This document is designed to inform you about my background and to ensure that you understand our professional relationship. I received a doctorate in Counseling and Counselor Education from North Carolina State University and a master's degree in Rehabilitation Counseling and Psychology in August 2008 from the University of North Carolina at Chapel Hill. I have been a Licensed Professional Counselor in the State of North Carolina since 2010 (#7772). I am also a Licensed Professional Counselor Supervisor, providing training and supervision to provisionally licensed counselors.
COUNSELING SERVICES OFFERED/THEORETICAL APPROACHES Counseling is a process by which we work together to identify and work on any issues you bring to our sessions. My approach to counseling involves helping you to identify strengths and develop self-awareness. My therapeutic approach includes Cognitive Behavior Therapy, Dialectical Behavior Therapy, mindfulness-based practice, psychodynamic theory, and Acceptance and Commitment Therapy. These therapies are well established, researched, and respected within the profession. You are encouraged to become knowledgeable about goals, methods, and effectiveness. Should you ever have reservations regarding counseling or any specific interventions, or feel you are not progressing as you wish, it is important to discuss your concerns with me. The counseling theory or model we use needs to be acceptable to you.
One of the important steps in counseling is establishing your goals for counseling. Along with your goals, the counseling plan will include the methods for achieving your goals, 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 counseling plan, goals, and methods.
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. 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. 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 changes may lead to what seems to be worsening circumstances or even losses (for example, counseling will not necessarily keep a marriage from dissolution). I will enter our relationship with optimism and an eagerness to work with you. I have a special interest in helping adults and adolescents with personal growth, substance abuse, and spiritual development. I also have experience working with children, adolescents, and adults with mood disorders and behavioral issues. I do not take on clients whom, in my professional opinion, I cannot help using the techniques I have available. I voluntarily participate in peer supervision to ensure best practice techniques. Any cases reviewed in such supervision are kept confidential by changing names and any other identifying information.
CONFIDENTIALITY I regard the information you share with me with the greatest respect, so I want us to be as clear as possible about how it will be handled. I have to report your progress to the North Carolina Board of Licensed Professional Counselors or to your university program in order to meet requirements specified by your program or licensing board. Therefore, I will be sharing information regarding your capabilities as a counselor with outside parties. I will, however attempt to keep information regarding you and your clients as confidential as possible. Occasionally there are situations that require that I break confidentiality. These include (1) threats to harm self or others; (2) reasonable suspicion of abuse of a child or other vulnerable person; and (3) when ordered by the court. Confidentiality may also be broken in one’s defense against a legal action before a court.
EXPLANATION OF DUAL RELATIONSHIPS Our relationship will be professional, not personal. Contact will be limited to only counseling sessions. You will be best served while I am seeing you for counseling and therapy if our relationship stays strictly professional and if our sessions concentrate exclusively on your concerns.
LENGTH OF SESSIONS My services will be rendered in a professional manner consistent with accepted ethical standards. Sessions are 50 minutes in duration. If you are unable to keep an appointment, please call the office to cancel or reschedule at least 24 hours in advance. If I do not receive such advance notice, you may be responsible for paying for the session that you missed. Please understand that missed appointments cannot be billed to insurance. If seen through an Employee Assistance Program, a late cancellation or missed appointment may count as one of your sessions. Please note that it is impossible to guarantee any specific results regarding your counseling goals. However, together we will work to achieve the best possible results for you.
FEES/METHODS OF PAYMENT Individual sessions are $110 with sliding scales available in limited cases. Cash, credit/debit cards, and personal checks are acceptable for payment at the time services are rendered. I currently accept Blue Cross Blue Shield and file as an out-of-network provider for other insurance carriers. You will be responsible for deductibles and co-payments according to your insurance plan at the time services are rendered. Claims will be filed by my office.
CONTACT INFORMATION Phone: 919 345 2132 Fax: 919 890 0852
If you are in crisis and need immediate assistance, please call Holly Hill First Responder at 250-7000, dial 911, or proceed to your nearest emergency room
COMPLAINT PROCEDURES I abide by the NBCC, ACA, and NCBLPC Code of Ethics as well as the CCE’s Standards for the Ethical Practice of Clinical Supervision. Although supervisees are encouraged to discuss any concerns with me first, you may file a complaint against me with any of these organizations should you feel I am in violation of any of these codes of ethics.
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 board at
North Carolina Board of Licensed Professional Counselors PO Box 77819 Greensboro, NC 27417 Phone: 844-622-3572 Fax: 336-217-9450
Should you have any questions, please feel free to ask. Please sign and date both copies of this form. A copy for your records will be returned to you and I will retain a copy in my confidential records.