Dear Client,

This document tells you what you can expect from the therapy process and me. It also explains what your responsibilities are. Please read it with care. If there is something you do not understand you must please discuss it with me.

Evaluation Phase
In order for me to render a service to you, I need to do a proper evaluation. In the course of this evaluation I will ask you a number of questions about your symptoms, your personal history, relationships and so forth. Some of these questions may be very personal but I will not ask you anything that is not pertinent. It is possible that I may need to do psychological testing and this will be communicated to you so that we can arrange further sessions. It is also sometimes valuable to interview other people who know you to obtain additional information. I will only do so with your consent. After the evaluation we will have a session where we will discuss my findings and decide on a future plan of action. This evaluation and report-back phase normally takes three sessions and should I require more time I will discuss this with you. The duration of a therapy session is 50 minutes.

Therapeutic Phase
Therapy usually brings improved functioning and personal growth in the long term. In the short term, however, it may be an unsettling experience, as it is usually an emotional experience. Some temporary emotional distress is possible. This may have a negative influence on your work as well as your social and personal functioning for a period of time.

Successful therapy may sometimes have negative consequences in the long run. The purpose of therapy is to bring about change. As a result clients sometimes feel that they should make changes in their circumstances as well. The may specifically induce you to bring about changes in your relationships with others. Such changes at times are not welcomed by those affected and this may lead to interpersonal tension.

The success of therapy is influenced by a number of factors. One of the most important factors is the degree to which clients take responsibility to bring about change. No therapist can give a guarantee that therapy will be successful.


  1. I will treat all private information that I collect about you as highly confidential. I will not, subject to what is said in paragraph 2, disclose any information about you without your consent.
  2. In certain exceptional situation, however, legal or professional rules may force me to disclose information about you. This will include:
  • Emergency situation
    In this regard I want you to know that should a situation develop where I believe there is a real risk that you may harm yourself, another person or myself, I will be compelled to take necessary steps to prevent such harm, even if this may entail me breaching my promise to you to keep information confidential.
  • Statutory duty
    A provision in an Act may oblige me to disclose confidential information about you.
  • Court orders
    A court may order me to disclose private information. In terms of my professional rules I must, however, endeavour to do everything possible to prevent the disclosure of your private information.
  1. That which I have pointed out in paragraphs 1 and 2 above is also applicable in respect of children under the age of 18. I will on a regular basis inform parents of guardians about the therapeutic process and the progress of the client. As a general rule, no information will be given to a parent or guardian about the content of a session without the relevant client’s consent. I do, however, reserve the right to inform a parent or guardian if it appears that the relevant child makes him or herself guilty of criminal behaviour, or threatens with, or is involved in behaviour that I consider to be dangerous or potentially dangerous to self or others.
  2. Subject to what is stated about confidentiality, I will not issue a medical certificate or report regarding you or your minor child without,
  • Your consent, and
  • Until I have given you an opportunity to read the relevant document and discuss it with me.
  1. As from the 1st January 2005, it is required by medical aid schemes for therapists to state the ICD-10 diagnostic code on statements. Without an ICD-10 code medical aid schemes will not pay out for claims. During the first session the diagnostic code that will appear on your invoice will be discussed and agreed upon between the client and myself. If you refuse to allow me to furnish your medical aid scheme with the required information the medical aid scheme may refuse to refund you for the payment of a session.


  1. I charge the following fees: R  per 50-minute individual consultation, R  per 50 minute couples consultation (Increased annually in March subject to Medical aid tariff structures).
  2. If the person to whom I will be attending i.e. the client, does not accept responsibility for payment of my account, the name and other particulars of the person who does accept responsibility must be indicated on the Client Intake Form that was handed to you with this document.
  3. Should you not be able to keep an appointment you must please cancel it at least 24 hours in advance. If you fail to do so, the person responsible for the payment of the account will be held liable for payment of the full amount of the session.
  4. As I work on an appointment basis, I will not be able to exceed the time set aside for a session. Should you be late for a session without making an arrangement timeously, the relevant session will be shorter than the standard 50-minutes. The person responsible for the payment of the account will still be liable to pay for the full session.
  5. The person responsible for the payment of the account is personally liable for the payment of the full account for each session. If the person responsible is a member of a medical aid scheme, it is his or her duty to find out which portion of my account the scheme will pay.
  6. I am not contracted to any medical aid scheme and therefore accounts must be paid after each consultation, following which you are responsible to claim the fees from your medical aid scheme.
  7. Please let me know if you think that you may have difficulty paying my account. If it is at all possible, I will try to accommodate you in the best way I can.
  8. No relaxation or amendment of these rules will be binding unless recorded in writing and signed by both “Therapist” and “Client”.
  9. If I am forced to hand an outstanding account to an attorney for collection, the person responsible for the payment thereof will be liable to the legal costs on attorney-client scale.

Psychological Testing
Information collected by means of psychological tests is only meaningful if it is interpreted by somebody who knows the theory that underlies the relevant tests and interprets it within the context of the situation that the client is in. My professional rules accordingly prevent me from giving the results of such tests to anybody other than a qualified and registered psychologist. After I have interpreted the test results, I will discuss my findings and their implications with you, however no raw scores will be provided. If you are not prepared to accept this, you must please tell me.

The fees charged include up to 5 hours of assessment and a written report. The feedback session discussing the report is charged separately. (This rate is subject to change in March of every year with tariff increases).

Either you, or myself, can terminate therapy at any stage. I will only terminate therapy in consultation with you and in a professionally ethical and accountable way.

Further Information
Before we commence the first session, I will allow you an opportunity to raise any questions you may have. Please feel free to ask any questions you may have regarding the information in this document. If, at any stage, you fail to understand what is taking place, you must please ask me for an explanation. In particular, I want you to tell me if you feel uncomfortable about what is taking place, or about what I am suggesting, or with any procedure I use.

Please note that by signing the Client Information Form, you have agreed that you have read this document in its entirety and agree to the terms and conditions set out in this document.