Eugene O'Reilly Counselling & Psychotherapy

Counselling Contract Form

The following document is intended to form an agreement for a professional therapeutic relationship between the two parties outlined below.
PLEASE READ IT VERY CAREFULLY THEN FILL IN THE FORM BELOW.
Failure to adhere to the agreed contract between either parties may lead to the termination of the agreement. This contract is subject to renegotiation at any stage of the working relationship by agreement of both parties.

SUBMISSION OF THE  FORM INDICATES YOUR AGREEMENT TO THE TERMS AND CONDITONS OF THE CONTRACT

Frequency and duration of counselling

The duration of the therapeutic process will depend on the type of difficulty or problem you are facing. Some people prefer to work with an open contract, whereas other people prefer to work with a fixed number of sessions followed by a review. In all cases, every 6 sessions Eugene and his client will review the therapeutic process together. This helps to assess whether the client’s needs are being met and, this will also help (if required) to carry out the necessary adjustments and/or establish new goals for the process.

Session Fees

Following the initial 45 minute consultation fee of €70.00, session fees are €80.00 per 50 minute sessions for individuals and €100.00 per 60 minute sessions for couples. Online sessions for individuals are €70.00 per 45 min session. Payment for your counselling sessions should be given to Eugene at the end of each session either by cash or card. Remote payments can be done via Sumup or Revolut.

Receipts can be issued after each session or can be requested at any time after.

Eugene offers a limited space to clients on a sliding scale basis. Sliding scale fees are variable prices for his professional services based on the client’s ability to pay. Such fees are thereby reduced for those who have lower incomes. This can be discussed and agreed at the initial consultation.

Cancellation Policy

Cancellation of sessions with less than 24 hours’ notice will incur the full fee. For cancellations with between 24 and 72 hours notice given, a cancellation fee of 50% will be charged to cover room hire and other costs. Eugene will not be able to keep the counselling space open for you in the following circumstances:

  1. If you do not attend 2 counselling sessions without contacting him.
  2. If you do not attend 3 out of the first 12 counselling sessions.

Eugene will always aim to give the client as much notice as possible of any holidays, training workshops, conferences or illness that might prevent him from being available at the time/day of the scheduled session. In such cases the counsellor will always aim to offer an alternative arrangement.

Confidentiality

If you have referred yourself for counselling then no one apart from Eugene would know you have attended or what was discussed.  If you feel that someone may need to know information about your counselling sessions, please make this clear to him at the beginning of the sessions. For example, if you have been referred to him by another party it may be in your interest for there to be some liaison.

As part of Eugene’s professional standards, from time to time he may need to share and discuss some of the information in the sessions with a qualified supervisor, always under a strict confidential and professional framework. The client identity is always kept anonymous.

Where written confirmation may be required to be passed on to a third party, this is restricted to a minimum. He is not able to provide in-depth reports on the sessions or give opinions or diagnosis.

General Data Protection Regulation

Your privacy is important to me, and if I need to communicate with you in a way which has your consent, and which is in line with Irish data protection. As a result of a change in Irish law, I now need your consent to how I contact you. Please fill in the contact details you want me to use to communicate with you in the second part of the form.  Where you do not grant consent I will not be able to use your personal data; so for example he may not be able to let you know about cancellations or share CBT material for work between sessions; except in certain limited situations, such as where required to do so by law or to protect members of the public from serious harm. Please note that all of your personal data will cease once you have withdrawn consent, other than where this is required by law, but this will not affect any personal data that has already been processed prior to this point.

Exceptions

  1. Where you as a client give consent for the confidence to be broken.
  2. Where Eugene feel it is appropriate to consult with, or involve other professionals such as your GP in circumstances where there is a risk of harm to you or to a third party. In such cases he will aim to discuss any action with you first and seek to gain your co-operation.
  3. Where in extreme cases where he is compelled by a court of law.
  4. Where statutory law requires him to inform the relevant authorities, such as terrorist activities, drug trafficking, or abuse of a child or vulnerable people.

Notes and Record Keeping

Eugene’s policy is to keep minimum notes and records. The information includes:

  • Personal information, such as your name, date of birth, address etc;
  • Background information that might be relevant to the counselling process;
  • Your signed contract with him;
  • Confidential case notes (describing the main focus of the session with any important information);
  • Information for service evaluation and statistical purposes.

If you have any concerns about Eugene’s policy on confidentiality and note-keeping, you’re welcome to discuss it fully at any stage. All files are kept in a locked file, in a locked room. The building is  alarmed and is monitored by CCTV. No information about clients is kept electronically, except where email correspondences might occur and a GDPR consent has been given.

Influence of alcohol or substances

Sessions will not take place if the client is under the influence of any misuse of alcohol or substances.

Complaints

Eugene is an Accredited Counsellor with the Irish Association for Counselling and Psychotherapy

(IACP). Any complaints about his work should be made through IACP on 01 2303536

Please fill in all fields in the form below.  

Where the answer  is  ‘None’ or n/a, please say so.

You will also be asked your contact preferences in line with Data Protection Regulations and your permssion for your contact inforamtion to be shared should it be required by the HSE for Covid 19 contact-tracing purposes.

Thank you!

Your form has been sent securely.