This section contains the informed consent information I ask new clients to review and sign consent to after the first session.

Populations I work with

I work individually with adults, and with couples, either married or unmarried, without regard to gender, race, ethnicity, sexual orientation, or political affiliation. I will consider working with an adolescent when the adolescent expresses a desire for the counseling. I provide family counseling provided all participating family members actively consent to the family counseling. In general, I am strict regarding client consent: I will not provide counseling to individuals, whether child or adult, who do not want to receive counseling from me. 

Medications

I generally do not give advice or make recommendations regarding the use of medications. I will, however, help you think through the decision to use medications. If desired, I will provide referrals for psychiatrists who do advise and prescribe medications, and I will work collaboratively with medication providers. 

Counseling approach

I am trained in many counseling approaches, including cognitive-behavioral therapy (CBT), motivational interviewing (MI), acceptance and commitment therapy (ACT) and many others. Please let me know if you want more information regarding any approach, or are interested in using a particular approach.

I tend to use any of these techniques fluidly and flexibly in response to the counseling situation. One of my guiding principles in counseling is: “the person is not the problem, the problem is the problem,” and I hope you will consider adopting that view yourself.

In my experience, clients’ use of counseling tends to fall into two broad categories. The first way people use counseling is to achieve a particular goal—for example “feel happy” or “be more comfortable at parties.” Others, however, use counseling in less goal-oriented ways. In these cases, people don’t focus on a specific change, but rather use counseling to explore and better understand themselves. In my view, either approach (or a combination of both) is potentially beneficial.

Couples counseling. I am a certified Emotionally Focused Therapist (EFT) for couples. EFT is a proven highly effective approach to addressing couple problems through identifying and strengthening partners inherent needs for secure attachment with each other. Learn more about EFT at www.iceeft.com. 

Ethics and regulations

I am a member of the American Counseling Association (ACA), and am pledged to comply with the ACA code of ethics, which can be found at: https://www.counseling.org/resources/aca-code-of-ethics.pdf. If you feel I have violated this code and wish to make a complaint to the ACA about me, you can do so here: [email protected].

If you are located in Virginia at the time I provide you counseling services, I am governed by regulations established by the Virginia Board of Counseling (VBC). These regulations can be accessed at: https://www.dhp.virginia.gov/counseling/counseling_laws_regs.htm. If you feel I have violated VBC regulations and wish to make a complaint, you can do so here: https://www.dhp.virginia.gov/counseling/counseling_laws_regs.htm.

If you are in West Virginia at the time I provide you counseling services, I am governed by regulations established by the West Virginia Board of Examiners in Counseling (WVBEC). WVBEC uses the ACA code of ethics (see above). If you feel I have violated WVBEC regulations and wish to make a complaint against me, you can find information here: https://wvbec.org/wp-content/uploads/2021/08/Statement-of-Complaint-Form.pdf

Fees and payments

My fee for a 50 minute counseling session is $150. As of January 1, 2023, my fee will increase to $175. If we are meeting in person,I ask for the payment at the beginning of the session, and will accept cash, checks and credit cards. I will charge a $45 fee for returned checks.

If we are meeting virtually, you can pay me by giving me credit card information.  Unless you direct me otherwise, I will securely store your credit card information and use it for any subsequent sessions. PayPal is also an option.

I will bill you for any reports, letters, assessments, evaluations, telephone conversations (except for very brief ones), time spent making copies of records, or any other types of professional activities that you request of me, at the rate of $175/hour.  

If I am asked by you or your attorney to appear in court on your behalf, I will charge you $175/hour for the following: court preparation, travel time to the court, time waiting at the court, time spent testifying, and travel time from the court.  I will probably require that you pay me in advance a deposit of funds sufficient to cover anticipated expenses.  Be aware that I am not an expert on child custody, disability, or any other types of legal evaluations, and therefore cannot provide them.

Health insurance

I am not a network provider for any health insurance plans.

Highmark BC/BS may still consider me a network provider. Although I have sent them a letter early in 2021 withdrawing from my contract with them, they have not responded to me.

Many health insurance plans include benefits for out of network counseling services. You can find out by contacting your insurance company. You may find it worthwhile to submit claims for services with me to your insurance company for possible benefit payment. If asked, I will be happy to provide you with a session slip with all the information you will need to submit a claims. 

