I understand that my counsellor will help me to understand myself, assist me in clarifying my problems, goals, and objectives, and help me look at alternative solutions to my problems. This will involve homework, which I am prepared to commit myself to, as requested. I further understand that I am fully responsible for the decisions I make concerning my life and behaviour. 

I understand that the model of therapy used looks at the past and the present. It considers my family of origin, feelings, thought patterns and communication skills, all having in view personal and family restoration to wholeness. It is designed to help me focus on achieving optimum health, encouraging me to seek and find an enriching and fulfilling life. 
I understand that the information discussed will be treated confidentially. I also understand that there are some matters that may not be kept secret in counselling. These include information that I give permission to disclose, matters that relate to possible serious harm to myself or others, children at risk of abuse, matters that need to be disclosed to a court and matters to be discussed during counselling supervision. 
Some clients need only a few counselling sessions to achieve their goals; others may require months or even years of counselling. As a client, you are in complete control and may end our counselling relationship at any time, though a termination session is highly recommended.
You also have the right to refuse or discuss any suggestions I make that you don’t feel comfortable with. I will always respect your decision and not insist in any way on continuing with an ‘intervention’ you don’t feel completely safe and comfortable with.