www.transitions-counseling.com :  Where Your Help Begins Online^SM

Client Handbook

& Professional Disclosure Statement (Web Version)

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Dear Client:

Welcome to the counseling opportunities offered by TRANSITIONS Personal & Family Counseling Services. If you are beginning counseling for the first time, and you are like most of us who have been down that road, you may be a little anxious. This is okay and a little expected. It involved a lot of personal courage on your part to take this first step — a step which is a move to your being able to make the changes you need in your life.

Even though I have been in clinical counseling work for thirty years, I increasingly feel a deep sense of respect and appreciation for each new client who decides to enter counseling with the courage and commitment to discover and make the changes that will give his or her life new meaning and direction. Having walked this road personally, as well as professionally, I know how challenging it can be. The shared trust and the opportunity to participate in, and witness, the growth of another is a sacred honor to me. My experience in this work has taught me that there is no tragedy so great, no shame so deep, and no pain so overwhelming but that the power of the human spirit can break through to the light. May it be so with you, as I trust it will.

Before we begin, it is important to inform you about my background and orientation, some things about the counseling experience, and the mutual responsibilities we are about to undertake in the professional counseling relationship.

CONFIDENTIALITY

TRANSITIONS has a policy of assured confidentiality, which ignores recent privacy-eroding trends in behavioral healthcare and in our society and holds to original standards of confidentiality as being the foundation of the counseling process. Everything we discuss in counseling will be held in professional confidence. By policy, the only way any information would be authorized to go outside my office is if you decide to sign a Release of Information Form, if you want some information to go to another professional. Since people typically do not understand the potential consequences of blanket release statements (for example, from insurance companies and managed care organizations), I do not honor such statements without written consent of the client — after discussion about potential consequences.

There are two exceptions under which the ethical principles of my profession and State law cannot guarantee confidentiality: (1) when I believe you actually intend to harm yourself or another person; and, (2) when I believe a child or elder person has been or will be abused or neglected. There are rare circumstances in which a professional can be ordered by a judge to release information. (However, court-ordered information leading to potential client harm is extremely rare — much rarer than data-loss due to computer malfunction.) Finally, because use of insurance companies for third party reimbursement involves some confidentiality risk (see below), signing of the Release of Information form would be necessary in such instances.

 

COUNSELING PROVIDER INFORMATION

I have over thirty years in post-graduate professional counseling. In 1974, I graduated Phi Beta Kappa, with high honors and Departmental honors, in Psychology, from the University Of Florida; where I went on to complete Master and Specialist (between master and doctorate) degrees in Counseling in 1977. I have practiced various aspects of the discipline of professional counseling over the years, accumulating clinical experience in mental health outpatient, family agency, psychiatric inpatient, correctional, and substance abuse treatment settings, as well as private practice; the last six years being full-time private practice. I am a member of the American Counseling Association, the International Association of Marriage And Family Counselors, and the North Carolina Society of Clinical Hypnosis.

I am Board Certified by the National Board For Certified Counselors (N.C.C.) and am a Licensed Professional Counselor in N. C.

In addition to my years of experience in individual, couples, and family therapy, I have over two years experience and clinical training in multiple family therapy, with an interest in exploring the use of that treatment modality on an outpatient basis with families presenting a diversity of problems; from substance abuse, to families experiencing catastrophic illness, to families making difficult transitions.

My continuing education over the post-graduate years has included either, or a combination of: workshop/conference study, supervised practice, and personal study in the above-referenced settings; with skill development relevant to the settings. These include such areas as: family work, including marriage counseling; mental health counseling; recovery from life crises and trauma; substance abuse counseling; clinical hypnosis; developmental conflicts and issues from adolescence through late adulthood; relationship conflicts; parenting skills; counseling for some specific disorders, such as ADD/ADHD; counseling for catastrophic illness and other life transitions; sexual dysfunction (psychogenic); psychoneuroimmunological counseling.

 

RANGE OF SERVICES

This range of experience has been useful in developing a family-oriented, broad-based counseling service in a predominantly rural setting. Many counseling needs present themselves, and besides family and friends, a significant number of referrals to TRANSITIONS come from family practice physicians. And, as in the case of a family medical practice, this counseling practice will meet the needs of most clients. However some clients may require referral to other mental health professionals or specialists, as an alternative or supplement to treatment in this setting. If it becomes apparent that you may need to be referred, please be reassured that it is policy for us to discuss your options in detail prior to any decision. The primary concern is that your needs will be met appropriately.

