Rose McMahill, M.A., LMHCA

401 Olympia Ave NE, #342

Renton, WA 98056

Disclosure of Information, Policies, and Client Agreement

The State of Washington requires that the following information be given to each client. Please read it carefully and sign below. I welcome any questions or concerns that you might have about this statement.

Your Rights as a Client in Counseling

As a client, you have certain rights and privileges. I will protect your confidentiality as specified by state and federal laws and ethical standards. As part of this protection, I will not approach you or acknowledge our therapeutic relationship outside of the counseling office. Please do not take this personally! It is for your own protection. I also ask that you maintain the confidentiality of other clients you may see in the counseling office.

The following are exceptions to your right of confidentiality:

  1. If I believe you are likely to hurt yourself or another person, I am required by law to take steps to protect you or the other person.
  2. If I suspect any form of child abuse or neglect, the law requires that I report it to Child Protective Services.
  3. If you reveal that you have committed or are contemplating committing a crime, I may report it to the appropriate authorities.
  4. I must turn my records over and testify regarding therapy treatment if I get a subpoena from a court of law requiring me to do so.
  5. If a couple or a family seeks therapy together, information may be shared in joint couple or family sessions.

I regularly consult with colleagues and consultants regarding treatment plans and/or issues. All discussions of this type are subject to the same confidentiality provisions as above.

Appointments and Fees

Individual Intake Session / 80 minutes / $75
Individual orCouples Session / 50 minutes / $60
Couples IntakeSession / 80 minutes / $75
Extended Couples Session / 80 minutes / $75

The time for your session is set aside for you. If you miss an appointment without cancelling or fail to give 24 hour notice, you will be charged 100% of your fee for that missed appointment.

My Training and Approach to Therapy

I hold a Masters degree in Counseling Psychology from City University of Seattle, and am currently working toward full licensure with the State of Washington. My Mental Health Counselor Associate’s license number is MC60391677.

My areas of focus in counseling are depression, anxiety, life transitions, relationship conflicts, and emerging adult concerns. I use an integrated set of techniques drawn from psychodynamic theory and cognitive behavioral theory to provide a customized approach for each client. By providing an encouraging environment where problem behaviors can be critically examined without judgment, I collaborate with clients to help them achieve their stated goals and live their best lives. My goal is not only to help you get through your time of need, but also to give you tools to continue the growth process after counseling ends.To achieve this, at times you may be asked to do certain “homework exercises” such as reading, changing behaviors, and otherwise acting in your own best interest.

Much of the work done to resolve issues will depend on your honesty and willingness to do the things you need to do to move forward- even if it is painful and difficult. Although my job is to help guide you through these difficult transitions, please understand that you are entirely responsible for your own actions and will always be expected to make your own final decisions regarding counseling.

I adhere to the American Counseling Association (ACA) Code of Ethics. I must also answer to any code of ethics set forth by the state and the federal government.

If you are dissatisfied with any part of your therapy please feel welcome to talk with me about it.

Quality of Service

If you feel I have behaved in an unprofessional or unethical manner please advise me of such. It is my hope that we can resolve any problem that arises. If our conversation does not resolve this matter, you can contact the State of Washington Department of Health and Human Services at 360-753-1761.

Clinical Supervision

While I work toward my licensure, I have contracted with Michael Theisen for clinical supervision. Mr. Theisen provides backup when clients cannot contact me and/or when clients have concerns about my work.

Michael Theisen, MA, LMHC

Administrative Faculty/Program Director

MACP Program, City University of Seattle

Division of Arts and Sciences

Phone: 425.709.5442

Email:

I have read and understand this disclosure. I consent to the terms of this agreement.

Signature______Date______

Signature______Date______