Therapy Agreement

Welcome! Thank you for choosing to work with me.

Please read this agreement before our first session. You can ask me any questions about it at any time during our work together.

Please also read my Privacy, Data Protection & Digital Working Statement. It explains in more detail how I use and protect your information. A paper copy can be provided if you prefer. This contract includes reference to those terms.

 

Quick Highlights - What You Need to Know

• 🐾 Dogs: I work from home and have two gentle small dogs who are usually around. If you prefer not to meet dogs, online sessions are available.

• ↩ Cancellations: Sessions cancelled with less than 24 hours' notice are normally charged in full. Exceptions may be made at my discretion in genuinely exceptional and unavoidable circumstances and for those with ME/CFS and chronic illness.

• 🔒 Confidentiality: Sessions are confidential unless there is serious risk to yourself, others or animals, safeguarding concerns, or I am legally or professionally required to share information. Where possible, I will aim to discuss this with you first.

• ◯ Therapy Style: I work in a warm, practical, flexible way and draw upon counselling, EFT, mindfulness, therapeutic and life coaching, breathwork, somatic approaches, gentle movement, yin yoga, psychoeducation and creative techniques, depending on your needs, choices and preferences. Everything is led by your choices.

• ✓ Additional Support: I sometimes facilitate women's circles, workshops, retreats and offer other resources which may complement therapy. Please ask if you are interested.

 

About Me

I offer a safe, flexible space for reflection, healing, growth and change.

I specialise in supporting women, children and young people and use a range of therapeutic approaches very much tailored to your individual needs. I am a qualified counsellor, EFT practitioner, mindfulness and yin yoga teacher, with over 30 years' experience working with children, young people, families and adults in education prior to becoming a therapist.

I am an accredited and registered member of the National Counselling and Psychotherapy Society (NCPS: NCS23-00264), fully insured, enhanced DBS checked, and registered with the Information Commissioner's Office (ICO: ZB844611).

I also have lived experience of complex trauma, ADHD and ME/chronic fatigue syndrome, which clients tell me leads to genuinely experienced insight, understanding and compassion within my work.

We will regularly review our work together and collaborate towards the outcomes that matter most to you. Clients often experience impact and results within as little as 3 sessions, though all clients are different and complex issues usually require longer-term work.

 

Sessions, Fees & Cancellations

• Sessions: Sessions last 50 minutes and usually take place weekly. Sessions may be face-to-face, online, by telephone, or a combination of these. Fees are £75 for face-to-face or hybrid/online sessions but concessions are available for those unable to pay full cost though there may be a wait. Concessions are limited in number to allow for those with most need to access help.

• Payment: Payment by BACS is due 24 hours before your appointment. Cash payments are accepted at the start of all face to face sessions. Bank details are available on request and when we start working together.

• Fee changes: Any fee increases will be communicated with a minimum of four weeks' notice. These are usually annually.

• Cancellations: Sessions cancelled with less than 24 hours' notice will normally be charged in full (100% of the session fee). Exceptions may be made at my discretion in genuinely exceptional and unavoidable circumstances.

• Missed sessions: More than three missed appointments, repeated short-notice cancellations, or extended breaks in therapy without agreement may result in therapy ending. You are always welcome to enquire about returning in the future.

 

Confidentiality & Records

What you tell me in counselling is confidential. The main exceptions are where I believe there is a serious risk of harm to you, another person or an animal, there is a safeguarding concern, or disclosure is legally or professionally required. If I need to share information, I will aim to discuss this with you first where it is safe and appropriate to do so.

I discuss my work in professional supervision. Cases are discussed anonymously wherever practicable and identifying information is kept to a minimum. My clinical supervisor is also bound by confidentiality. Information may also be shared with my insurer, professional body, legal advisers or relevant authorities where necessary and appropriate.

Recording of sessions by either of us is not permitted without prior written agreement.

I keep appropriate records of our work. Adult retained records are normally kept for seven years after therapy ends; records relating to clients under 18 are normally retained until age 25. Full details about what I keep, storage, retention, your data-protection rights and how to request access to your information are in my Privacy, Data Protection & Digital Working Statement.

I normally ask clients to provide current GP details and to keep these up to date. Providing an emergency contact is optional. I contact your emergency contact only in a medical emergency.

If I become seriously ill, incapacitated or die, my clinical supervisor, who is also my nominated clinical-will counsellor, may contact active clients, make necessary arrangements and securely manage my counselling records.

 

Artificial Intelligence (AI)

I sometimes use AI-assisted tools for limited professional purposes such as general research, reflection, drafting, developing ideas and resources. I do not enter identifying client information, copies of client records or private, identifiable details into AI systems. AI supports my work but does not lead it: it does not replace professional supervision or judgement, and I remain responsible for all professional decisions. I have undertaken various trainings for counsellors on the ethical use of AI as a counsellor.

Some clients choose to use AI-based chat tools or apps for personal support. These systems do not know you as a person over time, do not hold a professional duty of care, and may provide inaccurate information whilst sounding confident. Information shared with them may be stored or processed outside my control and outside the confidentiality protections offered within therapy.

If you use AI tools for personal support, you are warmly invited to discuss this within our work so we can reflect on any benefits, concerns or questions that arise, should you wish to do so.

 

Limitations & Breaks

I usually take one week off every 5-6 weeks, along with longer breaks over Christmas, Easter and Summer. Online sessions may occasionally be offered during these periods where continuing therapy is considered beneficial, but this is entirely optional. Sometimes I may need to cancel a session myself which would be exceptional. I would give you as much notice as possible.

