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  • Stepping Stones Psychology Tel: 079 39 321 332 Email: contact@steppingstonespsychology.com www.steppingstonepsychology
  • MEDICAL INFORMATION

  • This form collects relevant medical and personal information to help your therapist provide safe, appropriate, and effective support. It includes questions about your physical and mental health history, current medications, and any conditions that may impact your therapy. All information will be treated confidentially and in accordance with GDPR regulations.

  • CLIENT DETAILS

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  • DETAILS OF GENERAL PRACTITIONER

  • DETAILS OF ANY OTHER PROFESSIONALS & SERVICES

  • BRIEF DETAILS OF ANY RELEVANT PREVIOUS MEDICAL HISTORY

  • DETAILS OF ANY CURRENT PRESCRIBED MEDICATION

  • DETAILS OF ANY CURRENT NON-PRESCRIBEDMEDICATION

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  • DETAILS OFRECREATIONAL DRUG CONSUMPTION (WEEKLY)

  • ADDITIONAL INFORMATION

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  • This document outlines the terms and conditions of your therapeutic work with Stepping Stones Psychology. It includes important information about confidentiality, booking and cancellation policies, therapist and client responsibilities, session structure, and ethical boundaries. Signing this contract confirms your understanding and agreement to engage in therapy within these guidelines.

    The following are our company policies:

    • Therapy Agreement & Service Terms (incl. Booking and Cancellation Policy)
    • Confidentiality Policy
    • Boundary Policy
    • Data Protection Policy
    • Agreement and Signature (Therapy Contract)
  • OUR POLCIES

  • BOOKING AND CANCELLATION POLICY

     

    1. Booking & Payment Terms:

     

    • Prepayment Required: All sessions must be paid for in advance.
    • Zoom sessions: Payment required  no later than 48 hours before. 
    • In-person sessions: Payment required  no later than 72 hours before, including room fee (£12/hr Mon–Fri for counselling/standard psychotherapy/ £18.75 per session for EMDR).           
    • A session will not be booked or confirmed until full payment is received. 
    • Clients with outstanding balances will not be able to book further sessions until cleared.

     

    2. Cancellation & Refund Policy:

     

    Zoom Appointments:

    • Cancellations with at least 48 hours’ notice incur no charge.                           
    • Cancellations with less than 48 hours’ notice are non-refundable and charged in full.

    In-Person Appointments:

    • Cancellations with at least 72 hours’ notice incur no charge.                           
    • Cancellations with less than 72 hours’ notice are non-refundable, and the room fee will still apply.                                                                        

    Additional Booking and Cancellation Agreement

    • Missed sessions or late arrivals (10+ minutes for zoom/ 15+ minutes for in-person) without contact will be treated as cancellations and charged in full. 
    • Transferred or rescheduled sessions are subject to the same cancellation terms and conditions as the original booking. 
    • Repeated short-notice cancellations may result in therapy being paused or terminated without refund.                                                        

     

    3. Session Conduct & Attendance:

     

    Clients are expected to:

    • Arrive on time, fully clothed, and free from drugs or alcohol.                           
    • If under the influence, the session will be terminated and charged.                   
    • Ensure privacy during remote sessions. Public spaces or shared environments (including children present) may require rescheduling.                                   
    • Understand that sessions cannot be extended if the client is late.                       
    • If the therapist is late, the full session time will still be provided.
    • All emotions are welcome, including clients expressing anger and swearing. However, I have a firm boundary regarding aggression and verbal abuse directed toward me. I will not tolerate any aggression or verbal abuse directed at me. If this occurs, I will have to end the session, and I will not be able to continue working with you. This is nothing personal against you, but rather me taking personal accountability and responsibility by not working with clients whom I do not feel are a good fit for me. I am unable to do my best work in that situation. There are therapists who may feel comfortable with this and who are able to continue working with a client behaving in this manner, but it is outside my competence. As explicitly explained in this contract within the Boundary Policy, and agreed to by the client when signing, any such behaviour will be considered a boundary breach by the client. If a session ends early due to a boundary breach, the payment for that session will not be refunded. 

     

    Session Frequency & Therapeutic Commitment

    While your autonomy and pace are important, infrequent sessions can be unsafe, especially with high-risk mental health conditions that may cause harm or severe impairment. Long gaps between sessions risk emotional destabilisation or retraumatisation because therapy can bring sensitive material up to the surface

    For effective trauma work, sessions are ideally weekly at first (Phase 1 & 2). I require sessions at least every two weeks unless we are in Phase 3 (winding down therapy).

    Monthly sessions are usually for review and support, not in-depth therapy. They don’t provide the continuity or relational depth needed for trauma work and would not be clinically appropriate.

    To keep therapy safe and effective, I cannot continue monthly sessions unless we both agree you are near discharge. If you prefer a slower pace, we can discuss goals that fit that approach. If you are unsure and want to understand this a bit better, please see here under 'Session Frequency and Therapeutic Commitment'.

     

    4. Notice Period (Therapy End)


    Notice Requirement

    A four-week notice period is required when ending therapy. This notice period is in place to allow for appropriate clinical closure, planning, and transition, which are considered best practice in therapy.


