dr. victoria galbraith DPsych FHEA CPsychol AFBPsS
Agreement
Psychological
Therapist Section
You may want to write to me as often as you like, knowing I will respond to all your e-mails on a set day each week.
You
may want me to respond to each e-mail as I receive it. I
normally reply to e-mails within 3 days and will let you know when this
is not
possible.
You
may want to make a weekly payment to exchange as many
e-mails as you choose during that week.
My
main initial response to you I call a Therapeutic E-mail
and that is the one I charge for (I number the e-mails in a pre-paid
package in
the subject line as TE1/3 or TE2/5 etc.). You may have a query after
you have
read a TE and I reply briefly to such queries at no additional charge.
Any
administrative e-mails (e.g. to query something I have written or to
book a
live session) are also not charged for.
Live
Sessions need to be booked with me in advance by e-mail
or telephone (07780 680 607). It normally takes 24 hours to arrange but
can
sometimes be done more quickly.
Confidentiality
I
keep our therapy sessions and records confidential within
the framework described on my website. I work to the Guidelines for
Good
Practice of my professional body, the British Psychological Society
(BPS) where
I am an Associate Fellow and accredited to practice as a Chartered
Counselling
Psychologist. You can check my details in the BPS’ online
directory at http://www.bps.org.uk
Referral:
It is not always possible to know if working online is the
most appropriate way for you to get help. If I believed that
face-to-face therapy
would be a better way to help you I would suggest that either we hold
face-to-face sessions or, if this is possible, I would help you find a
psychological
therapist near to you and support you whilst you made the change to
face-to-face counselling. If I felt that another online therapist might
be
better placed to help you than I am (because they had specialised skill
or
experience) I would suggest a change and support you whilst you made it.
Emergency
Contact:
In
the event of complete technology failure, I suggest we
send a text message to each other’s mobile phones (cell
phone) and use the same
system to let the other know when we are back online. My mobile
telephone number
is 07780 680 607.
Payment:
The
charges for my psychological therapy services are set
out here (See Fees: How much do you charge?). I respond to your e-mails
and
hold live sessions after I receive notification of payment. Payment can
be made
using:
Paypal
UK
cheque
Cash
Client Section
Please
ask any questions before completing the blank spaces
below and return the form to me with your next e-mail.
Basic
Details about me
Name..............................................................................................
Telephone
number..........................................................................
E-mail
address................................................................................
Gender:
………………………………………………………………...
Age:……………………………………………………………………..
Communication
I
would like to communicate in the following way (please put
X against the option you prefer – you can always change it
later)
· Receive
e-mail responses on a set day each week (indicate which day)
·
Receive
e-mail response to every e-mail I send
· Exchange
as many e-mails as I choose during any one week... (cost £...
per week. Please
allow 24 hours for my replies)
Method of Payment
I
will pay for my counselling in advance using (put X
against method)
Paypal
... UK Cheque ...
Name
of GP
.......................................................................................................
Tel.
No of Surgery
.............................................................................................
·
All
of the shared correspondence between therapist and client remains
strictly
confidential unless the therapist has reason to believe that the client
may be
at risk of harming him/herself or others.
· My
therapist will store all personal information securely and unless
explicitly agreed
otherwise, all information is only seen by your allocated therapist.
· My
therapist is an accredited member of the British Psychological Society
(BPS)
and holds a practising certificate enabling her to offer psychological
therapy
services as a Chartered Counselling Psychologist. The BPS’
Code of Conduct and
Ethical Guidelines are therefore adhered to.
· I
am responsible for data security on my computer and it is up to me to
keep
correspondence secure.
· I
am entering into a two-way contract that will allow me the time and
space for
my thoughts and feelings to be heard and understood.
· Psychological
therapy is not a miracle cure and that it does not necessarily work for
everybody.
· The
goal of the therapy process is paramount and therapy will only continue
whilst
it is of benefit to me (the client). If at any stage the process
becomes
counter productive, either party (therapist or client) is free to
terminate the
relationship.
· If
for any reason my therapist believes that the continuation of therapy
is not in
my best interest, I will be contacted and some alternative therapy
options best
suited to me may be offered or suggested.
· My
therapist is not providing an emergency service.
IMPORTANT
NOTICE for clients who are resident in the US or
Canada. My professional indemnity insurance covers me to work with any
client
no matter where in the world they reside. However, if a resident in the
US or
Canada makes a claim against me, this insurance cover will only apply
if the
case is “heard in a British court under American or Canadian
law” (whichever is
appropriate).
So
far, I have never had any claim made against me either
for face-to-face or online work. If you live in the US or Canada and
you agree
to work with me, please add your name and the date below to show you
have read,
understood and agree to this limitation in the unlikely event you may
wish to
make a claim against me.
I
have read, understood and agree to the terms of this Agreement.
I confirm that I am over 18 years of age and that the information given
by me
here is accurate to the best of my knowledge.
Name.................................................................
Date:......................................
When you have read this Agreement, and clarified any points,
please send the form below back to me by e-mail. Once I have received
this form
along with your payment, we can then begin to work therapeutically. I
look
forward to hearing from you.
