Counsellor/psychotherapist accreditation application form · Web viewYou must show the word count at the end of your piece of work for each of the criterion below. Please insert your

British Association for Counselling and Psychotherapywww.bacp.co.ukOctober 2020

BACP membership number: 0 0 Click or tap here to

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Counsellor/psychotherapist accreditation application form ‘A quality standard for the experienced practitioner who can demonstrate high standards of competent and ethical practice’


This form must be completed in conjunction with the Application GuidePlease retain a complete copy for your own records as applications won’t be returned after assessment



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BACP Fair Processing NoticeThe information you provide in this form is required to processes your accreditation application. Only our accreditation team will have access to this information while your application is being processed after which it will be removed from our systems.

You will have the right to access the information you have provided as well as the other rights afforded to you under data protection laws.

We need this information to process your accreditation application. You may withdraw your application at any point and request for the information to be destroyed. This will result in your withdrawal from the process.

If you do not provide all the information required on this form your application may not be processed

To find out more about the way we look after personal data please see the BACP privacy notice (www.bacp.co.uk/privacy-notice/)

New interactive Accreditation Resources are available to help you understand the requirements and assist you through our accreditation process. These resources are free to access at www.bacp.co.uk/accreditation

http://www.bacp.co.uk/accreditation

http://www.bacp.co.uk/privacy-notice/



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Completing your applicationYou will need to refer to a copy of the Accreditation as a Counsellor/Psychotherapist – Application Guide in order to complete this application form. Please ensure you read the eligibility section before proceeding.

Part A – Personal Information

Your detailsBACP member number: 0 0

BACP Register number:

You must remain a Registered Member in order to submit your application

Title (Mr, Mrs, Ms, other):

First name(s):

Surname:

Please confirm that the personal contact details that we hold are correct, if the details are incorrect, please update in your member’s area on the BACP website

Yes

Did you complete a PCE-CfD IAPT accredited course? Yes No



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Complaints and refusalIf a formal complaint against you is being investigated, we'll be unable to accept your application for accreditation until the outcome of the investigation has been decided. Please provide a response to the following questions:

Is there a formal complaint against you currently being investigated by us or any other relevant professional body? Yes ☐ No ☐

If you've answered 'yes', we're unable to process your application until the outcome of the investigation has been decided.

Has any formal complaint made against you been upheld by us or any other relevant professional body? Yes ☐ No ☐

If you’ve answered ‘yes’, please provide details of the complaint and outcome from the relevant body with your application.

Have you been refused recognition, certification or accreditation by any relevant professional body? Yes ☐ No ☐

If you’ve answered ‘yes’, please include a copy of the details of the refusal from the body concerned with your application


BACP membership number: 0 0 Click or tap here to enter

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Part B – Current practicePlease provide details of your current practice as follows: Are you currently in practice as a counsellor / psychotherapist? Yes ☐ No ☐

Does your general current practice include:Working with individual adults? Yes ☐ No ☐

Working with children and young people? Yes ☐ No ☐Working with couples? Yes ☐ No ☐Working with groups? Yes ☐ No ☐Working face-to-face? Yes ☐ No ☐

Working online? Yes ☐ No ☐Working by telephone? Yes ☐ No ☐

If you have answered yes to any of these, please make sure you include them in your rationale for criterion

8.1.

How many client hours do you undertake each month on average? Click or tap here to enter text.

Please give details of all your current counselling/psychotherapy practice. (In each case please give your job title, role (e.g. counsellor, psychotherapist), the setting (e.g. NHS, school, private practice), the type of clients you see (e.g. individual adults, children and young people, couples), how you offer sessions (e.g. face-to-face, online, by phone) and include your employer’s details)Click or tap here to enter text.



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Diary of current practiceType: Click or tap here to enter text.Client Details: Click or tap here to enter text.

Date Session No. Client Length

(mins) Main concerns of session

Type: Click or tap here to enter text.Client Details: Click or tap here to enter text.












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Your route to accreditationIf you’re applying using BACP accredited training, you should now go to part C

If you’re applying using any other training, you should now go to part D

See the Application Guide if you are not sure which route is right for you.



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Part C: BACP accredited course Full title of course: Click or tap here to enter text.

Main theoretical approach: Click or tap here to enter text.

Other theoretical approaches: Click or tap here to enter text.

Training institution’s name: Click or tap here to enter text.

Institution’s address: Click or tap here to enter text.

Postcode: Click or tap here to enter text.

Institution’s phone number: Click or tap here to enter text.

Start date of course: Click or tap here to enter text.

Date completed: Click or tap here to enter text.

Title of the award you received: Click or tap here to enter text.

Date received: Click or tap here to enter text.



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Part D: Training not accredited by BACP

See the Application Guide for more information

Full title of course: Click or tap here to enter text.

Main theoretical approach: Click or tap here to enter text.

Other theoretical approaches: Click or tap here to enter text.

Training institution’s name: Click or tap here to enter text.