    Prepayment of Final Sessions

    To simplify this process and ensure the notice period is covered, clients are asked, after the initial consultation and when confirming the first session, to pay in advance for their final sessions as follows:

    • Four sessions (standard), or
    • Two sessions (if the client has financial difficulties and a reduced payment plan has been agreed).

    These pre-paid sessions act as the final sessions of therapy and automatically cover the required four-week notice period.

    No additional payment required

    When notice is given, clients will already have paid for their final sessions (two or four, depending on the agreement) and will not be required to make any additional payments for those sessions.


    Sudden Termination / Missed Sessions

    If therapy is ended suddenly without providing the required notice, or if the pre-paid final sessions are not attended, the pre-paid sessions will be retained in lieu of notice, in accordance with the contract.


    Purpose and Ethical Rationale

    This policy is in place as a contractual provision designed to:

    • Ensure fairness for both client and therapist,
    • Maintain the integrity of the therapeutic process, and
    • Allow the therapist to manage clinical scheduling responsibly.

    This approach aligns with ethical guidelines from professional bodies, which support clear agreements regarding notice, fees, and structured, safe endings to therapy.

     

    5. Addiction & EMDR Protocol:

     

    If you have relapsed or taken substances within 12–24 hours before a session:

    • EMDR cannot be provided.                                                                                   
    • You may either:

    -        Reschedule (cancellation terms still apply), or

    -        Switch to a general counselling session.

    • If the room has been booked, full room and session fees apply even if EMDR is not delivered.                                                                                          
    • In this case, you will be charged the counselling rate, and if applicable, the EMDR room booking fee.

     

    6. Therapy Planning & Breaks:

     

    • Once a therapy plan (e.g. EMDR, counselling) is agreed, it will be followed unless reviewed together and changed by mutual agreement.                                
    • Clients may request to switch therapy types, but this requires a new agreement and re-contracting.                                                                           
    • Clients must give:                                                                                              
    • 1 week’s notice for short breaks or adjustments due to life circumstances affecting EMDR/intensive work.                                                                             
    • 1 month’s notice for extended breaks (over 2 weeks) or permanent schedule changes.                                                                                                            
    • Therapy may be paused if this notice is not given. Unused sessions witout notice will still be charged.

     

    7. Therapist Commitment to You:

     

    Your therapist agrees to:

    • Keep to time boundaries. If late, will try to ensure you receive the full session.                                                                                                       
    • Offer sessions via Zoom in colder months (Oct–Mar) or on windy days due to medical health needs.                                                                                                               
    • Contact you promptly in the event of illness or cancellation. Where possible, sessions will be rearranged within the same week (If I have a sudden health flare up, I will have to take sick leave and will not be able to work. I will do my best to give you as much notice as possible, but sometimes short notice can’t be avoidable. I’ll do my best to offer you a session another day that same week)
                                                   
    • Maintain professional boundaries, including if you cross paths outside sessions (see Boundary Policy below for further details).                                                    
    • Be emotionally and physically fit for work and work within their competence.              
    • Refer you to another practitioner if issues arise beyond their capacity.                          
    • Provide a minimum of one month’s notice if therapy must end unexpectedly (except in emergencies).                                                                                      
    • Follow the NCPS Code of Ethics, hold valid insurance, and attend regular clinical supervision (at least once monthly).

     

    8. Confidentiality & Ethics:

     

    • Your sessions are confidential, with limits outlined in the Confidentiality Policy.                                                                                                               
    • Confidentiality may be broken if you are at risk of serious harm to yourself or others. Where possible, you will be informed beforehand.                                      
    • Supervision is held with a qualified supervisor and fully anonymised.                      
    • Support sessions as an addition to regular therapy sessions are available. These are not emergency/crisis support. Therapists do not provide emergency/crisis support. Clients should contact emergency services or crisis helplines if/when required.  

     

    9. Record Keeping & Data Protection:

     

    • Notes are kept brief, factual, securely stored, and coded. You have a right to access them.                                                                                                      
    • Data is processed in compliance with the UK GDPR and guidance from the ICO.                                                                                                                   
    • If you consent, secure AI tools may be used to support supervision or note-taking.                                                                                                              
    • Therapists may occasionally request consent to record sessions for training, always without identifying you.
    • Some administrative tasks are handled by a trusted third party under strict confidentiality agreements, for example my PA
    • Other sensitive data that may be accessed by trusted third parties includes information held within my scheduling platforms (Acuity/Squarespace) accessed by Acuity/Squarespace, as well as my bank and my accountant. However, all of these services are GDPR-compliant, and I only grant access to any third party after confirming their compliance with GDPR regulations in advance.

     

    10. Medical Limitations:

     

    • Therapists cannot prescribe medication, diagnose medical conditions, or provide medical advice.                                                                                       
    • Clients are responsible for informing their therapist of:                                     
    • Any mental or physical health conditions, past or present.                                     
    • Any substance use, prescribed or recreational.                                                     
    • Any changes in health or medication between sessions.

