ONLINE THERAPY CONTRACT
This Contract is made between Carmel Semple (therapist) and the Client. Please read this document carefully and ensure that you fully understand its contents. You must confirm by email that you have read, understood and have freely given your consent to engage in therapy and separately, you have also given your Consent under the requirements of GDPR 2018. Further details are available on www.GDPRandyou.ie.
Your therapist will treat your voluntary disclosure of sensitive and personal information in a confidential manner and in accordance with GDPR 2018, except in the following circumstances: (a) Concern about actual or possible serious physical harm or death, including threatened suicide or terrorism. (b) Under Children First: National Guidance for the Protection and Welfare of Children, 2017: Disclosure of a named child abuser (a child is 18 or under) or abuse (including bullying) towards vulnerable persons by a client or child, including historical cases, requires mandatory referral of suspicions or reasonable grounds concerning bullying to the HSE Duty Social Worker (full details on www.tusla.ie). (c) Anonymously, as part of professional supervision. You are also expected to keep your sessions confidential to support your outcome.
2. Respect for the Rights and Dignity of a Client
Your therapist will not intentionally intrude on matters that do not relate to therapy; your dignity will be respected, including your moral and cultural values.
It is important to ensure that your therapist is qualified to provide the services that are offered and is a current member of a relevant professional organisation. Please review my website www.carmelsemple.com for up to date information.
4. Shared Responsibility
Your therapist is totally committed to helping you achieve your realistic outcome and she will act in a trustworthy, reputable and accountable manner to provide the service you require. Similarly, your total co-operation and commitment are required to achieve the best outcome. This may include journalling, undertaking exercises between sessions and fully participating in the therapeutic process. Having made the decision to attend therapy, it is important that you get into a routine of attending regular sessions online to deal with issues as they arise. A desire to terminate therapy that is becoming uncomfortable can signal an imminent breakthrough. If uncomfortable or embarrassing feelings/thoughts arise, please share them, otherwise, you will only inhibit your progress. The purpose of the treatment is to help you resolve what is troubling you in a non-judgemental and supportive environment. If there is a personality mismatch between you and your therapist or if the nature of your consultation requires a different level of expertise, this will be discussed without delay.
5. Code of Ethics
Your therapist will honour professional commitments and treat you with respect, fairness, openness and honesty in a non-judgemental manner. She will answer any questions you may have to the best of her ability. If a conflict of interest arises, she will address the matter immediately and will not intentionally take advantage of the professional relationship in any way. A copy of the Code of Ethics is available on request. If it becomes apparent that you are not fully committed (cancelling/changing appointment times/not showing up, avoiding homework or acting in a way that suggests you are not ready to commit to therapy), your therapist will discuss the issue(s) with you, renegotiate or terminate the Contract or refer you to an alternative therapist.
6. Session and Treatment details
Your first session involves clarifying details of the Contract, completing a detailed Client Intake and answering any questions you may have. It is an opportunity to build trust and decide whether you and your therapist are a good match. An evaluation of your needs will inform agreed goals and help to identify steps to achieve a realistic outcome (this plan may be amended as therapy progresses). By the end of the session, your therapist will discuss and agree the most appropriate intervention. Your therapist does not treat serious depressive disorders or psychosis e.g. schizophrenia, which is the remit of a psychiatrist. A session lasts approximately 50 minutes and will generally take place weekly or bi-weekly by mutual consent. It is your responsibility to arrive on time, as delays cannot be made up at the end of a session.
7. Appointments, Cancellations and Online sessions
Appointments can be made for online sessions subject to availability at a mutually suitable time using the Zoom platform. A link and password will be sent to you on confirmation of appointment.
Weekend appointments are made by agreement. Once an appointment hour is scheduled, you will be expected to pay for it in full unless you provide a minimum of 24 hours’ notice (1 full working days) by sending a text to your therapist. Otherwise, the full fee will be liable with immediate effect. Online sessions may not be recorded and by confirming your consent by email, you expressly agree that you will not record sessions or allow a third party to access the therapy hour, as to do so would be considered a breach of privacy and client confidentiality. Please be aware that Zoom may not have the level of encryption required for confidentiality.
Payment is required to confirm an appointment and during the Covid-19 emergency, the first session is reduced to €65 with subsequent sessions being reduced to €50 until further notice. Your therapist will send a payment request to your phone using SumUp and instructions are easy to follow. Please note that fees are not normally refundable under medical insurance policies in the Republic of Ireland but please check with your insurance provider. In all cases, a receipt is provided using SumUp.
9. Professional Standards – Complaints
If you feel you are being unfairly treated during sessions, please raise the matter with your therapist as soon as possible. If a resolution cannot be found, you can request a complaint form from www.eaph.ie/contact
10. Record Keeping and Termination of Therapy
In accordance with Data Protection regulation, client files are confidential and can only be accessed by your therapist. They are held in a locked box for six years following completion of therapy and then shredded. Therapy may be terminated at any stage by you or your therapist; the latter will explain the reason and offer a referral if required.
Please record your thoughts, dreams, challenges and feedback in a Journal. You will be asked to write in your Journal daily because doing so helps to maximise the benefit of therapy and it helps to generate meaning and insight from your writings. Your journal should be kept in a safe place, away from the curious eyes of others. Please bring your journal with you to each session for the purpose of taking notes, logging homework or facilitating discussions. Above all, please be honest and non-judgemental in your reflection.
