Su WallaceCounselling for Couples, Individuals and Families

Client registration

This form is sent to me electronically as soon as you press submit.
If you would like a copy of the confidentiality policy for you to keep, please just ask.

All information will be treated as confidential.

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Your details

Can I contact you by email?
Can I leave a phone message?
Does your partner know you have contacted a counsellor?
Do you have any additional needs due to any mental or physical condition which require a reasonable adjustment to enable you to participate in counselling?
Are you currently receiving other counselling or psychotherapy?
I have read and agreed to the terms of the counselling service as set out below.


Su holds information about each of her clients and the counselling they receive in confidence. If you come with a partner or your family, she may suggest seeing each of you individually. It is important for you to know that what is said in those individual sessions will be confidential and not shared with your partner or family.

Data protection

Su will collect the personal data that you provide on this form, and may receive information about you if you are referred to her by another provider. Su holds and uses your personal data in accordance with Data Protection legislation. Information about you is used to provide the counselling service, to manage and quality assure the service, and for statistical purposes. These are legitimate interests under the law. Any sensitive information about a disability is used to tailor the service to your individual needs if you give your consent. Records are kept for as long as is needed to provide the service to you, and for as long as is required for insurance purposes.

By law, you have a right to receive the copy of the data that Su holds, to ask her to correct any errors or to delete it once it is no longer needed. Please contact Su in writing to request access to your information, providing evidence of your identity, and she will respond to your request within one month. Su’s response will normally be in the form of an appointment listing and a description of the personal data she holds on you. If you don’t feel that she has dealt with your request appropriately, you can appeal to the Information Commissioner’s Office. Often during counselling, information is provided by more than one individual. In these cases, Su will only release information if consent has been given by all of the individuals involved.

Records are kept securely and confidentially and are normally only seen by Su. There are exceptional cases where she might share your information if it is required by a third party for ethical or legal reasons, such as Safeguarding a child or vulnerable adult.

Su may share your information if you have been referred by another provider that requires it. She will make you aware of what is being shared and why. Occasionally Su is asked by her clients or by external agencies such as Social Services or the NHS to write reports on the progress made in counselling. Su is not normally in a position to do this because of the duty of confidentiality to clients and because she is not trained in the specialist areas of psychiatric/psychological diagnosis or social work assessment. However, in some circumstances, and on receipt of written consent from the client(s) who attended counselling, she will provide brief information about the dates and number of sessions attended. In addition, she is sometimes asked by clients, their solicitors, the police and the courts for access to client records. These are not suitable as evidence in legal proceedings and Su reserves the right to resist legal requests to produce the records in court. She does this in order to protect her duty of confidentiality to all clients and to preserve her reputation as the provider of confidential counselling.

Domestic violence

Violence and abuse is an issue for many people who come to Su for help with their relationship. Su knows from experience that in this situation, working with couples or family members together may not be safe. If this is the case, Su will undertake ongoing risk assessment, couples counselling may not be possible and Su may help each person to get individual specialist support from another Counsellor or a specialist agency. Su will not undertake work with couples where there is current Police or Social Services involvement or a pending court case.


Mobile phones - Please switch off your mobile phone during your counselling sessions as it can create an unhelpful distraction and interruption.

Unauthorised electronic recording - In order for you to work safely and effectively, it is important that the privacy of the work is respected. Please do not attempt to record your counselling session using devices such as mobile phones or dictaphones. If it is found that recordings have been made covertly, counselling services for the individual responsible will be discontinued immediately and Su reserves the right to seek legal advice regarding possible further action.

Authorised electronic recording - Some counsellors regularly use audio or video recording in their work and in these circumstances you will be asked to give your written consent for this to happen. The consent will specify all the ways in which the recording will be used (for example training, supervision or research) and will specify how and when the recording will be destroyed.

Code of ethics and practice

Su is required to comply with the code of ethics and practice that is appropriate to the work she undertakes. Relational counselling is covered by the British Association for Counselling & Psychotherapy Ethical Framework for Good Practice.

Feedback and complaints

If you have any feedback about the service you receive or you are not satisfied with your experience, please tell Su, she welcomes feedback, will always take it seriously to improve the service she offers to her clients and will try to resolve any complaints.

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