer on the day of the service.
My bank account details are:
Zsofia Kigyossy ANZ 06-0574-0875877-00
If you are unable to come to your scheduled session, I require at least 24 hour notice to cancel your session. It is at my discretion, but generally if you fail to notify me within 24 hours, the following fees apply:If you notify me within 24 hours, but at least 3 hours before the time of your session I charge 50% of your session fee. If you don’t show up at the time of your appointment or give me less than 3 hours notice you must pay the full fee of your session.
I keep appropriate records of the counselling services I provide. The records are maintained in a secure location in the office. I keep brief records of my sessions noting your reasons for seeking therapy, the goals and progress for therapy, my impression, topics we discussed, your medical, social, and treatment history, records I receive from you. Clients can ask to see their file. However, as clients can find reading the reports emotionally difficult, and they may be written in a clinical style, clients are not permitted to take reports away from the therapy room.
Email: firstname.lastname@example.orgYou can email me any time. You can leave a detailed message and ask me to contact you. I will read your email as soon as I can. Generally, I will reply the same day, but it may take a day or two for non-urgent matters. I don’t reply to emails over the weekend or on holidays.
Phone: 022-585-5759You can call me during normal working hours, but I do not answer the phone during sessions, after 8pm or on the weekends. If you can’t reach me, please leave a text message or send me an email. I will return your call as soon as possible.
If your situation is urgent or an emergency and you can’t wait for my reply, you can
If you are unhappy with what is happening in therapy, please raise the issue with me first so I can respond to your concerns. Such comments will be taken seriously and handled with care and respect. You can end the therapy with me at any time and go to another professional. There might be situations when I may need to stop seeing you as your therapist; this could be if there is a conflict of interest, ethical concerns, or if with clinical judgment I identify that I might not be able to help you at this point in time. If this is the case, I will provide referrals for you to see another therapist.
You have the right to receive safe and respectful care without discrimination as to race, ethnicity, gender, sexual orientation, age, religion or country of origin. You have the right to ask questions about any aspects of the therapy and about my training and experience. I will not engage in social, professional, or sexual relationships with clients.
All communication from you to me as your therapist is confidential. That is, with the exceptions discussed below, I will not disclose information that you have provided me, either in person, or by phone, or email to anyone without your permission.
Limitations to confidentialityThere are certain circumstances when confidentiality does not apply. If the therapist’s assessment of a situation indicates you are at immediate or imminent risk of: serious self-harm; attempting suicide; physically harming someone else; abuse to another person or carrying out a major crime, the therapist must, in the interest of safety, take appropriate action. I will, if possible, fully discuss the situation with you, and develop a plan of action and involve relevant services.
In some cases, a situation may arise where you are involved in a court case, and the court subpoenas information held by the therapist for use in court proceedings. This will naturally be discussed with you.
Supervision: Any discussion between me and my supervisor is kept confidential. You can always ask the name of my supervisor.