12. Contacting me
Please text your therapist on 086 3446673 if you wish to change your next appointment at least 24 hours in advance of the due date and she will make every effort to return your call at the earliest possible opportunity. For emergencies, please contact your family doctor or dial 999 immediately.
13. Next of Kin
In the unlikely event of you becoming ill or requiring assistance, you expressly give your therapist consent to contact the person you nominate on the final page of this Contract.
14. Disclosure and Disclaimer
Services offered are not intended to substitute those provided by your mental health professional (doctor, clinical psychologist or psychiatrist). Your therapist is not in a position to diagnose, offer a prognosis, treat or cure medical conditions, illnesses, or diseases; neither does she write reports for Solicitors if litigation is involved with a third party. If you are experiencing any mental health issue, please consult with your mental health provider first, before exploring alternatives to traditional medicine. If you are taking medication, please do not discontinue taking it without your doctor’s consent. Your results may vary and results cannot be guaranteed because success depends on a number of factors, including your background, discipline, readiness for change and commitment to the process.
15. Governing Law and Informed Consent
The terms and conditions of this Therapy Contract shall be governed by and construed in accordance with the laws of the Republic of Ireland, and the parties hereby submit to the non-exclusive jurisdiction of the Irish courts to settle any dispute which may arise in connection with these terms and conditions. Your email confirmation confirms that you have read this Therapy Contract, and agree to abide by its terms, method of contact and have voluntarily provided details of next of kin in the event of an emergency. Please email confirmation of your agreement and consent to the above terms to email@example.com
If you have any queries, please contact me on 086 3446673 (International: +353 86 3446673)
General Data Protection Regulations (GDPR) Information
The General Data Protection Regulation (GDPR) came into force on 25th May 2018 to protect the privacy and data of EU citizens. It gives you greater control over your personal data by setting out additional and more clearly defined rights for individuals whose personal data is collected and processed by organisations and businesses.
Personal data is any information that can identify an individual person. This includes a name, an ID number, location data (for example, location data collected by a mobile phone) or a postal address, online browsing history, images or anything relating to the physical, physiological, genetic, mental, economic, cultural or social identity of a person.
GDPR is based on the core principles of data protection which exist under the current law.
Further details may be found on www.gdprandyou.ie
Information Collected and how it is used
Your therapist takes your privacy seriously and will only request information from you that relates to your presenting issue(s) in order to provide you with the services you require. With the exception of circumstances outlined under the Confidentiality section (1) of the Contract, no identifiable information will be passed to a third party. Occasionally, she may send you information about various aspects of therapy, developments, workshops etc.
You should ensure that the information she holds about you is accurate and kept up to date. If you would like to review your information at any time, please send a request in writing. You have the right to be given a copy of your information held within 30 calendar days of the receipt of a valid request in writing. She may request you to provide additional information to enable her to identify your personal data and/or to verify your identity. You also have the right to have the information erased if there is no legitimate reason for retaining it.
Industry standard cyber security measures are used to protect your information and to prevent the loss, misuse or alteration of any information. However, the transmission of information via the internet is not completely secure and it cannot be guaranteed that your private communications or other personally identifiable information will never be compromised.
However, all reasonable endeavours are taken to ensure that such information is kept as secure as possible. Please note your contact information and/or personal details are not shared with anyone unless required to do so by law.
If any part of this Privacy Statement is held to be invalid or unenforceable, the validity or enforceability of the remainder will not be affected. Your privacy is important. If you have any comments or questions regarding this statement, you can contact your therapist or GDPR.e.
Your signature confirms that you have understood the aforementioned and have been given a copy of this Privacy Notice.
Please confirm in your email the method by which you wish to give me permission to communicate with you (by post, email, telephone and/or text).
Your consent by email confirms your agreement to the above.
Consent under GDPR 2018
The General Data Protection Regulation (‘the GDPR’) is effective from 25th May 2018 across the European Union for the purpose of giving individuals more rights, control and understanding of how their personal data is processed.
In compliance with this EU Directive, please read the following information and if you are in agreement with the contents, please sign your Consent at the end:
Only information that is relevant and important to the daily/weekly interaction with you will be requested.
· If working with minors, your therapist will ask for explicit consent from all parents/guardians to obtain and maintain this information.
· The information obtained by the therapist will only be used for the reasons outlined when obtaining the information and identifiable information will never be passed to any third party, unless required by law to do so or as part of normal supervision.
Your therapist may at times contact you in relation to upcoming events, workshops or follow-up enquiries about your progress. You have the right to withdraw consent at any time – please do so by emailing firstname.lastname@example.org.
All information disclosed will be stored securely and in the unlikely event that any of this information has been lost or compromised, your therapist will notify you immediately before informing the Data Commissioner. Any information stored on laptops owned and/or operated by me have password and anti-virus protection. Cloud servers are based in the EU and are GDPR compliant.
Please note that all information received will only be stored for a long as is necessary to comply with regulations.
You have the right to legal recourse if you believe your data has been breached/leaked.
If you believe that any/some of the information that is held is incorrect, you have the right to rectify it at any time.
Your therapist is obliged to retain files for 6 years following termination of therapy, after which time data will be automatically shredded.
All requests received in writing will be replied to in the same format – if there is any confusion or question over possible legal issues, she will contact her Solicitor for further clarification, and you may wish to exercise your right to seek legal advice
Your point of contact is Carmel Semple – email@example.com. 086 3446673.
Your consent by email confirms that you have understood the contents and give your explicit consent to the above.