Efficient Counseling

PO Box 69701

Seattle, WA. 98168

DISCLOSURE STATEMENT

This is a statement of your rights and responsibilities for our therapeutic relationship. The RCW 18.19.060 and WAC 246-810-031 require counselors to provide written disclosure of the following information to clients before counseling begins. Counselors offering services to the public must be licensed or registered with the State of Washington, Department of Health. I am a Licensed Marriage and Family Therapist in the State of Washington (LF60077033).

Please read this statement thoroughly and then sign the consent for treatment at the end. If you have any questions or concerns, please let me know and I will be happy to assist you. If you suspect my conduct has been unprofessional in any way, feel free to contact:

  • Health Professions Quality Assurance

CustomerServiceCenter

PO Box 47865

Olympia, WA. 98054

(360) 236-4700

CLIENT’S RIGHTS AND RESPONSIBILITIES

You have the right to choose a counselor who best suits their needs and purposes. You may ask questions about treatment at any time and may choose to terminate services at any time. If you wish to find a new therapist I may be able to assist with a referral.

EDUCATION AND TRAINING

  • Masters Degree in Marriage and Family Therapy, PacificLutheranUniversity
  • Bachelor of Arts Degree in Psychology, University of California, Berkeley
  • Completed 30hrs of training about domestic violence from an established domestic violence victim’s program and 30hrs of training from an established domestic violence perpetrator treatment program.
  • I currently practice at Navos Mental Health Solutions, formerly Highline West Seattle, Mental Health in the child and family department. I also work as a certified domestic violence treatment provider for Navos as well. In no way do I represent Navos Mental Health Solutions in my work with you. If you are mandated to attend a domestic abuse batterers program, our work together will NOT fulfill this requirement.

THERAPEUTIC APPROACH

People come to counseling because they want something to be different in their lives. I believe the therapeutic process is something we do together. It is important to think of therapy as a work in progress. We will set a general direction for our work, but will maintain flexibility to be responsive to your needs. I use many different therapeutic styles and techniques to reach the established goals depending on what fits best with you and your situation.

  • First and foremost, therapy is about you.
  • I believe you are the expert on your problem and that it is my job to facilitate the direction of change and improvement.

Counseling can be exciting and rewarding, but can also be difficult, challenging, and at times painful. It is important to establish a relationship based on mutual trust, safety, respect, and honesty. However, the goal is always to create positive change in your life.

Ultimately, the approach to therapy, and its length, is determined by your needs. I believe therapy is most effective when clients work on issues between sessions, therefore, I generally assign “homework” and will study how this affects the way you feel.

PRIVILEGE

As of July 26, 2009 a new law went into effect granting privilege to Licensed Marriage and Family Therapists (LMFT’s). According to RCW 5.60.060, I may not disclose, or be compelled to testify, about information gathered during the course of our work together EXCEPT:

  • With your written consent, or upon death, a legal representative;
  • You waive privilege by bringing charges against me;
  • In response to a subpoena by the secretary of health. The secretary may subpoena only records related to a complaint or report under RCW 18.130.050;
  • There is reasonable suspicion of abuse and/or neglect of a child or a dependent adult;
  • There is reasonable belief that the disclosure will avoid or minimize an imminent danger to your health or safety, or to the health or safety of someone else.

Lastly, it should be noted that during consultations I may discuss your case using non identifying information.

FEES, SCHEDULING, AND OFFICE POLICIES

  • Counseling sessions are by appointment only (Fridays or Saturdays).
  • The initial session (intake) is $125 (typically 1.5hrs); each additional session $95 (50min.) The remaining 10 minutes of the hour is used for case management (writing progress notes, making phone calls, sending faxes, updating files, treatment planning, etc.).
  • Payments are due at the beginning of each session and may be made by, cash or money orders (credit cards are not being accepted at this time).
  • Cancellation less than 24hrs in advance will result in you being charged the regular rate.
  • I am currently unable to bill insurance at this time. I can provide you with a receipt of services received for you to submit to your insurance provider for reimbursement, however I cannot guarantee reimbursement.

ADDITIONAL SERVICES

  • There will be a charge for telephone consultations with other professionals (including attorneys and other health care providers), which arise out of legal matters that are a party to a case. These are pro-rated based on the length of the call. If there are multiple calls, which collectively last over 10 minutes, they will be put together and charged to your account as appropriate. During regular business hours, the fee is $95 per hour.
  • Consultations outside these hours will be considered emergency hours and will be billed at $150 per hour.
  • File & Case reviews - $175 per hour
  • Report writing - $175 per hour
  • Transportation to court - $175 per hour (door to door)
  • Waiting for court to testify, etc. - $300 per hour
  • Testifying or Dispositions - $300 per hour
  • Parking reimbursement - (whatever I was charged)

CONTACT INFORMATION

You can reach me at 206-854-0609. If you get my voicemail please leave a message and I will return your call within 24hrs, except Sundays or holidays, in which case I will return calls on the next business day. I can also be reached by email . I am the only person who checks this email. If you are experiencing an emergency, do not hesitate to call 9-1-1 or the Crisis Clinic at 206-461-3222.

Mailing address:

  • Efficient Counseling

PO Box 69701

Seattle, WA. 98168

SIGNATURES

  • Please review this agreement carefully, your signature gives consent to begin therapy and all services that will be billed under this contract.
  • By signing this Disclosure Statement, you acknowledge that you have read and understand the information provided.

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