Disclosure Statement for Couples Counseling Clients
Credentials and Work Experience
Process of Counseling
My Responsibilities as a Counselor
Your Rights as a Client
Fees
Contact Information
I have a doctoral degree in counseling from the University of North Carolina at Greensboro, and I am a National Certified Counselor and a Texas Licensed Professional Counselor. Upon receiving my Ph.D., I taught courses in career counseling and assessment techniques to master’s and doctoral-level students at several universities in the Austin/San Antonio area. I have published a variety of academic journal articles in the areas of career development, multicultural issues, and counseling supervision. In April 1997, my book, Career Development, Assessment, and Counseling, was released by the American Counseling Association (ACA). In March 1998, I received a national research award from ACA. I have also served on the Executive Council of the Association for Assessment in Counseling and Education (AACE) and, currently, on the editorial review board for the Texas Counseling Association’s journal. Periodically, I supervise master’s-level counseling interns for their practicum experiences. I am a current member of AACE, the National Career Development Association, and the International Association of Marriage and Family Counselors.
My professional training has included counseling experience primarily with college students in a college counseling center, career services center, and residence halls. However, I have also counseled high school students, adult college students, and adults in my private practice. I have worked with clients' career and personal concerns, such as relationship difficulties, depression, anxiety, divorce adjustment, academic skills development, and attention deficit issues. Currently, I am working towards certification as a Gottman-Certified Couples Therapist. As part of this training, my work is being supervised by Dr. Pam Monday, LPC, LMFT.
The approach that I will use with you is based on the research of John Gottman and his colleagues at the University of Washington. They have studied over 650 married, heterosexual couples, some over a period of 15 years, and are able to predict with 90% accuracy which couples will divorce and which ones will stay married. The techniques that I use are derived from this research knowledge of what factors seem to keep couples together and satisfied. The weekly sessions will each be 90 minutes in length; most couples are able to terminate counseling with 16 sessions or fewer.
For counseling to be most effective, you must make a commitment of time and energy and take an active part in the process; this may well involve activities you undertake between sessions, such as completing assessment inventories or practicing new behaviors. It is important to recognize that there are risks with any type of counseling. You may feel worse before you begin to feel better. It is also not possible to make guarantees about counseling outcomes.
I will keep anything that you tell me in strictest confidence unless I have your permission to tell someone. The only exceptions are: (1) I may consult with another professional about your concerns and how I might proceed in order to help you, but I will do so without using your name. You have the right to ask me not to consult with anyone, (2) If you tell me you are going to harm yourself or someone else, I may choose to do what I reasonably can to prevent that, (3) In the event that my records are subpoenaed, in as much as Texas does not have privileged communication for counselors, I could be required to make available to the court my records pertaining to you and our work together, (4) If you report to me that you have been sexually abused by another professional in the mental health field or that you have knowledge of a child or elder abuse situation, I am required by law to report that.
Since I am working towards my Gottman certification, I will be consulting with Dr. Pam Monday regarding your case. She will be reviewing parts of your tapes for the purpose of giving me feedback to facilitate my training. These tapes will be erased as soon as they are reviewed.
On occasion, I will be asking to meet with you individually. It is important to emphasize that anything you tell me in these sessions may be disclosed by me to your partner. In other words, I will not keep secrets.
In the event of my permanent disability or death, my client files will be turned over to Leslie Tourish, LPC. She will make sure that you are appropriately referred to another counselor.
You have the right to understand my reasons for making suggestions or using particular procedures. I will try to explain clearly, but if you have any questions, please ask them--another of your rights. You also have the right to refuse to do anything I suggest. And you have the right, at any time and for any reason, to decide you do not wish to continue counseling. In that case, I would request a termination session to bring closure to our work together. Furthermore, you have the right to any and all of your records.
Fees
The initial assessment fee is $200. Session fees are $125 per 75-minute session. Payment is due at the end of each session. I do accept MasterCard, Visa, and AMEX at no extra charge. Additional prorated fees will be charged for additional session time, telephone and email consultations over five minutes long that do not involve solely the scheduling of appointments or initial contact with you, and any other services I perform outside of the session.
Your session time has been reserved for you. Please give me as much notice as possible if you must cancel your appointment so that your time may be given to someone else. In order to avoid being charged your session fee for missed appointments, a 24-hour notice of cancellation is required. Please phone me instead of using email; I do not check my email regularly everyday. If you are paying a co-pay instead of full fee, you will be charged the full fee for a missed session. If I need to re-schedule or am late for our appointment, you will receive additional time or there will be no charge for the missed session time. Fees that go unpaid for three months may be turned over to a bill collection agency.
I realize that your time is valuable, as is mine. It is important that you be prompt for your sessions, as your time has been reserved for you. If you are late for an appointment, I will be able to see you only for the time remaining that has been scheduled for you, and I will charge you for your scheduled time.
Please let me know if you have any questions or concerns. I will be happy to discuss them with you, and I am looking forward to establishing a successful therapeutic relationship with you.
I look forward to working with you.
For additional information or to schedule an initial consultation, phone 512-689-7105 or email me at counseling@minerweb.com.
Claire U. Miner, Ph.D., NCC, LPC
June 28, 2007