Informed Consent and Intake Form for Couples Counselling Services

Albatross Counselling and Wellbeing

NATURE OF COUPLES COUNSELLING

Couples counselling focuses on understanding the interaction patterns, communication processes, emotional dynamics and relational difficulties occurring within the relationship.

The aim is not to determine who is "right" or "wrong," but to help both partners better understand and respond to one another in healthier and more constructive ways.

It may involve discussing personal experiences, thoughts and emotions, some of which may feel uncomfortable or difficult.

While many individuals experience clarity, relief and growth, the process may also involve periods of emotional intensity or uncertainty.

Outcomes vary depending on individual circumstances, engagement and time. Counselling is not a quick fix, but a gradual process.

SCOPE OF SERVICES
Services are provided to adults (18+) and are conducted online.

These services may include:
• Individual Counselling
• Couples Counselling
• Individual Wellness Sessions

These services are not a substitute for:
• Emergency services
• Inpatient or crisis care
• Psychiatric treatment requiring medication

RISK AWARENESS
To ensure appropriate support, it is important to acknowledge the following, please fill in your responses below:

If such risks are present or increase during the course of counselling, additional support, referral or changes to the scope of service may be required. These responses will be reviewed and may be discussed further to ensure appropriate support.

CONFIDENTIALITY & ITS LIMITS
Information shared during sessions is treated as private and handled in accordance with professional ethical standards.

Confidentiality may be limited in the following situations:
• Risk of harm to yourself or others
• Disclosure or suspicion of abuse or neglect
• Legal requirements
• Professional consultation (without identifying details)

A detailed Confidentiality Policy is available on the website.

If you would like information to be shared with a relative, employer, insurance provider or any third party, this request must be made in writing via email. Disclosure will only be made with your explicit written consent.

The emergency contact provided may be used only in situations where there is significant concern regarding your safety and you are unreachable.

COUPLES COUNSELLING FRAMEWORK

Neutrality
The counsellor does not take sides or act as an arbitrator regarding who is "correct" in disagreements. The therapeutic focus is on understanding relational patterns, communication processes, emotional responses and behavioural dynamics within the relationship.

 

Participation Expectations
For couples counselling to be productive, both partners are expected to:

• Participate honestly and respectfully
• Allow each other uninterrupted opportunities to speak
• Engage with the process even during difficult conversations
• Avoid abusive, threatening or intimidating behaviour

 

Behaviour During Sessions
The following behaviours are not permitted during sessions:

• Name-calling
• Verbal abuse
• Threats
• Intimidation
• Shouting over one another
• Deliberate humiliation

If escalation occurs, the counsellor may interrupt, redirect, pause or temporarily stop the interaction to maintain a safe and workable therapeutic environment.

 

No-Secrets Policy
Because the relationship is the focus of treatment, the counselling process generally operates under a no-secrets policy.

Information disclosed individually that significantly affects the relationship or the direction of treatment may need to be addressed within joint sessions. Temporary short-term confidentiality may occasionally be maintained while planning how to discuss sensitive matters constructively.

 

Suitability For Couples Counselling
Couples counselling may not be appropriate in situations involving:

• Ongoing physical violence
• Severe coercive control
• Active fear for safety
• Serious untreated addiction
• Ongoing undisclosed affairs where one partner refuses transparency
• Situations where one partner is participating solely under coercion

The counsellor reserves the right to recommend alternative or adjunct services where clinically appropriate.

 

ONLINE SESSIONS & LIMITATIONS
Sessions are conducted online. Assessment and understanding may be limited by the nature of the online format. While reasonable steps are taken to maintain privacy and security, there are inherent limitations to online communication. You acknowledge and accept the inherent limitations and potential risks associated with online communication, including data breaches or technological failures beyond the practitioner’s control.

You agree to:
• Attend sessions from a private and safe environment
• Ensure a stable internet connection
• Not attend sessions while driving or under the influence

COMMUNICATION & BOUNDARIES
Communication outside sessions is limited to scheduling and administrative matters.
Therapeutic work is conducted within sessions.

Sessions are not to be recorded and session content is expected to be treated with mutual respect and confidentiality.

Communication via calls or messaging platforms such as WhatsApp is strictly limited to logistical purposes (scheduling, rescheduling or administrative coordination). If a call extends beyond 10 minutes, it will be considered a session and charged accordingly.

TIMINGS & CANCELLATIONS
Each session is typically 60 minutes long at such place as may be mutually decided upon.

If you need to cancel or reschedule an appointment, please do so at the earliest through the website and inform me via call, email or text message at least 24 hours before the session.
If a session is missed without prior notice or cancelled with less than 24 hours notice, the session fee will be forfeited, and a new booking will be required to schedule another session.

Sessions begin and end at the scheduled time. If you are late, the remaining time will constitute the session for that day. If a session is interrupted, shortened or ended early due to client-side factors (including disengagement, distractions or leaving the session), the full session will still be considered as completed.

If I need to cancel a session, I will make every effort to provide at least 24 hours notice. In cases of short notice cancellations due to unforeseen circumstances, you will be informed via email. I will only contact you by phone if I have your prior permission to do so.

Fees are subject to revision and any changes will be communicated in advance.

CRISIS & EMERGENCY
This service does not provide 24-hour crisis support.

If you are in immediate danger or require urgent assistance, please contact local emergency services or a crisis helpline. If you are in India, you may contact local emergency services (112) or a mental health helpline such as AASRA (91-22-27546669).

CLIENT RESPONSIBILITY
By engaging in counselling, you acknowledge that:
• You are responsible for your decisions, actions and wellbeing outside sessions
• You will engage honestly and respectfully in the process
• You will communicate relevant information that impacts your care
• If you are referred to any health, mental health, or substance use professionals, you are responsible for any fees or charges incurred with those services.
• You are not required to share everything at once and may proceed at a pace that feels manageable to you
• If you feel uncertain, stuck or uncomfortable at any point, you are encouraged to bring this into the session

ENDING COUNSELLING
Counselling may end:
• When goals have been met
• By your choice at any time
• If the work is no longer appropriate or within scope

Where possible, this will be discussed collaboratively leading up to the last session.

In unlikely circumstances involving misuse of services or risk to the counsellor, sessions may be terminated immediately. This includes but is not limited to:
• Non-payment of fees
• Refusal to refrain from engaging in dangerous practices
• Risk to physical or emotional safety
• Attending sessions under the influence of substances
• Aggressive or inappropriate behaviour

The practitioner reserves the right to decline or discontinue services if the scope of concern falls outside professional competence or if the structure of the service is not suitable for the client’s needs.

COMPLAINTS
If you are unhappy with any aspect of the counselling process, you are encouraged to share your concerns. Feedback will be taken seriously and addressed appropriately.

You are free to ask questions or seek clarification before providing consent.

CONSENT
I confirm that:
• I have read and understood the information above
• I understand the nature and limitations of counselling
• I understand the limits of confidentiality
• I agree to engage in counselling services

LEGAL JURISDICTION
This Agreement shall be governed by and construed in accordance with the laws of India, and the courts in Mumbai shall have exclusive jurisdiction over any disputes arising out of or in connection with this Agreement.