Consent for Counselling and Confidentiality Agreement
Consent for Counselling and Confidentiality Agreement
Thank you for choosing me to support you on your journey toward achieving your personal goals. Please carefully read the following information regarding our counselling relationship, services, and confidentiality. If you have any questions, feel free to ask for clarification. By signing at the end of this document, you acknowledge that you have read, understood, and agree to the terms outlined below, including payment and service conditions.
COUNSELLING RELATIONSHIP
Our therapeutic relationship is a partnership where you bring knowledge of your life, and I provide expertise in the therapeutic process. I encourage active participation as we work together toward your goals. To enhance your progress, I may assign self-help activities or homework between sessions. We will discuss and agree on what tasks would be most beneficial to you. In some cases, we may communicate between sessions for brief updates via mail or phone.
SESSION FORMAT
Sessions typically last 50 minutes and are conducted in person or virtually. During our sessions, we may engage in one or more of the following:
• Listening to and discussing your concerns.
• Identifying your strengths and resources.
• Exploring thoughts, feelings, or behaviors that may be hindering your progress.
• Setting clear goals and developing action plans.
• Using interventions tailored to your goals.
• Providing information through discussion, handouts, or visual aids. • Conducting assessments to track progress and motivate you.
• Suggesting reading or writing exercises to deepen your understanding.
• Assigning homework for completion between sessions.
YOUR RIGHTS
You have the right to ask questions about any methods used in therapy and to make informed decisions about your treatment. If you feel therapy is not benefiting you, you have the right to discontinue sessions, and I would appreciate feedback on what isn’t working. If needed, I can suggest alternative resources or referrals. You are also entitled to request a referral if it is in your best interest.
RISKS OF PSYCHOTHERAPY
Engaging in psychotherapy can involve discussing difficult emotions and past experiences, which may be uncomfortable. Change, even positive change, can disrupt established patterns in your life, potentially leading to challenges in relationships or other areas. Be aware that therapy is a process of growth and transformation that may come with some resistance from others around you.
CONFIDENTIALITY
Everything you share in therapy is kept confidential, and your records are stored securely. Digital files are protected with password encryption, though full confidentiality cannot be guaranteed for electronic communications. If we decide to share your therapy information with another party (e.g., your doctor), I will request your written consent.
For couples, any information shared in individual sessions can remain confidential unless it affects the integrity of your ongoing couples therapy.
EXCEPTIONS TO CONFIDENTIALITY
In certain situations, I am ethically and legally obligated to break confidentiality:
• If you express a serious intent to harm yourself or someone else, I am required to inform the relevant parties, such as your family or the intended person.
• Under the Child Welfare Act, I am mandated to report any known or suspected abuse (physical, emotional, sexual, or neglect) of children under the age of 18 to the appropriate authorities.
• If you are involved in legal proceedings and disclose your therapy participation to the court, your right to confidentiality may be waived, and I may be required to provide information if subpoenaed.
Communication between a therapist and client is not privileged in legal terms, except in certain circumstances, such as child abuse or direct harm threats.
FEES
The fee for a virtual session is KES 1000 and for a physical session is 2,500 per 50-minute session. Payments should be made via MPESA to the SIKI Youth Till number 8559678.
CANCELLATION POLICY
Please provide at least 48 hours notice if you need to cancel or reschedule an appointment. This allows me to offer the slot to someone on the waitlist. Cancellations made less than 24 hours before the scheduled session or missed appointments without prior notice will incur the full session fee.
TERMINATING THERAPY
Therapy is a structured process with a clear beginning, middle, and end. If you wish to stop therapy, it is recommended that we discuss this decision and plan for a smooth conclusion.
By continuing with therapy, you acknowledge that you have read and understood this agreement. You agree to the terms and conditions, including the 24-hour cancellation policy, and you commit to participating in the therapy process.