Help Counselling


For 9 - 25 year olds
Bristol, Yate, Chippenham, Glastonbury
Help Counselling - Contact Form
CONTACT FORM

If you would like to access our services please fill in the Contact form below and press submit, we will reply to you via
email or phone. All information is treated as confidential.

* Denotes Required Field First Name


Last Name


Date of Birth


Age






Bristol Address








Is it ok for us to write to you at this address? Yes No

Home Address








Is it ok for us to write to you at this address? Yes No


Telephone Numbers
When can we call this number
Morning AfternoonEvening


Email


Please write in the box below the main reason why you would like to talk to someone.
This can help us to choose which counsellor might best help you.



DO YOU HAVE ANY SPECIAL NEEDS?
For example: wheelchair access, assistance with stairs, hearing problems, problems
with movement, dyslexia, problems with reading or writing. If you can describe what
you need it will help us to avoid difficulties for you



DOCTOR’S NAME AND ADDRESS:
As we emphasise in our confidentiality document, we will not contact a doctor without your knowledge.



IS THERE ANYTHING ELSE YOU THINK THAT WE SHOULD KNOW?
Please type below.



Confidentiality Statement

The matters discussed in counselling sessions with HELP! are treated as strictly confidential within the
supervision structure used to support the counselling process.
This means that we would not normally reveal any information to other people, including parents, teachers,
employer, social workers or probation officers, other than at your request or with your agreement.
The legal limitations are: There is a legal requirement for any citizen to report information relating to an act
of terrorism or money laundering, and, for very serious reasons; it is possible for a judge to demand access
to confidential information.


The ethical limitations are:

If you disclose that there is a serious risk to your own or someone else’s life, we have a procedure to evaluate the risk and we would wish to support you in acting to remove that risk. If this is not possible, we will inform the authorities if the risk is evaluated as serious.

If you disclose that a child is currently experiencing or is in danger of experiencing abuse,as defined by the Child Protection Act, we would wish to support you in acting to protect that child. If the abuse is serious we have procedures to act for the benefit and protection of the child that do not necessarily require the source of the information to be revealed.

Whenever possible, if we feel that we need to suspend confidentiality for one of these reasons, we would discuss.

(Giving us a name and ticking this box has the same legal significance as a signature.)



For a guardian: to signify that you understand and accept these conditions, please tick this box:

For Your Information

Records.

It is normal practice for a counsellor or therapist to write notes on each session. These constitute factual details, reflection on the counselling/therapy process, the making of therapeutic contracts and progress towards goals. With some notice a client may view the records of their sessions. We keep written or word-processed records of sessions. We follow the guidelines of the Data Protection Act.

We routinely record sessions. The recording is made unobtrusively. This is primarily to protect our counsellors from allegations, particularly when working with young people where recording is also part of our child protection policy. The client can, at any time, ask for recording to stop.

Clients often provide a lot of detailed information in the first few sessions and having a recording of this reduces the need for note taking. The recordings can also sometimes be helpful for supervision. Usually the recording is simply archived. A recording could be selected for examination purposes, as part of the counsellor’s ongoing professional development. When used in this way the identity of the client is not revealed. Specific permission for this use would be sought, and usually recorded on a form. The client can, at any time, ask for recording to stop.

Our counsellors/therapists reserve the right to use written and/or recorded material to defend themselves in the event of allegation or complaint.

Under exceptional circumstances, certain authorities can request legal access to records. We will refuse access unless ordered by a judge.

All information you provide is kept securely. Any paperwork no longer required is shredded.

Minors.

We work with minors on the understanding that no specific details of conversations will be revealed. The ‘client’ is the person we work with and we insist on the protection of their privacy as a therapeutic necessity.

The emotional and physical environment that the young person experiences is highly dependent on the caregivers and we will on occasion make general suggestions to the caregiver that are intended to facilitate the desired outcome. Such conversations will usually occur in the presence of the client.

The client should make payment of fees, even if parents, guardians or carers are providing the money. It recognises the client’s control over the working contract.

Once the counsellor has established a therapeutic relation with a client it is rarely in the interests of the client for the relationship to be unilaterally ended. We work with minors on the understanding that, when it requires the agreement of the counsellor and guardian to begin the sessions it also requires the agreement of both to end the sessions.

Security.

All our staff will respect the privacy given by this confidentiality agreement.

All our staff have enhanced CRB disclosures to meet our requirements for child protection.

Ethics.

We subscribe to and follow the ethical framework of the British Association for Counselling and Psychotherapy and the code of ethics of the UK Council for Psychotherapy.

Because issues may only become clear once sessions have started, we regard the first three sessions as mutually exploratory. The client may decide the mode of therapy not to suit them and the counsellor may decide that the clients needs are better met by a different therapeutic approach or a different practitioner. This would be explored in the session before making a decision.

Complaints.

The normal duration of a session is between fifty minutes and one hour. If you are under 18 we prefer for you to be accompanied by a parent, carer, teacher or other trusted adult but you could come on your own or with a friend if you wish. At the end of this session a mutual agreement for further counselling/therapy may be made.

The following conditions are intended to protect the physical and emotional safety of everyone involved.

Costs

We ask to consider the following:
We are a self-funding voluntary agency. We depend on payments from clients to pay the bills.The counsellors/therapists do not charge for their time and usually offer to provide four sessions a week. You will choose how much to pay, subject to a minimum fee of £3.

The overhead costs of providing a session is £10 so we would ask you to consider this as a minimum payment but if you cannot afford that, be assured that we respond only to client’s needs and we never select on the level of payment.

The charge for our service in private practice would be £40 a session. A payment above £10 allows us to provide a service to those who need it and can least afford it. This is the key to our continuing to provide a service, and we provide about 1500 sessions a year.

We ask you to make a responsible decision, please choose an amount you can live with and also supports us. You can change the amount at any time. It is always your decision.

Please indicate the level that you think that you are able to pay.

Cancellations

As client’s payments are used to cover our costs, and those costs are incurred on every session, we ask for a payment for every session, including the first.

Please give as much notice as possible if you are not going to come to a session.

If you give more than 24 hrs notice, there will be no charge for that session. If less than 24hrs notice is given half the fee will be charged. If no notice is given, that is, you simply don’t appear, the full fee will be charged.

If you fail to attend two consecutive sessions in this way, without contacting us, we will consider that you have terminated this contract. A high rate of non-attendance will lead to a review of the relevancy of the work at this time in your life and your commitment to it. As the counsellor to client relationship is exclusive, there is usually no cover if the counsellor is on vacation, ill or otherwise absent.

Ground Rules

We work with the expectation of mutual respect and valuing.

The counselling session will be ended if:

The client or anyone with them is abusive to the counsellor or other staff. The client or anyone with them threatens or acts to injure himself or herself, to hurt the counsellor or other staff, or to damage property. The client or anyone with them is under the influence of, or in possession of, alcohol or illegal drugs. You may at some time want someone to join you in a session. Please plan this with counsellor. We work from a number of different places. Some have disabled access, some do not. Some are only accessed by stairs. Please make it clear on the client contact form if you have any problems with access. If a responsible adult accompanies you and they wish to wait during your session, please check that is possible at the place you are seeing a counsellor. We encourage an adult to stay on the premises with any child under 16 years old if this is possible but on some of our sites there is no reception area. This can be discussed at the initial session.

For legal reasons we do not allow anyone under the age of 18 to wait unsupervised on our premises. This includes the grounds outside the building.

All our premises are NO SMOKING areas.

To signify that you understand and accept these conditions, please tick this box: