Imago Relationship Therapy
This agreement outlines the terms of our work together, including confidentiality, consent, fees, attendance, responsibilities and the boundaries of the therapeutic relationship.
Couples counselling is a collaborative process. My role is to provide a safe, respectful and structured environment in which you can explore your relationship, develop a deeper understanding of each other and work towards greater connection.
Please read this agreement carefully. Both partners are asked to confirm that they understand and agree to the terms before commencing counselling.
1. Confidentiality
Confidentiality is fundamental to the counselling relationship. Information shared during sessions will be treated confidentially, subject to the following exceptions:
- Where disclosure is required by a court of law or other applicable legal obligation.
- Where I reasonably believe that disclosure is necessary to address a serious risk of physical harm to either partner or another person.
- Where I reasonably believe that there is a serious risk of either partner causing physical harm to themselves.
- Where disclosure is otherwise permitted or required by applicable law or professional obligations.
Where it is safe and appropriate to do so, I will discuss any necessary disclosure with you beforehand.
Confidentiality in couples counselling
The therapeutic relationship is with you as a couple. I do not offer separate, confidential individual therapy within the couples counselling arrangement.
If either partner communicates information to me outside a joint session, including by telephone, email or message, I cannot guarantee that this information will be withheld from the other partner. Information relevant to the couples work may be brought into a joint session.
I will aim to discuss any such communication with the partner concerned before bringing it into a session, where appropriate.
If either partner wishes to share information privately that they do not want discussed in joint sessions, we will need to consider together how this affects the therapeutic work.
Supervision and professional development
I may discuss aspects of our work in professional supervision with other qualified psychotherapists or my supervisor. Supervision supports ethical practice, professional development and the quality of the counselling I provide.
Wherever possible, information will be anonymised, and identifying details will be limited to what is necessary and appropriate under my professional and legal obligations.
Video recording and training consent
Video recording is not automatically part of couples counselling. Any recording must be discussed and agreed in advance, with the purpose, access arrangements, storage, retention period and deletion arrangements explained clearly.
If recording is proposed for supervision or professional training, each partner must give their own informed, explicit consent before any recording takes place.
Consent to video recording is separate from consent to counselling. Either partner may decline recording without this automatically ending the counselling relationship.
2. Fees and Session Structure
Initial assessment session
The first session lasts 60 minutes and provides an opportunity for us to assess whether working together is appropriate for you as a couple.
The fee for this session is £90.
During this meeting, we will discuss your reasons for seeking counselling, your relationship goals, the therapeutic approach and any relevant circumstances that may affect our work.
Ongoing counselling sessions
If we mutually agree to proceed, sessions will normally last 90 minutes and take place every two weeks.
- Fee per session: £120.
- Session duration: 90 minutes.
- Frequency: Every two weeks.
- Initial commitment: Six sessions.
- Booking: The initial six sessions are to be booked in advance to secure your appointments.
After the sixth session, we will review your progress and decide together whether further sessions would be beneficial.
If we continue, we will undertake a further review after 12 sessions.
Any changes to the fees or arrangements will be discussed with you in advance. Where fees are increased, I will aim to provide at least one month’s notice.
3. Attendance and Punctuality
Please arrive promptly and be ready to begin at the agreed time.
If you have not arrived within 15 minutes of the scheduled start time and have not contacted me, I may assume that you will not be attending. I may not be available to begin the session after that point, and the cancellation policy may apply.
Both partners are expected to attend each couples counselling session.
If only one partner attends, the session will not proceed as an individual counselling session unless this has been discussed and mutually agreed in advance. The full session fee will apply if one partner attends alone or the other partner does not attend.
4. Cancellation Policy
A minimum of 72 hours’ notice is required to cancel or rearrange an appointment without charge.
Cancellations made with less than 72 hours’ notice will normally be charged at the full session fee of £120 for an ongoing session, or the applicable fee for the initial assessment.
The following examples illustrate the 72-hour cancellation period:
| Appointment day | Last day to cancel without charge |
|---|---|
| Tuesday | Saturday before |
| Wednesday | Sunday before |
| Thursday | Monday before |
| Friday | Tuesday before |
The precise deadline is 72 hours before the scheduled appointment. The examples above should be checked against the actual appointment time.
This policy is intended to protect reserved appointment time and support consistency in the therapeutic process. Couples counselling can sometimes bring up difficult emotions, and maintaining attendance can help you work through challenges rather than avoid them.
Any exceptional circumstances will be considered at my discretion.
5. The Therapeutic Approach and Couples Workshops
Our work will draw on the principles of Imago Relationship Therapy, including structured dialogue, empathic listening, mutual understanding and taking responsibility for individual contributions to relationship difficulties.
I may recommend the Getting the Love You Want Weekend Couples Workshop as a complement to counselling.
The workshop described in the original information costs £600 per couple; please confirm the current fee, availability and arrangements before booking.
The workshop is educational and skills-based rather than a substitute for individualised counselling. It aims to support communication and connection while allowing couples to practise the exercises together.
