People only open up in pastoral care when they trust that what they share stays protected. This agreement establishes that trust from the first session — and ensures your pastors know exactly when the law requires them to break it.
**[CHURCH_NAME]** **Effective Date:** [EFFECTIVE_DATE] **Pastoral Counsellor:** [COUNSELLOR_NAME] **Supervising Pastor (if applicable):** [SUPERVISING_PASTOR] ---
Welcome. We are grateful that you have chosen to seek pastoral support through [CHURCH_NAME]. This agreement is designed to help you understand how your information will be treated, and to build a foundation of trust for our conversations. Pastoral counselling is a ministry of care offered in the context of the Christian faith. It is distinct from professional psychological or psychiatric treatment, though it takes your wellbeing seriously. Please read this agreement carefully before your first session. ---
Information shared in pastoral counselling sessions is treated as confidential. This means: 1. What you share will not be disclosed to congregation members, family members, or anyone outside the counselling relationship without your express permission 2. Your participation in counselling will not be mentioned to others without your consent 3. Written notes from sessions are stored securely and are accessible only to [COUNSELLOR_NAME] and, where supervision is in place, [SUPERVISING_PASTOR] 4. Confidentiality continues after the counselling relationship ends ---
Confidentiality is not absolute. There are specific circumstances where [COUNSELLOR_NAME] is obligated to break confidentiality, with or without your consent. These situations are: ### 2.1 Risk of Harm to Self If you express a clear and credible intention to end your own life or seriously harm yourself, [COUNSELLOR_NAME] will take appropriate action to ensure your safety. This may include: - Contacting emergency services (112 or 10111) - Notifying a family member or emergency contact - Referring you immediately to a mental health professional or facility ### 2.2 Risk of Harm to Others If you express a credible intention to cause serious physical harm to another specific person, [COUNSELLOR_NAME] has a duty to take reasonable steps to protect that person. This may include warning the potential victim and/or alerting relevant authorities. ### 2.3 Child Abuse or Neglect Under the Children's Act 38 of 2005, [COUNSELLOR_NAME] is required to report any reasonable belief that a child is being abused, neglected, or is at risk of abuse, to SAPS or the Department of Social Development. **This is a legal obligation that cannot be waived.** ### 2.4 Abuse of a Vulnerable Adult If disclosure suggests that an elderly or vulnerable adult is being abused or exploited, appropriate protective action will be taken. ### 2.5 Supervision [COUNSELLOR_NAME] may share session content in confidential professional supervision with [SUPERVISING_PASTOR] for the purpose of improving care quality. Supervision conversations are themselves confidential. ### 2.6 Legal Process If a court of law issues a valid subpoena requiring disclosure of counselling records, [CHURCH_NAME] will comply with the legal process. [COUNSELLOR_NAME] will inform you before disclosing if possible. ---
Except where immediate safety prevents it, [COUNSELLOR_NAME] will: 1. Inform you of the need to disclose 2. Explain what will be shared and with whom 3. Offer you the opportunity to make the disclosure yourself where appropriate ---
### 4.1 Session Notes [COUNSELLOR_NAME] may keep brief session notes for: - Continuity of care between sessions - Supervision purposes - Safeguarding documentation if required Notes are stored [RECORD_STORAGE_LOCATION] and accessible only to authorised persons. ### 4.2 Retention Period Session records will be retained for [RETENTION_YEARS] years after the last session, after which they will be securely destroyed. ### 4.3 Access to Your Records You have the right to request access to your own records. Requests should be directed to [COUNSELLOR_NAME]. Notes about third parties shared during your sessions may be withheld to protect others' privacy. ---
### 5.1 Nature of Pastoral Counselling Pastoral counselling at [CHURCH_NAME] is: - A ministry of care offered from a Christian faith perspective - Suitable for: grief, relationship difficulties, spiritual questions, life transitions, mild to moderate personal struggles - **Not a substitute for** professional psychological therapy, psychiatric treatment, or medical advice If your needs exceed what pastoral care can appropriately address, [COUNSELLOR_NAME] will refer you to a qualified professional. A referral list is available upon request. ### 5.2 Referral Protocols Referral to a professional counsellor, psychologist, or other specialist will be considered when: - Clinical mental health conditions are indicated (depression, anxiety disorders, trauma) - Suicidal or self-harm ideation is present - Substance dependence is identified - Situations involve legal matters that require professional input A referral to [REFERRAL_RESOURCE] is available for [CHURCH_NAME] members. ### 5.3 Relationship Boundaries - Pastoral counselling sessions take place at [SESSION_LOCATION] during scheduled appointments - Sessions outside of church premises require approval from [SUPERVISING_PASTOR] and must not be conducted in private or isolated settings - [COUNSELLOR_NAME] will maintain appropriate professional and pastoral boundaries at all times - Dual relationships (e.g., counselling a close personal friend) will be carefully assessed and may require referral to another counsellor ### 5.4 Duration Sessions are typically [SESSION_LENGTH] minutes in length. The counselling relationship will be reviewed after [REVIEW_SESSIONS] sessions to assess progress and next steps. ---
- Emergency pastoral support is available by contacting [EMERGENCY_CONTACT] - Routine communication between sessions should be kept brief and directed through [CONTACT_METHOD] - [COUNSELLOR_NAME] is not able to provide ongoing real-time support via WhatsApp or similar platforms ---
As a person receiving pastoral care, you have the right to: - Receive respectful, non-judgmental care - Terminate the counselling relationship at any time - Request a referral to another pastor or professional counsellor - Raise concerns about how you have been treated with [SUPERVISING_PASTOR] or [SENIOR_LEADER] ---
I have read and understood this Pastoral Counselling Confidentiality Agreement. I understand the limits of confidentiality and agree to the terms of this agreement. **Name (Print):** _________________________ **Signature:** _________________________ **Date:** _____________ **Emergency Contact Name:** _________________________ **Emergency Contact Number:** _________________________ --- *[COUNSELLOR_NAME] — [CHURCH_NAME] | [EFFECTIVE_DATE]*