Self Disclosure Statement
I am pleased you have selected me as your counselor.
Counseling is a very personal shared interaction between two people and should
not be entered into lightly. This document is designed to 1) inform you about
my background, 2) insure that you understand our professional relationship, and
3) let you know what you can expect from counseling.
My highest degree is a Ph.D. in Human Services
(Marriage and Family emphasis) from Walden University in Minneapolis. I also
hold a Master of Science degree in Counseling and Guidance. I am licensed in
Wisconsin both as a Marriage and Family Therapist and Professional Counselor.
In addition, I am certified by the National Board for Certified Counselors and
also as a Family Life Educator with the National Council on Family Relations. I
have taken both Levels I and II trainings for the Eye Movement Desensitization
and Reprocessing (EMDR) procedure. I've lectured and given workshops, as well
as published a number of articles on counseling topics.
Nature and Purpose
Counseling is a cooperative effort to help individuals deal with life
situations. I believe clients have the capacity to resolve their own problems
with my assistance. I feel that as people become more accepting of themselves,
they are more capable of finding happiness and contentment in their lives.
However, self-awareness and self-acceptance are goals that sometimes take a
long time to achieve. Some clients need only a few sessions to achieve these goals, while others may require
months or years of a counseling relationship. If counseling is successful, you
should feel that you are able to face life's challenges in the future without
my support or intervention.
I strive to provide a supportive atmosphere
and may suggest other resources, options, skills, or behavioral exercises for
you to consider. At your request, psychological tests can be used as tools for
further exploration. Information concerning the costs, purposes, and results
of tests will be discussed with you. Counseling can be more beneficial if you
are willing to work on issues outside of our office meetings. Therefore, I may
ask that you do specific activities and/or read certain books between sessions.
This will help to facilitate the time it takes for you to work out your
concerns and problems.
Although our sessions may
be very intimate emotionally, it is important for you to realize that we have a
professional relationship rather than a personal one. Our contact will be
limited to the paid sessions you have with me. Please do not invite me to social
gatherings, offer gifts, or ask me to relate to you in any way other than in
the professional context of our counseling sessions. You will be best served if
our relationship remains strictly professional and if our sessions focus
exclusively on your concerns. You will learn a great deal about me as we work
together; however, please remember that you are relating to me only in my
Fees, Cancellation, and Insurance Reimbursement:
for each session will be due and must be paid at the end of each session. Cash, personal checks, or MasterCard/Visa are acceptable for payment. If you are unable to keep an
appointment, you must notify me 24 hours in advance. I maintain a 24 hour answering machine at (715)
386-9011, in case an appointment must
be broken. If I do not receive such advance notice, you will be responsible for
paying for the missed session.
Some health insurance companies will
reimburse clients for my counseling services and some will not. Most will
require that I diagnose your mental health condition, before they will agree to
reimburse you. I will inform you of any diagnosis I plan to submit, before I
notify the health insurance company. Some conditions do not qualify for
reimbursement. Any diagnosis made will become part of your permanent insurance
records. Because you will be paying for services each session, any reimbursement
from the insurance company should be sent directly to you.
All of our
communication becomes part of the clinical record, which is accessible to you
on request. I will keep confidential anything you say to me, with the following
a) you direct
me to tell someone else
determine that you are a danger to yourself or others
c) I must
comply with mandatory reporting laws concerning child or elder abuse/neglect
d) you report sexual exploitation by a former
It is my belief that children have the same confidentiality rights as
adults. If I am seeing your child on an individual or group basis, please do
not ask me to disclose to you any details of your child's conversations with
me. I will, however, provide parents/guardians with general feedback regarding
a child's progress.
For the full statement of Privacy Practices, click here.
If we discover your counseling needs do not fit within my
scope of knowledge, I will refer you to another counselor. If at any time for
any reason you are dissatisfied with my services, please let me know. If I am
not able to resolve your concerns, you may report your complaints to:
State of Wisconsin Department of Regulation and Licensing
P.O. Box 8935
Madison, WI 53708