Confidentiality

An important right of yours as my client is confidentiality: I will not provide anyone with any information about you, verbally, in writing, or otherwise, without your written permission to do so. There are however, some important exceptions to this rule. For example, I may disclose information about you, even without your permission, if:

1. You give me information indicating intention to do serious physical harm to yourself or another person.
2. You give me information about child or elder abuse.
3. A judge orders me to provide information about you.
4. You bring a malpractice lawsuit against me.

These are the main exceptions to the general rule of confidentiality; there may be others as well. In these situations, it is my policy to provide as little information as possible to insure a person’s safety, comply with a judge’s order, or defend myself legally. Please understand that your confidentiality is extremely important to me.

Internal confidentiality in couples counseling. In the course of providing couples counseling, I will often receive information from one of the partners without the other partner present (either through an individual meeting, or through phone or email contact). Because I think it’s potentially very harmful to the couples counseling for me to be a party to secrets partners keep from each other, I generally do NOT promise to hold confidential what one partner tells me from the other partner. Instead, I use my professional judgement regarding what I share or don’t share with the partner: please base any decision on sharing things with me on this understanding. I will not, however, in any instance reveal anything to your partner that I believe puts you at risk of abuse. All of the above applies equally to family counseling.

External confidentiality and couples or family counseling. When I agree to provide couples or family counseling, I consider the couple or family to be my “client,” not any one individual person. Therefore, I will release records or provide clinical information only with the consent of all members of the couple or family to whom I am providing counseling.

Confidentiality and minor clients. When your minor child is in counseling with me, I will usually respect any wishes he or she may have for me not to share non-life-threatening information with you. This may include such things as drug and alcohol use, and sexual behavior. If you object to this, please let me know right away.

Confidentiality and insurance. Claims submitted to an insurance company will include, at a minimum, a diagnosis. Be aware that once this information is provided to an insurance company, I no longer have any control over it. This information could conceivably have unanticipated consequences, possibly affecting things such as eligibility for life insurance.

Confidentiality and Consultation. In order to provide the best possible services to my clients, I participate in regular consultation groups with other counselors. I may, in a way that does not identify who you are, ask my colleagues for advice or ideas regarding something you and I are working on. Please let me know if you have any connection with any of my consult group members, so I can be extra sure not to reveal identifying information. They are:

• Karen Turner, LPC
• Lisa Williams, LCSW
• Michelle Bogdan, LCSW
• Russ Carlton, LPC

Risks to Confidentiality.

1. Somebody could hack into electronic communications.
2. Somebody could eavesdrop on face to face communications.
3. Somebody could steal my clinical files. 

Scheduling

I see clients for fifty-minute sessions, weekdays only, in the mornings and afternoons. I have very limited evening hours. I am off major holidays. Near the end of our first session, provided we want to continue, we will discuss what scheduling strategy works best for you and your needs. Here are some general possibilities:

1. Recurring appointment on the same day of the week and same time. Meeting weekly is the most frequent interval chosen, especially at the beginning of counseling. Clients in crisis, or who want more intensive counseling, often choose recurring appointments twice a week. Recurring appointments every other week are available, however I may encourage you to consider counseling weekly for at least several weeks at the beginning of counseling. Recurring scheduling less frequently than every other week is not available. Scheduling sessions recurrently involves no obligation: you can end the sessions at any time for any reason.
2. Scheduling appointments one appointment at a time. This strategy is sometimes chosen by clients who have little predictability about their schedules. It is also sometimes chosen by clients who aren’t sure they want ongoing counseling with me. The actual scheduling can be done during the session itself, or outside the session via phone or email. Be aware that there may be limited appointments available to choose from when using this strategy.
3. Scheduling on an “as needed” basis. Clients using this strategy simply contact me by phone or email when they feel the need for an appointment. This strategy is sometimes selected by clients who have worked with for some time, and no longer feel the need for regular counseling.
4. Some combination of the above strategies.

I am as flexible as possible with scheduling strategies. At the same time, I find that the majority of clients do best using a recurring weekly appointment approach. 

Cancelling appointments and missed appointments

You can cancel or reschedule appointments with me without financial penalty, provided give me 24 hours notice.

If you cancel or reschedule an appointment with less than 24 hours notice, or if you forget an appointment, I will charge you the full amount of the session ($150 for a 50 minute session, or, if I am seeing you under an insurance contract, the contractual amount, which is your copay plus the amount the insurance company pays me for a session). This is to insure that I am not financially affected by the cancellation.

Sometimes clients feel angry about the enforcement of this cancellation policy, and think that it is unfair. Please consider whether you can agree to this policy, and let me know if you cannot. 