Participation is a recommendation, not a condition of receiving counselling.
6. Responsibilities of the Therapist
As your therapist, I undertake to:
- Attend appointments punctually and end sessions at the agreed time.
- Explain my fees and provide reasonable advance notice of any fee increases.
- Remain neutral and avoid taking sides in the relationship.
- Communicate with both partners together wherever possible, unless an alternative arrangement is mutually agreed.
- Balance understanding and compassion with appropriate boundaries.
- Support you in recognising your own resources and capacity for connection and change.
- Be attentive, present and engaged throughout sessions.
- Treat both partners with respect and without shaming or humiliation.
- Listen and respond constructively if either partner raises concerns about my conduct or the therapeutic process.
- Explain Imago concepts clearly and balance education with therapeutic dialogue.
- Offer exercises or between-session activities where appropriate.
- Maintain appropriate professional records and continuity of care in accordance with my professional, ethical and legal obligations.
7. Responsibilities of Both Partners
By participating in couples counselling, you agree to make a reasonable effort to:
- Attend sessions punctually and pay the agreed fees.
- Speak as honestly as you feel able to about your thoughts, emotions and experiences.
- Follow the therapist’s guidance in structured dialogue exercises.
- Approach your partner’s perspective with curiosity and a willingness to understand.
- Take responsibility for your own actions and contributions to relationship difficulties.
- Treat each other respectfully during and outside sessions.
- Raise concerns about the relationship or the counselling process constructively with your partner or therapist.
- Avoid using information shared in sessions to threaten, humiliate, manipulate or retaliate against your partner.
- Practise expressing appreciation and gratitude where appropriate.
- Be willing to take emotional risks at a pace that feels manageable and safe.
- Work towards repairing misunderstandings and conflict when possible.
- Make a genuine effort to understand and advocate for your partner’s perspective without abandoning your own needs or boundaries.
- Consider recommended exercises, resources or educational workshops.
- Respect the therapist’s professional boundaries and contact arrangements.
Neither partner is expected to agree with everything the other says. The aim is to foster understanding, honesty, respect and constructive communication.
8. Contact Outside Sessions
Contact outside sessions should ordinarily be limited to practical matters such as appointments, scheduling and payment.
Please do not use email, telephone, text or messaging services to conduct counselling between sessions.
If you need to raise a therapeutic concern, please bring it to the next session wherever possible. If an urgent safety concern arises, seek appropriate emergency or professional support rather than relying on routine contact with the therapist.
9. Privacy and Data Protection
Personal information will be collected and processed for the purposes of arranging and providing counselling, maintaining appropriate records, managing payments and meeting applicable legal and professional obligations.
Information will be handled in accordance with applicable UK data protection law and the therapist’s privacy notice.
The therapist will explain:
- What personal information is collected and why.
- How counselling records are stored and protected.
- Who may have access to information and in what circumstances.
- How long information is retained and when it is securely deleted.
- How you can exercise your applicable data protection rights.
Please read the therapist’s privacy notice alongside this agreement. Consent to counselling, consent to video recording and consent to the use of recordings for training are separate matters and should not be treated as interchangeable.
10. Review and Ending Counselling
The counselling process will be reviewed after six sessions and, if further work is agreed, again after 12 sessions.
Either partner may raise concerns about the process or whether counselling remains appropriate. We will aim to discuss these concerns openly and respectfully.
If the work is no longer appropriate or beneficial, we may discuss ending counselling, changing the therapeutic approach or considering alternative support.
Where there are concerns about coercion, intimidation, abuse or a partner’s safety, the therapist may need to assess whether joint counselling remains appropriate and discuss alternative arrangements.
11. Declaration and Consent
By signing below, each partner confirms that:
- They have read and understood this agreement.
- They have had the opportunity to ask questions and seek clarification.
- They understand the session structure, fees, attendance requirements and cancellation policy.
- They understand the limits of confidentiality in couples counselling.
- They understand how information may be handled for supervision and professional purposes.
- They understand that consent to video recording and use of recordings for training must be obtained separately.
- They understand that they may raise concerns about the therapeutic process at any time.
Partner 1
Full name: ______________________________________
Email address: __________________________________
Telephone number: _______________________________
Signature: ______________________________________
Date: __________________________________________
Partner 2
Full name: ______________________________________
Email address: __________________________________
Telephone number: _______________________________
Signature: ______________________________________
Date: __________________________________________
Therapist
Therapist’s name: _______________________________
Signature: ______________________________________
Date: __________________________________________
Separate Consent: Video Recording
Please complete this section only if video recording has been proposed and explained.
Purpose of recording:
☐ Professional supervision
☐ Other specified purpose: __________________________
I understand the purpose of recording, how the recording will be accessed, stored, retained and deleted, and the arrangements for withdrawing consent.
Partner 1:
☐ I consent to video recording for the purpose specified above.
☐ I do not consent.
Signature: _______________________ Date: ____________
Partner 2:
☐ I consent to video recording for the purpose specified above.
☐ I do not consent.
Signature: _______________________ Date: ____________