Institution’s address: Click or tap here to enter text.

Postcode: Click or tap here to enter text.

Institution’s phone number: Click or tap here to enter text.

Please provide a breakdown of the number of formal taught contact hours (not including hours in placement). For example, three hours a week, two 20-hour residential weekends over two academic years = 202 hours: Click or tap here to enter text.

Total taught hours: Click or tap here to enter text.



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Start date of course: Click or tap here to enter text.

Date completed: Click or tap here to enter text.

Title of the award you received: Click or tap here to enter text.

Date received: Click or tap here to enter text.

Dates of your placement: Click or tap here to enter text.

Please give details of your placement: Click or tap here to enter text.

Please briefly describe how theory, skills, professional issues and personal development were covered on the course:

Theory:Click or tap here to enter text.

Skills:Click or tap here to enter text.

Professional Issues:Click or tap here to enter text.

Personal Development:Click or tap here to enter text.



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Part E: Practice hours Please provide details of your submitted practice by completing the table below

Dates for each 12-month period(from - to)

Your role, the place and setting for this practice

Hours of practice during period

How many are post-training practice hours?

Number of months practiced in this period

From:

To:

From:

To:

From:

To:

From:

To:

From:

To:

Please give totals for these two columns:



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Part F - Supervision Arrangements See the Application Guide section on ‘Supervision’ for more information

Individual supervision arrangements

Please complete a copy of this sheet for each individual supervision arrangement.

Supervisor’s name

Supervisor’s email address:Click or tap here to enter text.

Supervisor’s qualification/s:

Contract start date Click or tap here to enter text. Contract end date Click or tap here to

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Contracted frequency of supervised session:Weekly ☐Fortnightly ☐Monthly ☐

Contracted length of session:Click or tap here to enter text.

Which practice(s) does this arrangement cover? (e.g. Albany GP surgery, Sept 01 to Sept 03)

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Is, or was there, any professional or personal relationship between you and your Supervisor, other than for the purpose of this supervision? For example, if your supervisor is also your line manager you need to tell us about the arrangements for additional supervision which you have put in place.

Yes ☐ No ☐

If yes, please explain:


Did this Supervisor supervise the case material you have used for Criterion 9? Yes ☐ No ☐


Peer or Group supervision arrangementsPlease complete a copy of this sheet for each peer or group supervision arrangement

Supervisor’s name or contact name for peer supervision group:Click or tap here to enter text.

Supervisor or group contact’s email address:Click or tap here to enter text.

Supervisor’s qualification/s:

Contract start date Click or tap to enter a date. Contract end date Click or tap to

enter a date.

Are you telling us about group or peer supervising Group ☐Peer ☐

Contracted frequency of supervised session:Weekly ☐Fortnightly ☐Monthly ☐

Contracted length of session:Click or tap here to enter text.

How many people are contracted to attend this group? Click or tap here to enter text. (if the arrangement is group supervision, do not include the group facilitator in this number)Which practice(s) does this arrangement cover? (e.g. Albany GP surgery, Sept 01 to Sept 03)


Is, or was there, any professional or personal relationship between you and your Supervisor, other than for the purpose of this supervision? For example, if your supervisor is also your line manager you need to tell us about the arrangements for additional supervision which you have put in place.

Yes ☐ No ☐

If yes, please explain:Click or tap here to enter text.

Did this Supervisor supervise the case material you have used for Criterion 9? Yes ☐ No ☐BACP membership number: 0 0 Click or tap here to enter

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Part G - Reflective practice criteria 6-9Please now provide evidence of your reflective practice.

Further information on these criteria is available in the Application Guide

Considerations Referencing – please ensure that you indicate where your work meets each

individual sub criterion within the work by using brackets, section headings or margin notes. For example, under 8, indicate where (8.1) is met.

Word count – Please keep within the word count for each criterion and do not exceed the count given. These are detailed below. You must show the word count at the end of your piece of work for each of the criterion below.

Please insert your reflective criteria 6 – 9 here. Criterion 6 (max 900 words)Click or tap here to enter text.

Criterion 7 (max 900 words)Click or tap here to enter text.

Criterion 8 (max 1,400 words)Click or tap here to enter text.

Criterion 9 (max 3,000 words)Click or tap here to enter text.



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Declaration of honestyI declare that as far as I know, my full application (part 1 and part 2) contains only true information. I understand the officers of BACP may make such enquiries as they consider necessary to verify the information given. I understand that if any incorrect, incomplete or plagiarised information is discovered, my application for accreditation may be invalidated and my application withdrawn. Such matters may also be referred for consideration under the Professional Conduct Procedure or the Article 12.6 procedure as appropriate.

Applicant’s signature/e-signature:Click or tap here to enter text.

Date:Click or tap here to enter text.

Documents

Counsellor/psychotherapist accreditation application form · Web viewYou must show the word count at the end of your piece of work for each of the criterion below. Please insert your