     

    11. Additional Terms:

     

    • Fees are: £85 for 50 mins  counselling/ £115 for 90 mins Specialist Trauma Therapy (and room fees where applicable). Reduced rates are applicable at the Clinical Director's discretion and the discounted fee will remain as agreed. Clients will be notified 2 months in advance of any changes.     
    • Clarification about how 90-minute sessions work: Booking 90 minutes (60-minutes for clients on the accessible therapy package) is the maximum time we would spend on an EMDR session, but it doesn’t mean we automatically go the full 90 minutes. If we naturally reach the end of a processing phase, we’ll finish there, especially after grounding and regulation, so we don’t start a new topic when it’s not ideal. Also, if you book a 90-minute session (60 minutes for clients on the accessible therapy package) but decide not to do EMDR, the session will be counted as a Phase 1 talking session and will end around the usual 60-minute mark (50-minute mark for clients on the accessible therapy package). 
                                  
    • One client per session unless prior agreement has been made for systemic/family/couple support sessions.                                                                           
    • Sessions moved to another day/time due to rescheduling or therapist illness are still subject to standard terms.                                                                        
    • Stepping Stones Psychology reserves the right to pause or end therapy at any time, particularly in cases involving high-risk behaviour, addiction relapse, or breach of agreement.                                                                                           
    • Therapy will not resume if there is any outstanding balance.                                                                                                                
  • SUPPORT AND CRISIS GUIDANCE


    11. Sharing risk and relapse


    If you experience suicidal thoughts, self-harm urges, or relapse, please let me know so we can address this together in therapy. Being open with me helps ensure I can plan sessions safely and appropriately, e.g., it would not be safe to proceed with EMDR/trauma therapy if you are not in active addiction recovery. I can offer psychological support in our sessions, including exploring what is happening for you and helping you strengthen your resources. However, this is not crisis or emergency support.


    Relapse, self-harm urges, or suicidal thoughts do not mean therapy has failed, but instead they are important signs that we can work on together in a safe and supportive way.


    12. Boundaries around contact


    Please note that I cannot guarantee immediate responses to emails, texts, or phone calls outside of session times. If you are in crisis, you must use the emergency support options outlined below.


    13. Crisis responsibility


    Letting me know about suicidal thoughts or relapse is important for our therapeutic work, but keeping yourself safe in the moment requires using crisis services if you are at risk. This does not replace seeking immediate crisis or emergency support, as I am not able to provide a crisis service.


    14. Trauma Therapy safety


    For your safety, trauma-focused therapy such as EMDR cannot proceed during periods of active relapse or severe crisis.


    15. Referral Pathways


    If ongoing crisis or relapse significantly affects your safety, I may recommend additional or alternative support alongside therapy (e.g. liaising with your GP or suggesting higher-level mental health services).


    16. Crisis Information


    As I am not able to provide a crisis or emergency service, if you ever feel you are in a mental health crisis, immediate danger or at risk of harm, please:


    • Call 999 or go to your nearest Accident & Emergency department if you feel you are at immediate risk of harm.

    • Contact your GP for urgent support.

    • Call NHS 111 (available 24/7) if you need urgent medical help or advice that is not life-threatening.

    • Call Samaritans (available 24/7) on 116 123 if you need someone to talk to.

    • If you are under the care of a mental health team, you can also use your local Crisis Team number if you have it.


    Please keep this information somewhere safe so you can access it quickly if you ever need to.

  • CONFIDENTIALITY POLICY

    For more details on our Confidentiality Policy, please click here.

     

    BOUNDARY POLICY

    For more details on our Boundary Policy, please click here.

     

    DATA POLICY 

    For more details on our Data Protection Policy, please click here.

     

    PRIVACY POLICY

    For more details on our Data Protection Policy,, please click here.

  • THERAPY CONTRACT

    Client Declaration & Agreement
  • By completing and submitting this form, you (the client) are agreeing to work together with me (the therapist) under the terms outlined here, and I am equally agreeing to provide services in line with this agreement. It begins on the date you submit the form and remains in place for as long as we continue working together.

    By signing this contract, you also confirm that:

    • You have read and understood the Data Protection Policy, and you accept how your personal data is processed, stored, and protected in accordance with GDPR and applicable data protection laws.
    • You understand how your personal information is handled and stored, and you consent to the use of GDPR-compliant platforms and trusted third-party services as outlined in the Privacy Policy.
    • You understand and agree to the Confidentiality Policy, including the role of administrative support, and agree to take shared responsibility for maintaining privacy in written communication (e.g. avoid sharing sensitive personal or therapeutic details by email. If absoloute necessary, clearly mark the subject as “Confidential” or “For Sharmi only”).
    • You have read, understood, and accepted the terms outlined in this Boundary Policy, and agree to uphold these principles throughout our work together.
  • Therapist's Agreement

  • Date: Automatically effective for both of us (the therapist and the client) on the date of client submission.

      

    Therapist's Name: Sharmi Gowri-Kriszyk

     

    Therapist's Signature:

     

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