Counselling is not a crisis service and cannot provide emergency support between sessions. For urgent support please contact your GP; Samaritans: 116 123; Worcestershire Crisis Line: 0808 196 9127; Shropshire Mental Health Helpline: 0808 196 4501; text SHOUT to 85258; or call 999 in an emergency or if you believe your life is at immediate risk.

Online and telephone sessions may take place using Microsoft Teams, WhatsApp, FaceTime or telephone. I take reasonable steps to maintain privacy at my end, but no online platform or electronic communication system can be guaranteed completely secure. Please choose a sufficiently private and safe place for your session and tell me if someone else may be able to hear or observe it.

 

Keeping You Safe

We may create a personalised safety plan together, or I can provide resources to help you create one independently.

Therapy can sometimes bring difficult emotions to the surface. While I work carefully and collaboratively to minimise overwhelm, you remain responsible for your choices and actions between sessions. I encourage open communication about how you are feeling so that we can work safely and effectively together.

If I believe you or someone else is at immediate risk of serious harm, I may contact emergency services, safeguarding agencies or your GP, with or without your consent if necessary. For clients under 18, I may contact a parent or guardian where safeguarding concerns arise, although I will seek to discuss this with you first wherever appropriate.

Emergency contact details will only be used in the event of a medical emergency.

 

Ending Therapy

Following our first three sessions, we will review together whether continuing therapy feels beneficial and appropriate. I will specifically ask whether there is anything you would like me to do differently or anything you would like to change about how we are working together. You can raise this at any other time too.

You may end therapy at any time without further cost or obligation. A final session is recommended but entirely optional.

I may end therapy due to unpaid fees, repeated missed appointments, inappropriate behaviour, conflicts of interest, professional limitations or ethical concerns or if I should become ill (this list is not exclusive). In some circumstances I may be unable to fully explain my reasons if doing so would compromise confidentiality, safety, professional boundaries or ethical obligations. Where appropriate and possible, I may offer onward referral options.

 

Feedback & Complaints

Feedback is welcomed, particularly during the first three sessions when we review whether we are a good fit to continue working together. It is a good opportunity to honestly express what is working well and not so well, and this is always helpful and welcomed.

If you have concerns about our work, please raise them with me so I have the opportunity to respond. If they remain unresolved, you may use the NCPS formal complaints procedure (NCPS: NCS23-00264).

At the end of therapy, you may be invited to provide feedback about your experience. Participation is entirely voluntary.

 

Your Responsibilities

• Appointments: Attend sessions regularly and on time and give as much notice as possible if you need to cancel.

• Payment: Pay fees at least 24 hours in advance of a session.

• Online sessions: Use a private, uninterrupted space and a reliable internet connection.

• Contact: Limit contact outside sessions to administrative matters or any therapeutic contact agreed between us.

• Working together: Be open and honest in sessions and share relevant medical or risk-related information so that I can support you safely. Tell me if there is anything you would like to change about how we are working together, particularly when I explicitly ask after our third session.

• Changes: Let me know if your contact details, GP details, emergency contact details or significant circumstances change.

• Medical care: Therapy is not a substitute for medical advice, diagnosis or treatment. If you have concerns about your physical or mental health, please contact your GP or another appropriate healthcare professional.

 

Social Media & Online Presence

To maintain professional boundaries, I do not accept personal friend requests or personal social-media connections from clients. You are welcome to follow or engage with my public business pages and professional content if you wish.

 

About My Dogs

I work from home with two friendly dogs. If you prefer no contact with dogs, or have allergies, please let me know.  I can offer online sessions. While I manage the space carefully, I cannot accept responsibility for accidental contact, trips, falls or allergic reactions (or dog licks!).

Please tick:     ☐ Happy to visit with dogs present      ☐ Prefer no dog contact and online work

 

Clients Under 18

My standard arrangement is for both the young person and a parent or person with parental responsibility to sign this agreement, so that everyone is aware of and agrees to the counselling arrangements. Other circumstances may arise and will be considered individually, taking account of the young person's age, understanding, circumstances and my professional responsibilities.

Counselling remains confidential to the young person, subject to the same limits of confidentiality described in this agreement. However, often in reality the young person likes for us to have chats together and that is fine too but I am led by what the young person wishes as they are my client.

For insurance purposes, where a client is under 16, a parent or responsible adult must remain on site throughout the counselling session.

 

Consent & Signatures

By signing this agreement, you confirm that you have read and understood these terms, including the limits of confidentiality, and have been given access to my Privacy, Data Protection & Digital Working Statement. You have had the opportunity to ask questions and agree to counselling on this basis. This does not affect your legal data-protection rights.

☐ Sensitive information: I explicitly consent to My Mindful Counsellor processing relevant sensitive information I provide, including health and mental-health information, where this is needed to provide counselling safely and effectively. I understand I can withdraw this consent, although this may affect whether counselling can safely continue. Limited processing may still be lawful without my consent where another legal basis applies, as explained in the Privacy Statement.

​

Please keep a copy for your records.

Therapist: Dionne Powell

Date: As per email contract sent

Client  (person receiving counselling:

Date

 

Parent / person with parental responsibility (for clients under 18)

Under-18s – Parent/Guardian Consent

✔ I consent for my child to work with Dionne Powell.

✔ I understand I remain on site where my child is under 16 years of age.

✔ My child understands the different options available and agrees to participate in counselling.

✔ I confirm that I have legal authority to provide consent and that no additional signature is required.

Parent/Guardian: ______________________

Date: ________________________________