The unifying focus of this counseling practice is helping clients make transitions: through a crisis; out of conflict; getting "unstuck;" finding meaning; from being wounded to becoming whole; from being emotionally frozen or blocked to becoming able to grieve and say goodbye to one stage of life in order to be able to accept or embrace the next. A substantial number of persons who come here are "normal" folks who do not require a psychiatric diagnosis for treatment.

Counseling approaches at TRANSITIONS are predominantly eclectic, client-centered and transpersonal; with modalities that may include one or more of the following, depending upon the needs of the client: individual counseling, marital/couples counseling, group counseling, family therapy, or multiple family therapy.

Find out about recent changes at TRANSITIONS

THE COUNSELING EXPERIENCE

The essence of the counseling experience involves the creation of an environment and a relationship in which you can feel safe to explore every aspect of yourself, your life and your relationships. In an atmosphere which eliminates the dynamics of shaming and blaming, the counseling experience presents a mirror in which you may see yourself and your life exactly as they are. As your courage grows, you will be able to feel free to explore other options and discover new aspects of yourself — to try on new ways of being. You may find undiscovered strengths in yourself and learn new skills that will allow you to resolve old conflicts and heal old wounds — to re-create old relationships or, when necessary, find the courage to move on in peace.

By now, you may be aware that the successful counseling experience will involve a lot of work on your part. It takes a great amount of courage and willingness to work through pain in order for us to change our lives and make our lives work. But the pain of the counseling process is never so great as the pain of allowing our lives to continue on their present course. With commitment to this process, you will notice positive change in how you think and feel, how you perceive and relate to others, and to life in general. This process probably will involve more than participating in counseling sessions. You may be invited to read books; listen to tapes; watch certain movies; keep a journal; participate in specific exercises; attend special meetings; or work on special projects. Of course, these activities will not be required of you, but they will enhance your progress. And, while they are not a substitute for counseling, they can reduce the number of necessary sessions and make the counseling process more cost-effective for you.

While some aspects of the positive change process in your life may be sudden and profound, other changes will only come slowly and through deliberate, repeated effort. Therefore, it is important to be patient and understanding — both toward yourself and toward any partner(s) who may be participating in the counseling process with you.

During our first session or two, we will begin by focusing in on the presenting problems you are bringing to the counseling process. We will discuss your history and how it might bear on those problems. Counseling treatment options will be discussed, along with possible risks and benefits. Finally, we will develop a plan, which will include your counseling treatment goals and the therapeutic modalities we will use to achieve them. This plan will include an initial determination of the approximate number of sessions involved, your costs per session and any other details relevant to your particular circumstances.

Additional sessions will assist you toward meeting your treatment goals, along with helping you adjust and grow through your changes. During the period you are undergoing counseling, you may experience some intensification of negative emotions (for example: sadness, anxiety, anger, guilt, confusion). This is normal and often a result of your allowing yourself to experience feelings that were already there in you at deeper levels. Also, you may temporarily experience increasing difficulties in relating to others as you abandon old defenses and begin to develop more effective ways of relating to others. It is likely that your personal growth and changes may evoke negative responses in some persons. Family, especially, are used to relating to you in certain ways. As those ways change, some family members may become uncomfortable and may tend to undermine your progress. Under strong-enough circumstances, the introduction of some type of relationship counseling (for example, marriage or family) may be indicated. Periodically, we will review your progress and revise your treatment plan as necessary.

The successful counseling relationship involves the development of a high degree of vulnerability and trust, as intimate and confidential aspects of one's life are shared in detail. It is normal under such circumstances for intense feelings of closeness and sharing to develop. For this reason, the counseling profession has developed strict ethical guidelines to protect persons involved in counseling relationships. It is essential in the professional relationship that you should feel absolutely safe from even the remote possibility of exploitation of any kind in the relationship. Our research and experience demonstrates that an effective professional counseling relationship will focus only on your counseling needs; and part of my role is to safeguard that. Therefore, meetings will be limited to scheduled counseling sessions, arranged by you, and potentially role confusing aspects of the typical social relationship, such as social gatherings, gift exchanging, etc., will be avoided.

Also, in relationship counseling (for example, marriage or family), it is essential that all persons involved feel equally supported in the counseling process. Taking sides, shaming and blaming, are not part of the counseling process, and I invite you to please inform me if you ever feel less supported than your partner!

