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My USC Lancaster

Professional Disclosure Statement

Hi and Welcome!
I appreciate your consideration in creating a therapeutic relationship. Please read through the following document in an effort to achieve mutual understanding and expectations about the provided counseling services. I will be happy to clarify information or answer concerns at anytime throughout the duration of the counseling relationship, and thereafter.

Qualifications, Experience, and Interests
In 2014, I received my Masters in Clinical Psychology from the University of Central Florida. I am currently a Licensed Professional Counselor Associate (LPCA:#6499) in the state of South Carolina and a Licensed Clinical Mental Health Counselor Associate (LCMHCA: #A12005). I have had experience providing individual, family, and group counseling services for children, adolescents, and adults for the past 3-4 years in a variety of settings. As required by state law, I have received education and training in individual, group, couples, and family therapies. My special interests include adjustment issues, family counseling, relationship concerns, self-esteem problems, developmental issues, parenting concerns, life transitions, community programs, and communication skills. If I feel that I do not have the necessary knowledge or training to work with your particular situation, I will provide referral information as needed.

Counseling Services
It is my belief that therapy is both a rewarding and challenging experience;therefore it is my goal to provide a safe, and nurturing environment to facilitate your personal growth in self-awareness and self-acceptance. I also believe that each person is unique, as is his or her situation, which is why I utilize an integrated approach to therapy. I may use concepts from different models, such as cognitive-behavioral, acceptance and commitment, solutions-focused, and mindbody-spiritual. Therapy is a collaborative process and requires "work," where I may request out-of-session assignments to reinforce growth. Sometimes therapy can bring about discomfort and unpleasant feelings, such as sadness, guilt, anger; on the other hand, therapy can lead to benefits, such as lower levels of distress, better relationships, solutions to problems, and overall improved well-being. My role is to facilitate your personal growth and well-being on your journey, whatever that may be.

I am currently a Licensed Clinical Mental Health Counselor Associate (LCMHCA)(#A12005) in the state of North Carolina and a Licensed Professional Counselor Intern (#6499) am under the direct clinical supervision of Tiffany Huggins, LPC-S, of Timeless Solutions Counseling Services. I find it may be helpful to consult with my supervisor and/or other professional staff about your case. Any discussions will be anonymous in nature, where specific identifiable information will not be given. In addition, my sessions may be audiotaped or videotaped from time to time to ensure clinical excellence. This would only occur with your consent. These files will be kept confidential. You do not need to consent in order to receive counseling services.

I use the Diagnostics and Statistical Manual of Mental of the American Psychiatric Association 5th Edition (DSM-V) to make clinical diagnoses. When clients use insurance, it is typically necessary for diagnoses to be provided in order for claims to be made. They may also require treatment plans or summaries regarding the diagnosis, which will become part of the client's permanent record. In addition, some conditions that clients seek help for may not be covered by insurance. I will inform you of any diagnoses, if any, before submitting any forms to the insurance company. Another scenario where diagnoses and other clinical information may be shared (upon client's request) is if a client transfers to another therapist or in collaboration with other health professionals.

Session Description/Missed Appointments or Cancellations
Intake sessions are 60-90 minutes long in duration and serve the purpose of evaluating your needs and concerns, and reviewing services offered. Individual sessions thereafter are 50 minutes, and couples and family sessions are 70 minutes. Group sessions vary depending on the type and will be disclosed prior to intake. In order to ensure the potential of therapeutic outcome, consistency of sessions are important. However, it is understandable that emergencies may arise. In the circumstance you should need to cancel a session, please give 24-hour notice so that your time slot may be provided for another student. Repeated or frequent missed appointments may result in termination of services.

Therapist Vacations or Cancellations/Client Emergencies
In the unlikely event that I need to cancel an appointment, I will try to contact you as quickly as possible with the provided contact information on file.I will inform you of scheduled vacations at least one week in advance. During this time or when I am otherwise unavailable to you, you may leave a message for meat( (803)-313-7131). However, should you have an emergency or a severe crisis,please contact the nearest mental health agency or dial 911.

Payments and Fees
Counseling services are provided at no charge to students of the University of South Carolina-Lancaster. Students are eligible for counseling services as long as they are registered and carry a course load.

Explanation of Dual Relationships
Although our sessions may be very intimate emotionally and psychologically, it is important to remember that our relationship is a professional one rather than a social one. Therefore, our contact is limited to your sessions, so please do not invite me to social gatherings, offer gifts, or ask me to relate to you in any other way beyond the professional context. If we happen to encounter one another outside of our sessions, I will not approach you in order to ensure confidentiality.

Discussions between you and me, and even the fact that you are in therapy are confidential. In psychotherapy, very intimate and personal details about you and your life may be revealed, and with this, I regard with utmost care and respect. Trust and confidentiality are essential to your therapeutic experience and outcome. In addition, The North Carolina Board of Licensed Professional Counselors (NCBLPC) and South Carolina Board sets forth legal and ethical guidelines of confidentiality to which I abide by. They state that any information spoken, written or disclosed in any matter throughout the duration of our counseling relationship, and anytime thereafter will be held confidential. However, there are situations in which I cannot legally or ethically hold the information confidential, such as:

(1) If you disclose or it is reasonably suspected that you will pose imminent danger to the health and safety of yourself or others;
(2) If at any time you disclose that a child, disabled person, or elder adult has been or will be abused or neglected;
(3) In the event that a court order requires the release of case records or direct testimony;
(4) If you request that your records be released, and sign a release of information form;
(5) If you are a minor, your confidentiality is constrained by the request of your parent and/or legal guardian.

*If you have any questions regarding these limitations listed, please feel free to ask at any time

It is the goal of therapy to get you into a more desirable place. Every situation and case is unique and it is difficult to know the course and length of therapy. Throughout the counseling process, therapeutic goals will be reassessed, and at the appropriate time, termination will be discussed.You may terminate services at any time. Should you terminate abruptly, I will make one attempt to call. If you do not reply or return, I will close your file and it will be noted that you terminated therapy with me without notice or consultation.

It is my goal to establish a nurturing relationship with all my clients, and I would want to know if that was not being achieved. If you are unhappy with any aspect of the services received, I encourage you to discuss it with me directly. However, if your concern is not resolved thereafter, you may contact my supervisor Tiffany Huggins, LPC-S, of Timeless Solutions Counseling Services, phone (704) 749-3815.
You may also file a complaint against me with the organization below should you feel I am in violation of any of these codes of ethics: I abide by the ACA Code of Ethics.
North Carolina Board of Licensed Clinical Mental Health Counselors
PO Box 77819
Greensboro, NC 27417
Phone: (844)-622-3572 or (336)-217-6007
Fax:( 336)-217-9450
South Carolina Board of Professional Counselors, Marriage and Family Therapists, and Psycho-educational Specialists
Phone: (803) 896-4470
Web:Labor Licensing Regulation

*Required fields

Consent for Audio/Videotaping
These audio/video files of your session(s) will be kept confidential and are only used for clinical training and will be permanently deleted. You can revoke your consent at any time. You do not need to consent in order to receive counseling services.

Consent for Audio/Videotaping *

Acceptance of Terms
We agree to these terms and will abide by these guidelines

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