Contacting me

Phone and email. You are encouraged to contact me at any time. You can call me by telephone (304-671-1356), and if I’m not available I will return voicemail messages as soon as I can. Please be advised that I will bill you for all but brief communication at my hourly rate. You can also contact me by email at [email protected] Please be aware that email is not a secure form of communication.

Distance counseling. During pandemic periods, secure videoconferencing is my usual mode of counseling. I use doxy.me for videoconferencing, which is HIPAA compliant and with home I have a Business Associate Agreement (BAA).

Social media. I will not respond to social media contacts, for example, a “friend” request on Facebook. This is to protect your confidentiality and our counseling relationship. 

Emergencies

If you are experiencing a crisis that is not life-threatening, please contact me right away, even if it is a holiday or I am on vacation. I check my messages frequently.

If you are experiencing a crisis that is life-threatening, for example, strong urges to kill yourself or someone else, contact 911 or go to the nearest hospital emergency room. You may also access trained volunteers at CrisisLink by calling 703-527-4077 or 1-800-SUICIDE. This service is available 24 hours/day. 

Counseling records

After every counseling session, I write notes in your chart about what happened during the session. You might notice me glancing at your chart from time to time while we talk, especially when you talk about family members. I do this to help me remember things about you, your family, or what we’ve talked about in past sessions. You may also notice me referring to or making notes on a schematic diagram I’ve made of your family.

Though my notes are primarily to help me be a better counselor to you, you have a right to know what’s in the notes if you wish. Please don’t hesitate to ask me about the notes if you are curious. You also have a right to a copy of your records if you so wish. If you do request a copy of your records, I recommend you schedule an appointment with me to review your records together so I can help you understand the information. 

Risks and benefits of counseling

As with any form of treatment, there are risks to counseling. Examples of these risks include, but are not limited, to: experiencing uncomfortable thoughts or feelings (this one I can practically guarantee will occur), being distressed by unpleasant memories, and experiencing relationship difficulties. An example of the latter is the possibility a partner will decide to divorce as a result of couples counseling. Some people, despite my best efforts, do not benefit from counseling with me, and some people may even feel worse off. On the other hand, unpleasant but temporary feelings (anger, pain, fear, shame, for example) are quite commonly a part of a counseling experience.

Despite these risks, you should be aware that most people who remain in counseling with me for six or more sessions report benefit from the experience. Benefits include, but are not limited to: reduction in the overall frequency and/or intensity of distressing thoughts, feelings or behaviors, overall improvement in self-concept, and overall improvement in satisfaction in relationships with others. Nevertheless, I do not guarantee that your counseling with me will be successful, or will not be harmful. I DO guarantee that I will do my best to make your experience with me a beneficial one.

Risks of courtroom testifying. If I am requested by you or your attorney, or compelled by a court order, to testify about you in court, the testimony I provide could be harmful to you or to your case. If I testify, I will be asked questions not only by your attorney, but by the opposing attorney as well. As your counselor, I may know very intimate and personal details about you, and having this information shared in an open court could be devastating to you and/or your reputation. Additionally, once testimony is provided, that information may then remain openly available as public record. For these reasons, I urge you to very carefully consider the risks before requesting that I testify in court on your behalf. 

The counseling relationship

The counseling relationship is unique and special. It is set up to provide you with a safe place to reveal and explore very intimate and private matters. That you have no responsibilities to me, other than paying my fee, is an important part of creating this safety. I am not your parent, spouse or best friend: people to whom you have personal responsibility and therefore must consider how what you share affects them. By contrast, our sessions are solely for your benefit. For this reason, it’s a good idea for you and me to limit our relationship to counseling. To the extent that you and I develop another relationship (doing business, becoming friends, etc.), we place at risk the safe sanctuary of the counseling relationship. This is also why I ask you to refrain from giving me any gifts that have more than nominal intrinsic value. 

What to expect in counseling with me

Counseling can seem like a mysterious process, and indeed there is nothing quite like a counseling relationship. With that in mind, I want you, as much as possible, to know what to expect. Some of these things are:

• I will, except in very rare circumstances, start our counseling sessions promptly at the time we are scheduled to meet, and promptly end the session fifty minutes later.
• In most cases, I will call you to see what’s going on if you do not arrive for your appointment within about fifteen minutes of the start time.
• During the session, I will direct my undivided attention to you, except for very brief periods when I may be thinking about something you said.
• At all times, I will be courteous and respectful towards you.
• I will place great emphasis on understanding your thoughts and feelings accurately.

