JAN E HOL M E S

C OG N ITIVE BE HAVI OU RAL

PSYC HO THE RA PIS T
PG Dip CBT, Dip SW. (BABCP) Accredited Psychotherapist
www.babcp.com
EMDR Trained Therapist Member of

www.emdrassociation.org.uk

Therapy Information and Agreement

Professional Information
I am a qualified Cognitive Behavioural Psychotherapist and hold a Post Graduate Diploma
in CBT (Cognitive Behaviour Therapy) and am trained in EMDR (Eye Movement Desensitising
Reprocessing). I am a qualified social worker and hold a Diploma in Social Work, although I
am not currently practising. I am accredited as a Cognitive Behavioural Psychotherapist
with the British Association of Behavioural and Cognitive Psychotherapists (BABCP) and as
such I adhere to the guidelines for good practice set out by this body www.babcp.com
It is a requirement of practice that I receive regular clinical supervision and this is with a
BABCP accredited supervisor. Therefore when you agree to enter into therapy you are also
agreeing for this information to be discussed with my supervisor, although this is
anonymous. As part of supervision and BABCP accreditation requirements I am required to
audio record occasional sessions with clients to help monitor standards and improve
practice. If sessions are recorded this will be explained to you and you will be asked to
sign a separate consent form.
Confidentiality
All sessions will be conducted in the strictest of privacy and confidence and this
confidence will be maintained and applied to all records, in accordance with the Data
Protection Act. Confidentiality will only be broken in the following circumstances: 1. Where the client provides written consent.
2. Where law or order of a court compels the therapist.
3. Where this can be justified in the public interest (usually where disclosure is
essential to protect the client or others from the risk of significant harm).
4. Where there is an issue of child protection.
In the event of any of the above I would always attempt to discuss this first before
breaking the confidentiality rule. In the case of working with young people the same
applies and we will agree together what to share with carers, unless any of the above
applies.
Sessions, Payment, Cancellations and Holidays
We will normally meet weekly or fortnightly and sessions will be for 55 minutes or in some
cases, such as EMDR sessions may be 90 minutes and charged accordingly. The fee is 80
for self-funded clients and should be paid for on a session-by-session basis if you are self

C/o The Orchard Town Street Horsforth Leeds LS18 5BL

T 07810 071895
E info@janeholmescbtpsychotherapyleeds.co.uk

funding. This payment should be in cash or BACS transfer payable prior to or immediately
after the session. I work under the premise missed or cancelled appointments with less
than 24 hours notice will require full payment. Receipts are available on request. I am
registered with several health insurance providers such as BUPA, AVIVA and CIGNA.
Other services that are provided during therapeutic work which incur costs such as; writing
letters to schools, GPs, Examinations Boards and other agencies are charged for at a rate
of 45 per hour. Visits to schools are also chargeable as are home visits.

BACS transfer can be made using the following details:Account Name -Jane Holmes
Barclays Bank - Account number 73583023
Sort Code 20.48.42
If you are funded through medical insurance missed sessions will be invoiced for cancelled
sessions and if you are funded by a healthcare organisation you may forfeit one of your
allocated sessions. I will endeavour to ensure you are inconvenienced as little as possible
and will inform you of holidays, sickness and professional commitments as as soon as is
possible.
I reserve the right to vary these terms where necessary giving full written notice and
discuss with you reasons for this.
Clients Name & Address:

Next of Kin:
General Practitioner Details / Medication:

I have read and understood the above information and agree to abide by the terms and
conditions outlined.
Clients Signature

Date

Therapist: Jane Holmes

Therapist Signature

Date
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C/o The Orchard Town Street Horsforth Leeds LS18 5BL T 07810 071895
E

info@janeholmescbtpsychotherapyleeds.co.uk