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Welcome! Please complete the intake form after accepting the policies and procedures.

Client Information

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Terms and Policy

CLIENT RESPONSIBILITIES
My request is that you arrive on time for your session, and turn your cell phone off so that you can give full attention to your time. If you are waiting for an emergency call, I can understand and we can discuss the course of action for that session. If you have to miss a session, please let me know as soon as possible to be courteous to other clients that may be waiting for an opening.

I include clients in the development of their own treatment plans. After an initial meeting, I will review with you the areas I feel are causing you the most distress and ask for your feedback and guidance. If you feel that we can agree on a course of treatment that will benefit you, then we will start to work on the most pressing issue first. There may be sessions where you feel that another issue is on your mind too much to focus on our plan. We can discuss that and adjust your session that week accordingly. Periodically, I will review the treatment plan with you and revise it based on our discussion.

At times, I may ask you to write a journal or complete other homework assignments. It is imperative that you work on this outside of the session, and do not come a few minutes early to complete the work just before you walk into the office. This will not help you and does not provide any benefit to your session.

If at any point it seems as though you cannot communicate with me or that I do not understand your needs, I encourage you to share your concerns. Therapy is a very personal experience; so accordingly, everyone does not feel rapport with every therapist. If we cannot address the issue, I cannot be of help to you, and would rather refer you to another therapist for your benefit. You have a right to discontinue services with me at any time, but I would prefer to terminate therapy in a gradual process unless you are displeased with your services.

If you become abusive verbally or physically in therapy, or threaten anyone in my office, myself or my family, I may terminate therapy services immediately. I will offer referrals to other providers but do not guarantee they will accept you as a client.
( Type Full Name )
SPECIFIC CONCERNS WITH FAMILY AND COUPLES THERAPY
If your family is pursuing therapy services together, it is important to understand that the entire family is the client. My goal and responsibility is to the whole family unit rather than one individual. In couple’s therapy, nothing said in private sessions is protected by confidentiality, so please do not disclose issues that you do not want discussed with your significant other.
( Type Full Name )
SESSIONS
My sessions are normally 60 minutes long. I ask that you arrive on time for your session, as I will not extend the length of time if you are late. I also understand that sometimes unforeseen events arise and/or emergencies, so if you need to cancel a session I ask that you do so 24 hours in advance if possible. If you do not cancel, or cancel very close in time to a scheduled session, it is at my discretion to charge you a cancellation fee of the amount due at the regular session.

If you are bringing a child to session, I ask that you wait for the child rather than leave the premises. I normally meet with parents in the first few minutes of session, but at times may want to include the family in later if necessary. I do understand that you may have other children who have events and need to be picked up, so I ask that you please try to arrive back at the office before the conclusion of session if this is necessary. I will not leave a minor in the waiting room unattended, so your absence will delay the start of someone else's session.


I will not release any information or have a discussion with another caregiver that may be dropping the child off. If you do need to send a message to me, please do so by phone before the session, or explain to the caregiver that they can ask to speak to me away from the child and provide me with the information. If you are a foster parent, please be aware that I cannot release any information to you without the signature of the social worker involved. Although your participation is necessary and I do need to hear feedback about the child's progress, I cannot discuss any details without consent.

In the event that an unforeseen circumstance occurs, such as an emergency, or weather related event, I have the option to conclude the session early. If the event was in no way preventable, I may pro-rate the session fee accordingly. If the event occurs on my end, I will not charge you for that session and will reschedule your session as soon as possible.

PROFESSIONAL FEES
My regular session fee is $100.00. If you need additional time in session, it will be pro-rated per half hour if I have time available. As stated previously, cancellation fees may apply if the session is canceled very closely to the session time, or not canceled at all. I also charge a fee for other work that may be requested, such as copies of records, summaries and other reports, telephone sessions, meetings with other agencies on your behalf, and other appropriate tasks. For legal proceedings, I charge $125.00 per hour including travel and preparation time due to the difficulty of rescheduling other clients and more detailed summaries.

PAYMENTS
You are required to provide payment at the conclusion of your session. I currently accept Blue Cross (Carefirst) and Magellan insurance, as well as payments by credit card, check or cash. If a check is returned, I do impose a fee equal to the bank charge, and after two returned checks, I will only accept a certified check or cash. I do understand that financial hardships occur, and am willing to discuss payment arrangements if an unforeseen hardship occurs, including a sliding scale option for some families.. I understand that things happen, and will try to work with you as best possible. I will use a collection agency if necessary to collect payment due for completed sessions that has remained unpaid with no payment arrangement. If you are using insurance, acknowledging this section constitutes agreement to release information for the purpose of receiving reimbursement.


CONTACTING ME
I am in session throughout the day and will not answer the phone while in session. I do return calls in between sessions, but if this is an emergency, please let me know where you are and how long you will be there. If you do not reach me and do not feel you can wait for me to return the call, I would like you to contact your general physician or the local emergency room. If I am going to be out of the office for a period of days, I will normally discuss this with you at prior sessions unless the plans are unexpected. If an emergency occurs on my end, I will contact you and advise how long I will be out of the office, and if the absence will be extended, the options for therapy services with another provider.

It is my preference not to communicate at length through email or text. If you choose to send me an email, please be advised that I have no way of providing you confidentiality, so your choice to do this indicates your understanding of this fact. I find email helpful for clients who may not journal and may forget some of their concerns in between sessions, and am fine with sending me a note about issues that they may want to discuss in the next session. I will also accept email cancellations but the 24 hour notice still applies. Texting should be used for cancellations/rescheduling issues only.

