Disclosure Statement

Please take the time to carefully read this disclosure statement. As my client, you have the right to know my qualifications, therapeutic methods, and mutual expectations of our professional relationship. The information presented below is provided to help you decide if my services are suitable for your needs. Please discuss any questions or concerns you may have either now or during the course of your treatment.

 

My qualifications and License

I am a Licensed Independent Clinical Social Worker in Washington State (License # LW60951940). I received my Master’s Degree in Social Work from Adelphi University in 2004. My Bachelor’s Degree is in Psychology from Rutgers University.

 

My professional background has been working primarily in outpatient settings providing individual and group therapy.  I have experience working specifically with adults. I have worked with geratric patients in an inpatient setting for behavioral care.  I have also worked in a residential setting with clients with severe mental issues. I have experience with clients and family members to assess for treatment levels, create treatment plans, provide resources and support for clients and family members. I have worked in the states of New York, Pennsylvania and New Jersey providing a wide range of mental health services. I have worked with clients in outpatient settings who have struggled with a wide variety of issues and life struggles, such as, depression, anxiety, relationship concerns, addiction, codependency, and trauma.

 

Therapeutic style

My practice is to be your guide in a supportive role as we explore the best therapeutic process for you. The hope is that this process will open you up to a better self-awareness, balance in life, and personal satisfaction.  Together we will create a plan that will change over time as you develop growth in the understanding of yourself.

 

I have experience over the past 20 years working with clients reporting depression, anxiety, bipolar symptoms and other mental health concerns. I have worked with clients struggling in relationships, parenting, grief, substance use and other emotional issues. I look forward to helping you explore and work through your concerns. We can discuss referrals for medication assistance if we conclude together that you would like to explore this type of treatment in addition to your psychotherapy.

 

I use cognitive behavioral, internal family systems and emotion focused therapy techniques in my therapeutic process.  I believe those approaches are helpful for people to build on the skills they already have and to develop new skills to make positive changes.

  

I work with all my clients on a weekly basis. If you cancel several sessions, in which I perceive as a barrier to a positive therapeutic process, I will ask that you be removed from your recurring appointment slot and be placed on my on-call list. The on-call list creates sessions based on cancelations. I will reach out to you via phone as those times become available. If you do not show up to your appointment without notifying me, all your future appointments will be cancelled until I hear from you.

 

Client’s Rights and Responsibilities

Confidentiality

All counselors who work for or with Greater Elevations Counseling PLLC are expected to keep your information strictly confidential. There is a legal privilege in Washington state to protect the confidentiality of the information that you share. As a professional, I can assure you that I will maintain the strictest ethical standards of confidentiality.

 

Access to Records

I keep brief notes on your sessions for your therapeutic benefit. All information disclosed within sessions and the records are confidential. It will not be disclosed to anyone without your written permission. Disclosure will be required when a client is a danger to self or others.

All clients have the right to a copy of their medical records at any time. A response to your request will be made within 15 working days to be in compliance with RCW 70.02.080.

 

Legal Exceptions To Confidentiality

If a legal exception arises in which confidentiality may need to be broken, I will make every effort to fully discuss it with you before taking any action, and I will limit my disclosure to what is necessary. Certain situations could arise when information may be shared with others without your consent or written authorization.

 

Professional Consultation

As a part of professional growth, I consult with other professionals in the field of psychology and mental health.  I consult about client cases with which I am working on. This allows me to gain other counseling perspectives and can provide me with ideas as to how to best help you reach your goals. In my consultations with other professionals, I make every effort to not reveal the identities of my clients.

 

Overdue Fees & Government Oversight

All records are kept confidential; however, if seeking collection of overdue fees this may constitute limits on confidentiality. Also, if a government or your insurance agency is requesting the information for health oversight activities, I may be required to provide that information to them.

 

Complaints and Confidentiality

Although it is rare, it is within a client’s rights to file a complaint or lawsuit against me. In these cases, I may disclose pertinent information regarding that client in order to protect myself.

 

If you have any concerns or complaints, you may contact the Department of Health.

Health Systems Quality Assurance Complaint Intake. 

P.O. Box 47857 

Olympia, WA 98504-7857

360-236-4700

HSQAComplaintIntake@doh.wa.gov 

 

Child & Elder Abuse

Due to the requirements of state law, if I have reasonable cause to believe that a child or elder has suffered abuse or neglect, I must file a report with the appropriate government agency. Once such a report is filed, I may be required to provide additional information.

 

Abuse Of Vulnerable Adults

Due to requirement of state law, if I have reasonable cause to believe that abuse, financial exploitation, abandonment, or neglect of a vulnerable adult has occurred, I must file a report with the appropriate government agency. Once such a report is filed, I may be required to provide additional information.

 

Confidentiality for Couples

The same legal privilege and confidentiality described above applies to couples treatment. As opposed to individual psychotherapy, confidentiality and treatment goals apply to the couple as a unit, rather than each individual that makes up the couple unit.

 

Sharing Between Partners

All verbal and written communication between a partner and myself, as the couples' therapist, will be accompanied with the intent to bring clinically relevant information into the couples' therapy work. In couples therapy there exists no protection of confidential or private information for individual partners, and the therapist will make every effort to encourage information sharing between partners to avoid the keeping of secrets in the therapeutic process.

 

Treatment and Termination of Treatment

Clients have the right to choose a therapist who best suits their needs and purposes. You may ask questions about treatment at any time and may choose to terminate therapy at any time. Therapy may also be ended when I feel that your needs will be better met by another provider. In that case, I will try my best to make appropriate referrals. 

 

Services

I offer telemental health therapy services for individuals, couples and family issues. I see clients 18 years old and above. 

 

Emergencies

If you are experiencing emergencies where you feel like you are a threat to yourself or others, please call 911 or go to the nearest hospital emergency room in your area.  I do not offer crisis counseling or 24 hour on-call crisis services.

 

Financial Responsibilities

Insurance

To avoid any surprising financial issues that might arise, I recommend all my clients begin by contacting their insurance company regarding their mental health benefits. If I am not in network with your insurance company that means you are responsible for the full fee at the time of our appointment.

 

Rates

Prior to scheduling, or our first meeting, I will call you for a free 15 minute phone consultation to determine right fit.  It is important that you engage in therapy services with a therapist who fits with you. You have values and desired outcomes for your health and you want to make sure you are putting your trust in someone who is the right fit for you.

 

All co-pays or patient financial responsibility (i.e. deductibles) determined by your insurer are due at each visit before your session begins. 

 

$140 - Individual session (a standard session is 50 min)

$160 - Couples/Family session (standard session is 50 min)

$90 (late appointment cancellation- less than 24 hours)  

I request that if you must cancel our appointment that you notify me at least 24 hours before your appointment time.  Insurance cannot be billed for missed sessions. This fee is implemented at my discretion, please direct all questions to me, not the administrative staff.

 

If you are unable to pay the rate at the time of service for more than one visit, without developing a payment plan, future appointments will be suspended until unpaid balances are resolved. 

Contact

Greater Elevations Counseling PLLC

6230 71st Ave Ct W

University Place, WA 98467

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Tel: 253-777-1540​

gecounseling19@gmail.com