WWTW Consent Form
Who is the service for?
This service is primarily provided to adults aged 18 and over. Adolescents will be provided a service with the consent of their parents.
What information do you collect about me and how will it be used?
During assessment and therapy, personal and sensitive data will be collected. This will include personal details, family details, lifestyle, social circumstances, physical and mental health details, as well as basic background information such as contact details and name and address of your GP. This will be collected verbally, and a written record will be kept in notes taken during and/or after the session. This information will not be routinely shared, save for potentially in the circumstances described in the confidentiality section below.
The legal basis for collecting this information is that you consent to provide it, since collecting this information is necessary for the performance of the contract to which you are party. West Midlands Psychotherapy Services Ltd has implemented technical and organisational measures to ensure that personal and sensitive data remains secure. An audit of all the storage methods used by us has been completed in accordance with the EU General Data Protection Regulation and information is kept secure in line with industry standard best practice.
You have rights in relation to the data we hold about you. These are summarised below. If you wish to assert any of these rights, then you should contact your therapist.
The right to be informed about the collection and use of personal data
The right of access to your personal data
The right to rectification, to have inaccurate personal data held rectified
The right to erasure, the right to be forgotten*
The right to restrict processing, sharing of information. In certain circumstances we have a duty of care to share information with relevant agencies, please see the confidentiality section below
The right to data portability, the right for you to request data, to re-use it for your own purposes
The right to object to direct marketing and research
Rights in relation to automated decision making and profiling, details can be found on our website privacy policy
*Under Common Law West Midlands Psychotherapy Services Ltd will keep information about you for seven years after your last treatment date, and in the case of children, seven years after someone turns 18. After this date the data will be deleted.
What are the boundaries of confidentiality during therapy?
The therapist-client relationship is essentially one of a confidential nature, although this is not absolute.
You have been referred to our service by WWTW who will have access to brief updates on your progress, questionnaire results and a final GP discharge report, this dicharge report is forwarded to your GP.
During treatment there are some times where confidential information would be released, even in the absence of your consent.
These include:
All health care professionals have a duty to act when there is a danger to the client or any other member of the public. This generally means that the therapist may involve others when it is necessary to protect the client or another person. For example, if you were to state that you were actively intent on harming yourself or another person, other relevant authorities will be informed.
The law requires that health care professionals report instances where they believe a child or children are in danger of harm, for example, through abuse or neglect. Therefore, if in the course of your sessions you release information pertaining to actual or potential harm to a child, the relevant authorities will be informed.
Health care professionals do consult with one another from time to time. The most frequent example of this is with respect to the therapist’s supervision, where they will discuss case material with their supervisor in the interests of providing a better service to their clients. Where practical, such material is conveyed without identification. At other times, identification may be necessary, for example if another therapist is covering phone calls in the absence of your therapist.
In response to a Court order a therapist must testify or release any records that are kept about you.
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What is the cancellation policy for appointments?
If you do not attend a scheduled session, or you cancel giving less than 24 hours’ notice, the session will be charged to WWTW and a session deducted from your total allowance to cover the missed appointment.
If you cancel giving more than 24 hours in advance, we can rearrange your appointment without deducting a session from your allowance.
If you arrive late for your session due to the therapist’s other commitments the time cannot be extended.
How do I make a complaint if I a dissatisfied with the service?
We are sorry to hear you are not satisfied with the service, should this be the case please email us on info@thepsychotherapyclinic.co.uk we will respond within 10 working days. Please detail your name, your allocated therapist name, your preferred method of contact and contact details alongside details of your complaint. We will take your complaint seriously and it will be dealt with professionally.
Will I receive an emergency service?
Our therapists do not provide formal emergency services as most therapists work part time hours, response times may take 1-3 working days. We have put together a client care guide which is attached to this consent form to help you to manage distress you may experience between sessions.
If you find you are experiencing high emotional distress ad you require further support the Samaritans provide a support service 24 hours a day for people who experience feelings of distress or despair, including those that could lead to suicide. They can be contacted by phone on 08457 90 90 90 or you can email jo@samaritans.org. Alternitively you can text SHOUT anonymously 24/7 on 85285. In addition please speak with your GP who can support you through this time. If you cannot keep youself safe and find yourself in an emergency situation you should seek urgent support by calling 111 or 999.
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