PAYMENT FOR SERVICES

TRANSITIONS is dedicated to providing competent, quality, professional counseling at an affordable fee structure. The key to this approach involves reducing overhead costs by making office operation simpler and more manageable in our Western Carolina setting. Services are available to a broad region by having the TRANSITIONS counseling/retreat facility in a beautiful, natural, woodland garden setting in Northbrook (Vale). This location offers greater privacy and costs less to operate, thus allowing for the lower fees.

Other overhead costs are reduced, and privacy assured, by providing office facilities that use confidential telephone answering resources in place of secretarial answering services. (In most instances, I will answer the phone, or I will attempt to call back within the hour.)

Expensive billing and bookkeeping procedures are also avoided by receiving fees immediately after services are rendered.

Every effort is made to increase the availability of counseling to you, including: an appropriate adjustment of fees as well as home, hospital or site visits for certain types of crises and handicaps; assured confidentiality; as well as prompt scheduling of appointments. This philosophy, with the above-noted innovative office management methods, allows the following SLIDING FEE SCALE:  

SLIDING FEE SCALE: OFFICE VISITS (NON-USE OF HEALTH INSURANCE Find out about recent changes at TRANSITIONS )

INCOME RANGE: Gross Family Income / Fee Per Session Hour

  From        To              Amount of Fee Upon Delivery of Service

20,000	and up	$60.00 Per Session Hour
18,000	20,000	$50.00 Per Session Hour
16,000	18,000	$40.00 Per Session Hour
14,000	16,000	$35.00 Per Session Hour
12,000	14,000	$30.00 Per Session Hour
10,000	12,000	$20.00 Per Session Hour
below	10,000	$20.00 Per Session Hour

BASED UPON GROSS FAMILY INCOME -- THE SAME SESSION HOUR RATE APPLIES, WHETHER AN INDIVIDUAL, COUPLE, OR FAMILY IS BEING SEEN. (COMBINED INCOME FEE-SETTING, NOT TO EXCEED $60.00, WILL BE APPLIED FOR SESSIONS INVOLVING PERSONS LIVING IN SEPARATE HOUSEHOLDS).

INSURANCE POLICY: Clients who wish to use health insurance coverage which, by policy, would compensate for my services will be charged the usual $60.00 per session fee, up front, and I will sign the appropriate documentation for the client to file with the insurance company. 

 CAUTIONS: At the present time, our society is undergoing many changes with regard to health policy; and particularly, mental health policy. I tend to discourage the use of health insurance and managed care for mental health purposes for the following reasons:

(1) Many counseling services are not covered (for example, marital counseling) and different companies tend to have different and changing policies regarding coverage, based on the service(s) provided and the qualifications of the provider.  

(2) In order to receive third party payment from a health insurance company, or managed care endorsement, the person receiving counseling services MUST have a DSM-IV psychiatric diagnosis, denoting "mental illness," which will become a permanent part of his or her medical/insurance records. However, counseling services for many situations can be provided without requiring a psychiatric diagnosis.

 (3) Insurance company (and HMO, PPO) policy can create more complication in the client's life than the possible reimbursement or savings are worth; for example, by designating an earlier brief counseling intervention as being for a "prior-existing condition" — thereby refusing payment for a later, more intensive intervention.

(4) Confidentiality is not as reliable as we would hope, considering the insurance and managed care information network. There is risk of diagnostic/treatment information leakage to present/potential employers, insurance companies, and finance organizations. Persons often sign blanket releases, unaware of the extent to which their personal information can be disclosed.  Signing such releases may be required for coverage.

Jobs have been lost and promotions denied; insurance policies refused and critical healthcare denied, as a result of such "managed" information. Feel free to review further information I have written on this topic by going to: The Risks Of Managed Care and Health Insurance. Also, check out the Web cross-links at transitions-counseling Online Services.

(5) The majority of health insurance companies, managed care (HMOs, PPOs), and EAP companies are self-serving business concerns, first. They make more income the less service they have to pay for, manage, or provide. Operating under the guise of ensuring appropriate and competent professional care, they use record review and telephone supervision to manage and limit the professional care of clients and patients with whom they have no first-hand, personal knowledge or experience. As a consequence, the consumer or employer pays higher and higher premiums for potentially reduced adequacy of care.

