Washington state law requires provision of the following information and written acknowledgement of its receipt. Please read it carefully. We welcome the opportunity to discuss any questions or concerns you may have regarding this agreement or services. This document provides the policies of Duncan Counseling Services and and information about my background and training.
My primary therapeutic orientation is Rogerian with underpinnings in Cognitive – Behavioral theories and Psychodynamic theories. I have training in trauma counseling and EMDR, and use these techniques, as well as other theoretical approaches, when appropriate. In addition, I have worked with individuals on the autism spectrum, mainly high-functioning autism, since 2003.
My core belief is that all individuals are valuable and deserving of happiness. I believe that if obstacles are removed, such as wounding from the past, addictions, and erroneous thinking patterns, all individuals can thrive psychologically and live a full, satisfying, and productive life. I will listen carefully and empathically to you, asking about your thoughts and feelings. I may suggest ways that you can become more content and satisfied by examining your thoughts and how they affect your feelings and behaviors. You will gain the most from therapy with regular attendance, doing homework as assigned between sessions, and trying to stay open to the therapist’s observations and feedback.
I earned my Master’s degree in Psychology, Mental Health Counseling from Antioch University Seattle in 2005, and was granted my license in the state of Washington in 2007. I began my training in EMDR in 2010, and became a Certified EMDR Therapist in 2014. From January 2014 through January of 2017 I served as the NW Regional EMDRIA Coordinator, facilitating trainings and collaboration for and among regional EMDR therapists.
Previously, I worked in the field of human resources for twenty years, in the areas of recruiting, training, and employee relations. I have also worked in the medical field, as a medical assistant in internal medicine.
Everything said during our counseling session is confidential. We will not disclose information about you that could identify you in any way, without your written and signed permission, unless the law binds me to do so. The circumstances in which we are required by law to release information include:
If you become involved in legal proceedings, you may be entitled to obtain a judicial ruling that our records and your therapist’s recollections pertaining to you are privileged and should be excluded from admission into evidence. You are responsible for claiming privilege in a timely and an acceptable manner. You should seek your own legal counsel for a full explanation of privilege and for possible assistance asserting a privilege claim.
If, at any time you have questions, doubts or concerns about the course of treatment or approaches used in therapy, you are encouraged to discuss these with us. You have the right to choose a counselor who best suits your needs and purposes. Remember that treatment is optional and can be terminated at anytime. If you choose to seek assistance from another counselor or therapist, or if I find your therapist unable to provide you with the help you need, we will offer you the names and phone numbers of at least two other counselors whom you may contact. It is your right to select and to make arrangements with another counselor if you decide to discontinue counseling.
If you think your therapist has behaved in an unprofessional or unethical manner, please advise us so that the problem can be clarified and resolved. If you think that this does not resolve the issue, you may contact the State of Washington Department of Licensing Attn: Counseling Division P.O. Box 9012 Olympia, WA. 98504-8001
The State of Washington requires that the following appear on every client’s disclosure statement:
“Counselors practicing counseling for a fee must be registered or certified with the department of health for the protection of the public health and safety. Registration of an individual with the department does not include a recognition of any practice standards, nor necessarily implies the effectiveness of any treatment.”
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
A federal regulation, known as the “HIPAA Privacy Rule” requires us to provide a detailed notice in writing of our privacy practices. Much of what is required has already been covered in my disclosure statement to you. This notice addresses topics not covered there.
In this notice we describe the way we may use or protect private information about you. The HIPAA Privacy Rule requires we protect the privacy of health information that identifies a patient, or where there is a reasonable basis to believe the information can be used to identify you. This information is called ‘Protected Health Information” or “PHI.” This notice further describes your rights as our patient and my obligations regarding the use and disclosure of PHI.
Although HIPAA allows the free exchange of information between treating professionals, we prefer not to disclose information regarding our work together without a specific release signed by you. The HIPAA Privacy Rule specifically protects Psychotherapy notes from disclosure unless specifically authorized by you, or otherwise required by law. This means we will not discuss your treatment with us with your Doctor or other professional without your written permission. Exceptions to this are outlined above in the section: Confidentiality.
you have the right to request that you receive communications regarding PHI in a certain manner or at a certain location. For example, you may request that we contact you at home, rather than at work. You must let us know your request, as well as notify us in writing.
You have the right to request an “accounting” of certain disclosures that I have made about PHI about you. This is a list of disclosures made by us during a specified period up to six years other than disclosures made prior to April 14, 2003. If you wish to make a request, please notify us in writing. The first list you request in a 12 month period will be free, but there may be a reasonable charge for subsequent requests.
If you are dissatisfied with our services in any way, your first recourse is to discuss the issue with us. We will do everything within our power, and within the scope of our licenses, to correct the problem. If you are still not satisfied, you can file a complaint with the Washington State Department of Health. We will not retaliate or take action against you for filing a complaint.
Our offices are locked except during hours in which we are in the office, protecting the confidentiality of your records and your private information. Telephone and e-mail messages are accessible through passwords known only by us. Client files are stored in a locked file cabinet.
If you have any questions, want more information, or want to report a problem about the handling of your information or case, please call me, at 425-591-7668
If you, during the course of your therapy, feel that you are in crisis and are unable to reach us, you agree to call 911 or the Care Crisis Line (425) 258-4357for immediate assistance 24 hours per day.
I have read, or have had satisfactorily explained to me, Duncan Counseling Services Disclosure of Information, Policies and Client Agreement and understand it. I have asked any questions that I had about this statement and about statements regarding fees and payment policies. I understand and agree to the description of confidentiality and its exceptions as stated above. I consent to counseling, for myself and/or for my minor child, under the terms described above with my therapist. I understand that both parents’ permission is required for treatment of a minor child.