Dr



Pamela Fagan Counseling, LLC

Pamela Fagan, MA, LCPC

7237 W. Potomac Drive, Suite B

Boise, Idaho 83704

Information Disclosure and Consent Form

Thank you for your interest in Pamela Fagan Counseling, LLC. The following disclosure statement is provided to assist you in making an informed decision regarding therapy services. As your therapist, I strive to create a positive environment of openness and mutual respect in therapy. It is my hope that you will feel safe and comfortable as we work together to achieve your therapeutic goals.

About your Therapist:

As a Licensed Clinical Professional Counselor (LCPC), I have been working in the mental health field since 2003. I received my Master’s degree in Counseling from Boise State University in 2005, and have been working specifically with families, couples, and individuals in a private practice setting since 2007. Additionally, I have gained extensive experience conducting family therapy sessions using the Functional Family Therapy model while working as a family therapist for a non-profit agency for the past five years. I also have specialized training in Adlerian Therapy for couples and families.

My general aim as a therapist is to help clients find lasting solutions to their problems, respecting the agency of power of each individual in finding his or her own path. I believe that we sometimes underestimate the power that is within us to improve our own reality through changing the way we process the events of life’s journey. My therapeutic approach is client-centered; I believe that people tend to move toward growth and healing, and have the capacity to find their own answers. I draw on interventions from theoretical frameworks such as Adlerian Therapy, Cognitive Behavioral Therapy, and Mindfulness and Acceptance as I try to match the most helpful and appropriate techniques to meet the unique needs of each client. I treat a variety of issues including relationship concerns, depression, mood and anxiety disorders, sexual identity and cultural identity issues, grief and loss, and trauma, to name a few.

Procedures and Goals of Therapy:

Goals of therapy treatment are to be established in the first few sessions of therapy, through collaboration between the therapist and client. Goals of therapy vary widely, based on the presenting concerns of the client. Some examples of treatment goals may include the following:

1) To gain insight and understanding of problematic life patterns and ways of viewing life events, which might be hindering the client from achieving lasting happiness and peace, and work to alter these patterns and adopt more positive behaviors.

2) To discover new coping techniques to deal more appropriately with the challenges of life such as stress, depression, and past traumatic events.

3) To learn new information about the significant components of personal and family relationships including styles of communication and conflict resolution, and develop skills to better meet a client’s needs.

Counseling Sessions:

A counseling session is normally fifty minutes in length. This length may be longer in cases of couples and family therapy sessions, or for certain presenting issues. Counseling sessions are usually scheduled once a week depending on need. Therapy treatment can range from a few sessions to 6-12 months of treatment, depending on the severity and nature of the presenting issues of each client. I will work to cater to the needs of each individual or family. Toward the end of treatment, sessions are sometimes reduced to bi-weekly or monthly, so as to allow for a smoother transition to termination. There is no minimum length of treatment, and each client may decide to end treatment at any time. I believe the success of therapy has much to do with the client-therapist relationship. If a client does not feel therapy is meeting his or her needs, I would be happy to suggest a number of other therapists in the community, and make an appropriate referral to a different mental health provider. Please remember that although therapists and clients do their best to progress in treatment, desired outcomes are not always met. There may be a period, often in the first few sessions of therapy, in which the issues that brought one to therapy can actually feel as if they have worsened. This can have a number of possible causes, usually having to do with opening up about difficult past emotional wounds. As a therapist, I work to challenge my clients to progress and grow, involving altering some past thinking patterns which can sometimes cause discomfort. I do work to create a safe, comfortable, therapeutic environment where personal growth can take place; and I respect each client’s free agency to keep any issues private if he or she is not yet ready to discuss them.

Confidentiality:

I take the right to privacy and confidentiality of each client very seriously. All information shared by a client in therapy is kept in confidence, unless one of the following applies:

1) The client authorizes a release of information, allowing the therapist to confer with another healthcare professional. This information will only be shared with your expressed consent, after you, as the client, sign a ‘Release of Information’ form, provided by your therapist. This permission to release personal information can be revoked by you at any time.

2) In the event that there is clear and imminent danger of self-harm to the client or specific threats of harm to someone else, including child abuse. In this case I am required by law to report such information to the appropriate authorities.

3) If your therapist receives a court ordered subpoena for your counseling records.

Documentation, such as case notes, is maintained by your therapist regarding the services you receive. You have the right to access your counseling records. These records are kept confidential and will not be released to outside parties without your written consent, or if any of the above situations apply.

Grievance/Complaints:

Initial complaints should be addressed with your therapist, either in therapy sessions, via phone conversation, or through email. As a client, you have the right to make complaints regarding ethical concerns to the Bureau of Occupational Licenses (located in Boise), at (208) 334-3233.

Fees and Financial Policy:

Fees for therapy services are determined by the format needed in order to meet the needs of the client. The established fee per 50 minute session is $100.00. I also operate on a sliding-fee scale, taking into account a client’s household income, financial resources, and number of dependent children. This reduced rate will be determined during the initial intake. It is my intention to not refuse services to anyone based on inability to pay.

Thank you again for your interest in seeking counseling. I congratulate you for your strength and commitment to improved mental health and wellness. It is my pleasure to be able to assist you in this journey.

Statement of Understanding:

I have read and understand the above-stated disclosure of information, and give my informed consent to receive therapy services from Meridian Counseling Center.

Client Signature Date

Client Signature Date

Parent/Guardian Signature Date

(Parent signature required if client is under 18)

Therapist, Pamela Fagan, MA, LCPC Date

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