As previously mentioned, you will probably find that unpleasant thoughts or feelings occur at times during or after counseling sessions. This is normal in counseling, and occurs, I believe, because very often our upset is related to efforts we make to avoid things that are sad, scary, or embarrassing. Counseling often largely involves encountering and dealing with these things. This can be distressing, but may be short-lived and result in an overall improvement in life satisfaction.

You may also find that at times you have strong feelings about me, be they negative feelings such as anger, fear or frustration, or positive feelings such as admiration, love or sexual feelings. These feelings are quite common for clients in counseling relationships. My strong belief is that there are no wrong or “inappropriate” feelings a client can have about his or her counselor. To the contrary, I believe that is often critically important to the counseling process that such feelings be identified and explored. For this reason, I strongly urge you to consider sharing with me any emotions you may be feeling about me, as well as any fear or apprehension you have about sharing them. 

How to maximize your benefit from counseling

Counseling is very much a collaborative enterprise, and there is much you can do to contribute to the success of your counseling. I urge the following:

• Think about what you hope will happen as a result of counseling.
• Think about how much time and effort you want to devote to making changes you want.
• Take an active role in your counseling. Ask a lot of questions. Do not be afraid to challenge me as to what I am doing or why. Tell me when something is happening that you don’t like.
• Make a commitment to speak only truthfully in counseling.
• Decide that no amount of counseling can help you change things that are not in your control.
• Decide to take some risks: to try doing things differently that haven’t been working.
• Make a commitment to pushing your “comfort zone” by doing things that make you a little uncomfortable or anxious.
• Ask any questions of me you like, personal or otherwise. I may decline to answer some questions, but I won’t be upset that you asked them. 

Relationships with clients outside the counseling relationship

Particularly if you live in Shepherdstown, there is a good chance that you and I will have some connection to each other, socially or otherwise, apart from our client-counselor relationship. Clinically, this is known as a “dual” or “multiple” relationship. Here, I will refer to it as an “outside relationship.”

Before counseling has started. If our “outside” relationship is fairly significant, I will probably decline to enter into a counseling relationship with you. This is because the special nature of the counseling relationship does not work well when the client and counselor have significant attachments to each other.

If you and I have connections to each other outside of counseling that I do NOT judge to reach a certain level of significance, then counseling can often still be successful. There are a couple of considerations, however. First, I will be quite attuned to protecting the privacy of your counseling relationship with me. In no case with any client would I divulge the existence of my counseling relationship with anyone, however this becomes even more important when we know people in common. You, as the client, however, are free to share the nature of our relationship with anyone you choose to. I just won’t do that.

After counseling has started. I will typically avoid doing things that might deepen our outside-counseling relationship. This is to protect the effectiveness of our counseling. For instance, I typically decline social invitations from clients. 

How do I know if you are the right counselor for me?

This is a very important question, though not always easy to answer. First recognize that, though your relationship with me as your counselor is a professional relationship, it is also intimate. Largely for this reason, there is no one counselor, including myself, who is right for every client. So, how do you tell? I suggest considering the following:

• You should feel that I “get” you, or understand you to some degree (or, at the very least, that I am trying to) and that I want to understand you better as we continue working together.
• You should feel that I care about you, and want the best for you. It is, however, not uncommon, especially as counseling continues, for clients to have anxieties or fears about my feelings about him or her. Ask yourself: do you believe your fears might be accurate?
• You should feel a sense of progress or, at least feel hopeful, fairly early on in the counseling. 

Ending counseling

It is important for you to know that you can stop counseling with me at any time for any reason. A good counseling experience, however, will likely include you and I discussing and understanding your reasons for stopping counseling. Many people, when feeling upset, feel the urge to abruptly cut off contact with their counselor. Abruptly cutting off counseling though, I believe, is likely to result in persistent negative feelings about the counseling for you. I urge you to make a commitment to discussing with me your negative feelings about me or counseling before stopping. You are more likely to feel better about stopping this way.

For my part, I will typically not end our counseling relationship before you are ready for it to end. I will almost certainly, however, end our relationship if you assault me, deliberately damage my property, bring legal action against me, or fail to pay for my services. I may also end our counseling if I conclude that your counseling goal is not one I can help with.

It is also possible that other unforeseen circumstances could force me to end the relationship. If this happens, and I am able, I will provide you with referrals to continue your counseling with another counselor. If I die suddenly or become incapacitated, please reach out to any of the clinicians in my peer support group (see the Confidentiality and Consultation subheading under the Confidentiality heading above), and they will assist you.