PROFESSIONAL RECORDS
I do keep treatment records of our sessions. However, I try to keep these records brief due to the confidential nature of our sessions. You are entitled to a copy of your records at any time, however I would prefer to review your file with you and will not charge for the time we spend doing this. Because mental health terminology can be very confusing, I would prefer to explain my notes to you. There also may be a diagnostic impression or clinical diagnosis in your file. If this is the case, I would be glad to discuss any concerns you have over this fact. Not every person that comes to therapy has what they consider to be a mental health diagnosis. Many clients come to therapy to adjust to new situations, or family transitions, and prefer not to be labeled.

All of my client records are stored in a locked file cabinet within a locked office to ensure your confidentiality. No one has access to these records except for me. I do not use clerical assistants or interns at this time. I will not remove your file from the office unless it is needed for a meeting that you have asked me to attend on your behalf or for court appearances.


MINORS
If you are under eighteen years of age, your parents have access to your records. It is my policy to discuss this with them and if they are in agreement, I will provide them only with general information about our work together, unless I feel there is a high risk that you will seriously harm yourself or someone else. In this case, I will notify them of my concern. I realize that it can be difficult to discuss topics that you feel may cause trouble at home, but it is my goal to help you include your parents in a way that can be beneficial to you both. This agreement can also be revoked at any time; however I will make every attempt to work with them on what is in your best interest.


CONFIDENTIALITY
Your privacy as a client is protected by law; I can only release information about our work to others with your written permission. But there are a few exceptions.

In most legal proceedings, you have the right to prevent me from providing any information about your treatment. In some proceedings involving child custody and those in which your emotional condition is an important issue, a judge may order my testimony if he/she determines that the issues demand it. If I am subpoenaed in court, I must appear and provide the information requested.

If I believe that you intend to harm yourself or someone else, I have a duty to protect you and that person. This can be direct or implied; if I feel you are a danger to yourself for someone else, I will take what steps necessary to prevent harm including emergency petitioning the client, notifying the police, and notifying the intended victim. I also may contact your emergency numbers provided at intake and include family members in the plan if necessary.

If you disclose knowledge of child abuse, I am mandated by law to report. This can be a difficult area in therapy, but it is important that you understand what I must report. You may be discussing details of yourself or another as a victim, or an offender. In any case, I must report the information to the local department of social services. Even if the disclosure comes when the victim who was a child at the time is now an adult, it still has to be reported. If the victim is an adult but is unable to care for themselves (vulnerable), I also have to report this type of abuse.

If I need to fax your information to another professional, I will do so with the utmost concern for your privacy. There will be a cover sheet directing the fax, and I will call to inform the office that it is being sent and ask that they confirm its receipt. I will not provide any information to another agency without a signed consent from the client. These procedures are provided for protection of your privacy under the Health Insurance Portability and Accountability Act (HIPAA).

I occasionally work with other professionals that I may consult about a case. During a consultation, I make every effort to avoid revealing the identity of my patient. The consultant is also legally bound to keep the information confidential. If you do not object, I will not tell you about these consultations unless I feel that it is important to our work together.

It is important that you understand this document completely. We can take additional time to discuss any concerns you have before signing below. Once you have signed it indicates that you agree to abide by the terms during our professional relationship.
( Type Full Name )
My Training and Therapeutic Approach
My background is in Community Counseling. I received my Master’s degree from St. Mary’s University in 2007, after spending an extended internship with an agency that focused on domestic violence and child abuse. I continue to specialize in those areas but also work with a variety of other issues that bring clients into therapy. I have continued my education with post-graduate work, most recently a post-graduate certificate in Child and Family Therapy from Wilmington University, which was conferred in January, 2010. I also continued my education at Wilmington University, completing a second Master’s degree in Administration of Justice with a concentration in Criminal Behavior in 2011. I continue to actively pursue continuing education for my profession.

I operate a small part time practice as a Licensed Clinical Professional Counselor, and am licensed by the state of Maryland to provide these services. I am also a National Certified Counselor through the National Board for Certified Counselors.

My personal approach centers on cognitive behavioral therapy, which theorizes that our thoughts affect our feelings and behaviors. My work allows you to learn ways to change the thoughts that are upsetting to you by using tools that will help you in daily life. This type of therapy includes education on various topics as well as the use of homework. I will also provide extended information on mental health issues if relevant to your treatment. There is also use of a mixture of other approaches that are person-centered and humanistic in nature. At times, play and art therapies may also be included.

Therapy can be difficult at times. There may be days that you leave my office and never want to come back, or days that you think about something that might have been discussed in your last session and become upset. It is important for you to understand that this is part of the normal process. When you start to uncover areas of your life that are unpleasant, it is normal to resist talking about them, but this is not always beneficial. Talking in a safe environment allows you to release those emotions and lessen their effect on you. If you feel this way and start to seriously consider ending your therapy, I encourage you to call me so that we can discuss your options.


Therapy has both benefits and risks. You do experience uncomfortable emotions at times, but working through them can give you greater clarity in relationships, problem solving and can provide stress reduction. I cannot guarantee that your experience will be pleasant, or that it will benefit you in the way you hope, but I will try to provide you with the tools and resources you need to change and grow the way you desire. My focus is on helping you improve the quality of your life. If I do not feel I possess the skills needed to help you with your problem, I will also refer you to a therapist that has the appropriate level of training.

Also, if at any time you have a grievance against me, you may contact the Maryland Board of Professional Counselors, 4201 Patterson Avenue, Baltimore, MD 21215, or phone 410-764-4732, and inform them of your concerns.
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