Supervision Professional Disclosure Statement



LPCA Professional Disclosure Statement

Samantha B. Afanador, M.S., NCC, LPCA

(919) 412-5685

Email: Samantha@

North Carolina State Licensure Professional Counselor Associate #10542A

My Qualifications and Experience

I hold a Master’s of Science degree in Mental Health Counseling with a Specialization in Crisis and Trauma (M.S.) from Walden University (May 2013). My undergraduate degree is in Social Work (BSW) from Capital University (December 2006). I have also earned an Associate’s Degree (A.A.) in Human Services Technology from Kent State University (December. 1999).

I am a National Board Certified Counselor (NCC, 04/2013) and I am a Licensed Professional Counselor Associate (LPCA #A10542) through the North Carolina Board of Licensed Professional Counselors (NCBLPC), working towards my Licensed Professional Counselor (LPC) licensure under the supervision of a Board approved supervisor: Dr. Grover Benjamin Young-Hall, Ph.D (Lic No. S3516). I began my professional counseling experience during my professional practicum and internship at a private practice setting during (2012-2013)

I also successfully completed all requirements for certification in Community Interpretation (English/Spanish) from Lake Erie College (July, 2001). Furthermore, I am a certified Life and Business Coach having completed the Associate Level training through Coaching for Wellness (May, 2012).

Restricted Licensure

As a Licensed Professional Counselor Associate, I am under the direct supervision of Dr. B. Grover Hall. Should you have a concern regarding my professional counseling feel free to discuss this with me or my designated supervisor- his contact information is: 8512 Six, Forks Road, Raleigh, NC 27615 (919)322-0831.

Counseling Background

Each professional counselor has a theoretical orientation. This theoretical orientation provides the lens through which each counselor views their client and provides a conceptual framework for conceptualizing client issues. It is the guiding light that gives way to structured formal interventions. My counseling background or theoretical orientation is based on the belief that problems/ challenges are often products of how we think, feel and act (Rational Emotive Behavior Theory/ Cognitive Behavior Theory). I also believe that I am not the expert in your life, rather that expert is you. To this end, as your counselor I work in partnership with you rather than tell you what to do. Through a strong therapeutic alliance (partnership), we work together towards solving issues/challenges and problems.

I provide counseling services to children, adolescents, families and couples who experiment a variety of issues that are negatively impacting their lives. Counseling services can be provided on an individual/group or family level both in a private office or in-home- depending on the particular circumstances of each client.

Nature of Counseling and the Counseling Relationships

There are many reasons why a person may seek counseling, regardless of the reasons it is my firm professional belief that an enhanced sense of self-understanding and acceptance is a essential to a healthy and self-determined lifestyle. With this in mind, I understand that past experiences (both positive and negative) shape the way we view life and interact with those around us.

Therapy provides the opportunity for growth, self-discovery and acceptance in a safe and non-judgmental environment. Because each client is unique, counseling techniques are tailored around the uniqueness of each client using a strengths-based perspective. It is with this in mind that I implement integrative counseling theories and techniques that are both evidence-based and adaptable to the unique situations and clients served. The techniques and theories that I implement include but are not limited to: Cognitive Behavioral Therapy (CBT); Dialectical Behavioral Therapy (DBT); Solution Focused Therapy (SFT); Rational Emotive Behavioral Therapy (REBT)- all within a person-centered perspective. I believe in the importance of practicing what is learned during counseling which is why “homework” can be assigned on occasions. “Homework” assignments just like counseling are voluntary.

It is important to understand that a counseling relationship is often a very intimate relationship in which very personal information and experiences is shared by the client. Because of this, I remain very professional boundaries with each and every counselor- I am your counselor not your friend.

Session Fees and Length of Service

At this time, fees are charged by Peak Professional Group, LLC or independently. These charges are billed to your particular insurance company or other arrangements that have been made. If you have any questions regarding session fees or the billing procedure, please feel free to discuss this with the billing department of Peak Professional Group, LLC

The length of each counseling session is 50-60 minutes in length. The duration of a counseling relationship will also depend upon the presenting problem and course of treatment agreed upon.

Use of Diagnosis

A diagnosis or clinical impression is an integral part of providing treatment. Never the less, a diagnosis is not something that I take lightly- diagnostic/clinical impressions are made using a variety of diagnostic tools that are evidence-based and widely accepted within the counseling profession.

Some health insurance companies will reimburse clients for counseling services and some will not. In addition, most will require that a diagnosis of a mental-health condition and indicate that you must have an “illness” before they will agree to reimburse you. Some conditions for which people seek counseling do not qualify for reimbursement. If a qualifying diagnosis is appropriate in your case, I will inform you of the diagnosis before we submit the diagnosis to the health insurance company. Any diagnosis made will become part of your permanent insurance records.

Confidentiality

All of our communication becomes part of the clinical record, which is accessible to you upon request. I will keep confidential anything you say as part of our counseling relationship, with the following exceptions: (a) you direct me in writing to disclose information to someone else, (b) it is determined you are a danger to yourself or others (including child or elder abuse), or (c) I am ordered by a court to disclose information.

Complaints

Although clients are encouraged to discuss any concerns with me, you may file a complaint against me with the North Carolina Board of Licensed Professional Counselors at the address below:

North Carolina Board of Licensed Professional Counselors

PO Box 77819

Greensboro, NC 27417

Phone: 844-622-3572

Fax: 336-217-9450

E-mail:LPCinfo@

Acceptance of Terms

We agree to these terms and will abide by these guidelines.

Client: ___________________________________________________ Date: ___________

Counselor: ________________________________________________ Date: ___________

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I was created, raised and educated to make a change in this world

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