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***Before you attend your first session at USW Therapy: 1. Please read the Privacy Notice below and sign your name at the bottom of the page 2. complete the Equal Opportunities Monitoring Questions****

The University of South Wales operate a Community Counselling service. We understand that either you were referred by another organisation to our service, who gained your permission to refer on your details to us for access to counselling, or you have contacted us directly to access our counselling services.

We respect you as an individual, with your own set of values, beliefs, strengths and experience. As such, following a referral to our service, you may be invited for an assessment, unless the referrer has previously carried this out. For example, in the case of Primary Mental Health Services.
The assessment is normally carried out over the telephone and takes approximately 30-40 minutes. We conduct assessments to help us understand difficulties you are presently experiencing and if our service will be suitable for you. This is a two-way process, which allows you to explore your needs and what you want to get out of therapy.
It also helps us to identify the most appropriate sort of therapy to meet your particular needs. We are able to offer a range of different types of counselling and psychotherapy services which will be discussed with you during the assessment.

These include:

  • Cognitive Behaviour Therapy
  • Integrative Therapy
  • Art Psychotherapy
  • Music Psychotherapy

You will be offered approximately 8 - 12 sessions with a supervised counsellor. Sessions will last for around 50 minutes. You will be encouraged to talk through your concerns initially to make sense of them. The process also seeks to assist you to build on your strengths and existing support networks and potentially find solutions to your concerns.
Appointments will be confidential unless it becomes apparent that you or someone else is at risk of serious harm. In such circumstances, decisions are made in the best interest regarding your safety or the safety of others. If you need additional help and support, this is discussed throughout and you will be encouraged and supported to access options to suit your individual needs and safety.

What information we collect?
Counsellors will keep a record about you, which includes a summary of what happens and of things said during the counselling session. The counsellor may take a photograph of artwork created by you within the counselling session, or ask to carry out an audio recording of a session with your expressed and informed consent. Below is a list of information the service collects.
During referral and/or assessment

  • Name
  • Date of Birth
  • Home Address
  • Phone Numbers
  • Email address
  • Safety Concerns
  • Communication preferences
  • Family setup
  • Gender
  • Ethnicity
  • Disability status
  • Learning/Cognitive difficulties
  • GP Surgery
  • Other related health information (such as history with mental health support services)

During Counselling
Your counsellor will discuss with you your personal goals for therapy. He/she will use evidenced based measures to help understand your difficulties. These measures will also be used to help recognize and understand changes in your mood and behavior which will be discussed throughout therapy with you. It also helps the service to monitor its performance and ensure a high quality service. Sometimes we are required to provide this information to funders. However, where this happens, the information will be anonymized. The only exception to this is in circumstances where we are required to share your information with Primary Mental Health services who are commissioning our service.

What is our legal basis for processing?

Article 6 - Personal Data
- We process personal information about you in order to provide counselling services relating to the contractual arrangement you have entered into.
Article 9 - Special Categories
- We also process data referred to as special category data due to the substantial public interest that relates to providing counselling (under schedule1 - part 2, 17.1.1a. of the DPA 2018).
‘Special categories’ of personal data relate to racial or ethnic origin, political opinions, religious or philosophical beliefs, trade union membership, genetic data, biometric data, data concerning health or data concerning a natural person's sex life or sexual orientation.
With whom do we share your information?
Personal data may also be disclosed when legally required or where there is a legitimate interest, for the University or you, taking into account any prejudice or harm that may be caused to you - the ‘data subject’.
During the course of carrying out counselling, we may need to share your information as required with the following categories of recipients:

  • GP / NHS (if there is a serious concern about the mental or physical health)
  • Social Services or Police (if there is a serious concern about your wellbeing or safety and that of others.
  • Clinical Supervisors to ensure ethical best practice

Retention of data
All data held about USW activities and all personal data will stored securely and appropriately in line with the University’s Retention Schedule. However, where we are processing your information on behalf of another organisation who have referred you to us for counselling, we may be guided by their regulations regarding retention. This Schedule is reviewed periodically and it serves to determine how long certain information will be retained.
Security of data
Data Protection legislation requires us to keep your information secure. This means that your confidentiality will be respected, and all appropriate measures will be taken to prevent unauthorised access and disclosure. Only members of staff who need access to relevant parts or all of your information will be authorised to do so. Information about you in electronic form will be subject to password and other security restrictions, while paper files will be stored in secure areas with controlled access. Some processing may be undertaken on the University’s behalf by an organisation contracted for that purpose. Organisations processing personal data on the University’s behalf will be bound by an obligation to process personal data in accordance with Data Protection legislation.

Your rights
You have a right to:

  • Be informed about the information with collect and hold in relation to you
  • Access your personal information and request access to your personal information
  • Request that we rectify any inaccuracies in your personal information
  • Request that we erase your personal information
  • Request that we stop processing your/your child’s personal information
  • Request that we transfer your/your child’s personal information to another organisation
  • Right to object
  • Right to challenge an automated decisions made (We do not make any automated decisions regarding you).

In relation to your personal information, the service manager will conduct an assessment of your request and a decision will be made no more than 30 days after your request has been received. You can contact the service manager on the following email address:
Any requests or objections should be made in writing to the University Data Protection Officer:-
Address: University Secretary’s Office,
University of South Wales Pontypridd,
CF37 1DL

If you are unhappy with the way in which your personal data has been processed you may in the first instance contact the University Data Protection Officer using the contact details above.
If you remain dissatisfied then you have the right to apply directly to the Information Commissioner for a decision. The Information Commissioner may be contacted at the following address and website:
Address: Information Commissioner’s Office, Wycliffe House, Water Lane, Wilmslow, Cheshire, SK9 5AF


a.1.a. I have read and agree to the Privacy Notice above Required

Next, please complete the following section for Equal Opportunites Monitoring

Equal Opportunites Monitoring

The Equality Monitoring information requested by USWTherapy will be used for monitoring purposes and to help us develop our policies and practice in relation to accessing the service. The information you provide will form part of our non-identifying statistical reports which may be shared with future funding partners and the University of South Wales Equalities and Human Resource Department.  However, all shared data will be anonymised.  All information collected will be stored securely in line with the General Data Protection Regulation 2018.


We would therefore like to request that you complete the following equality monitoring questions.  Information provided will be processed by the USWTherapy operational team, who will also have responsibility for secure storage of confidential data.  Any future use of the information provided will be limited as described above, as well as ensured anonymity. This information will not be provided to your therapist or counsellor. Where you do not wish to disclose information you are able to choose the ‘prefer not to say’ option, or leave those questions blank.

Thank you for your cooperation.

3.3. Disability Do you consider yourself to have a disability, impairment, health condition or learning difference which has a substantial and long-term impact on your ability to carry out day-to-day activities? Required
4.4. Is your nationality? Required
5.5. What is your ethnic origin? Required
6.6. Is your gender identity the same as the gender you were assigned at birth? Required
7.7. Which religion or belief do you most identify with? Required
8.8. What is your sex? Required
9.9. What is your sexual orientation? Required
10.10. Do you speak Welsh? Required
a.10.a. If yes, please choose one of the following categories Required