Personal Disclosure

I am pleased you have selected me as your counselor. This document is designed to inform you about my background and to ensure that you understand our professional relationship.

I hold a Master of Arts Degree from Appalachian State University, being received in 1982. I have been a professional counselor since 1983. I have had my Certified Employee Assistance Professional (#4860) credentials since May 1991. I am also a Licensed Professional Counselor (#1070) licensed by the state of North Carolina since July 1995. In July 1998, I was recognized as a Licensed Employee Assistance Professional (#60) by the state of North Carolina and in January 2008, I received my Licensed Clinical Addictions Specialist (#1223) credential.

Counseling Services Offered and Theoretical Approaches

People can make better decisions if they have enough information and understand how something works. Here are some aspects of counseling and therapy as I see and practice it:

Counseling includes your active involvement as well as efforts to change your thoughts, feelings and behaviors. You will have to work both in and out of the counseling sessions. There are no instant, painless, or passive cures, no “magic pills.” Instead, there will be homework assignments, exercises, writing and journals, and perhaps other projects. Most likely, you will have to work on relationships and make long-term efforts. Sometimes change will be easy and swift, but more often it will be slow and deliberate; effort may need to be repeated.

I take an educative approach to people’s problems and encourage you to learn more about the kind of therapy I do. My approach is derived from “Rational Emotive Therapy” developed by Dr. Albert Ellis, “Cognitive-Behavioral Therapy” formulated by Drs. Aaron Beck & Donald Michenbaum, and “Reality Therapy” created by Dr. William Glaser. These are well-established, researched and respected therapies. You are encouraged to become knowledgeable about goals, methods and effectiveness.

If we are to work together, we will need to specify the goals, foci and methods, risks and benefits of treatments, the approximate time commitment involved, costs and other aspects of your particular situation. Before going further, I expect us to agree on a plan to which we will both adhere. Periodically, we will evaluate our progress and, if necessary, redesign our treatment plan, goals and methods.

As with any powerful intervention, there are both benefits and risks associated with counseling and therapy. Risks might include experiencing uncomfortable levels of feelings like sadness, guilt, anxiety, anger or frustration, or having difficulties with other people. Some change may lead to what seems to be worsening circumstances or even losses (for example, counseling will not necessarily keep a marriage intact).

Clients I work with are psychologically and emotionally “healthy” and seek counseling for difficulties due to normal life events. I do not take on clients whom, in my professional opinion, I cannot help using the techniques I have available. I will enter our relationship with optimism and an eagerness to work with you. I have a special interest in helping people with career issues, academic and personal adjustment, and families with their relationships.

Fees and Methods of Payment

I assure you that my services will be rendered in a professional manner consistent with accepted ethical standards. Sessions are 50-60 minutes in duration. We will schedule our sessions for our mutual agreement. Please note that it is impossible to guarantee any specific results regarding your counseling goals. However, together we will work to achieve that best possible results for you. In return for a fee of $150.00 per session, I agree to provide counseling services for you. I would prefer that you pay for each session at the conclusion of each session. Cash or personal checks are acceptable for payment. I will provide you with a receipt for all fees paid.

CANCELLATION POLICY

Please help us to serve you and others better by keeping your scheduled appointments. If you need to cancel or reschedule, please give us as much notice as possible so we can offer that time to someone else.

Unless cancelled at least 24 hours in advance, our policy is to charge for missed appointments at the rate of a normal counseling session. This will be billed to you. We may require prepayment in order to schedule a subsequent appointment.

Billing and Insurance Reimbursement

If you wish to seek reimbursement for my services from your health insurance company, I will be happy to complete any forms related to your reimbursement provided by you or the insurance company. I am currently on several insurance panels including Aetna, BCBSNC, Cigna, Magellan, Medicaid, Mental Health Network and United Healthcare and will file insurance for you for those panels.

Some health insurance companies will reimburse clients for my counseling services and some will not. Those that do reimburse usually require that a standard amount be paid by you before reimbursement is allowed, and then usually only a company representative can determine whether your insurance company will reimburse you and about what schedule of reimbursement will be used. However, please remember that you are responsible and not your insurance company for paying the fees agreed upon.

Health insurance companies often require that I diagnose your mental health condition and indicate that you have an “illness” before they will agree to reimburse you. In the event a diagnosis is required, I will inform you of the diagnosis I plan to render before I submit it to the health insurance company. Any diagnosis made will become a part of your permanent insurance records.

 Confidentiality

I regard the information you share with me with the greatest respect, so I want us to be clear as possible about how it will be handled. Generally, I will tell no one what you tell me. The privacy and confidentiality of our conversations, and my records, is a privilege of yours and is protected by federal and state law (See 42 U.S.C. 290dd-3 and 290ee-3 for Federal laws and 42 CFR Part 2, 491.0147 FL) and my profession’s ethical principles, in all but a few circumstances. There are two circumstances in which I cannot guarantee confidentiality, legally and/or ethically: (1) which I believe you intend to harm yourself or another person; and, (2) when I believe a child or elder person has been or will be abused or neglected. In rare circumstances, Professional Counselors can be ordered by a judge to release information. Otherwise, I will not tell anyone anything about your treatment, diagnosis, history, or even that you are a client, without your full knowledge and usually a signed Release of Information Form.

Complaint Procedures

If you are dissatisfied with any aspect of our work, please inform me immediately. This will make our work together more efficient and effective. If you think that you have been treated unfairly or unethically, by me or any other counselor, and cannot resolve this problem with me, you can contact the North Carolina Board of Licensed Professional Counselors at PO Box 77819, Greensboro, NC 27417, (336) 217-6007, the North Carolina Substance Abuse Professional Practice Board at PO Box 10126, Raleigh, NC 27605, (919) 832-0975, the Employee Assistance Certification Commission at 4350 North Fairfax Drive, Suite 410, Arlington, Virginia 22203, (703)387-1000 or the North Carolina Employee Assistance Professionals Licensure Board at the Division of MH/DD/SAS, 3007 Mail Service Center, Raleigh, NC 27699-3007, (919)733-4670 for clarification of clients’ rights as I have explained them or even to lodge a complaint.