My concerns about the direction of the health care industry, with its potential for forcing compromise of the professional ethics of healthcare providers, are a large part of my inspiration to develop counseling services which can financially survive while providing good services outside the big business-based managed care environment. The goal of TRANSITIONS is to provide optimum and affordable professional counseling care without risking compromise of clients' confidentiality or counseling needs under pressure of outside concerns. I appreciate your being willing to wade through this weighty and detailed section. My ethics regarding disclosure policy required my writing this. With this information, if you are eligible to receive a percentage of health insurance coverage for my counseling services, and wish to use that method of payment, I will be happy to work with you.  

The first session is scheduled for at least 90 minutes and the first half hour of the first session is free.

It is important that you feel safe to come here and explore the possibilities of counseling for the first half hour without any sense of obligation. Feel free to ask questions, check credentials and discuss terms. (Better yet, ask those questions during your first telephone call, which involves no fee.) Then, if you don't want to pursue counseling with me, I can help refer you elsewhere.  If you do decide to use insurance or engage in any other activity involving electronic transmission of your counseling records, you will come under HIPAA Law.  Please be sure to read my HIPAA policies provided to you.

After the first session, our sessions will last 60 minutes. On occasion, sessions may go over an hour, depending on your need for closure and available time — but you will not be charged for additional time unless prior agreement has been made for a special extended session. Some of my clients require "double" or extended time sessions due to long travel distances, special procedures, and/or time constraints. In such circumstances, fees will be discussed and mutually agreed upon in advance. My SoulMentors program offers a completely innovative approach to services and fees.

Group Therapy and Multiple Family Therapy sessions usually will be charged one half the Individual/Family rate established for a particular client, couple or family. (For example, a client who pays $50.00 per hour for individual counseling will pay $25.00 per hour for group participation or multiple family therapy.)

STANDARD OF CARE

Counseling, like every clinical profession, has recognized standards of care for various types of problems, based upon research findings, accepted clinical criteria for providing treatment, and established methodologies based upon experience over time. As a routine, the resources we will use in your treatment will be based upon established standards of care. However, because some of my counseling work is "cutting edge," and holistic, some clients have the opportunity to experience emerging methodologies as part of their therapeutic work. In these cases, I have been in been in collaborative work, training/study or supervision in such areas (see examples above) and am qualified as far as the emerging area of exploration can allow at the time. The SoulMentors program uses many of these approaches.

If methods beyond currently accepted standards of care appear indicated in your case, I will offer them for your consideration and approval: that approval being formalized in some cases by your signing an appropriate authorization form.

SOME OTHER IMPORTANT THINGS TO KNOW

If you call and the answering system replies, please feel safe to leave a message. The answering system is confidential. I will return your call as soon as possible. On nights and weekends, your call will be call-forwarded to where I may be reached in an emergency or crisis. In such circumstances, please feel free to call if you cannot wait until the next scheduled session.

At the end of each session, fee payment will be due (in cash or personal check), unless other arrangements have been made in advance. At that time, we will schedule our next session.

IMPORTANT: Please consider that there are a limited number of time slots, with most clients wanting to schedule appointments during the "prime" period of the day most in demand. Unlike a doctor's office, where they call the next waiting patient, your scheduled appointment session is in an extended time slot reserved exclusively for you.  It cannot be made available for anybody else unless: (A) You decide to cancel or reschedule, AND (B) You call to cancel or reschedule with a reasonable amount of notice. Since my income also is based upon scheduled sessions, if you need to reschedule or cancel a session, PLEASE GIVE AT LEAST 24 HOURS NOTICE (MORE, IF POSSIBLE), so I might have a chance to reschedule in that time slot. Except in unforeseeable, crisis-type situations, clients who don't give at least the 24 hour notice in canceling a session will be responsible to pay for the session. Folks who don't cancel and don't show will be billed for the missed session.

When you have questions, concerns, or apprehensions about any aspect of your counseling, please feel free to share them with me. Everything about your sessions is for your recovery, growth and development and you have a right to expect to experience this process at some point into the sessions. Please share any complaints with me immediately to insure an efficient and effective counseling process. If you experience that you have been treated unfairly or unethically, such that you cannot resolve the problem with me, you can contact the North Carolina Board Of Licensed Professional Counselors at PO Box 21005, Raleigh, NC 27619-1005; (914) 787-1980.

TERMINATION OF COUNSELING SERVICES

Whether your counseling needs call for a few sessions or many, you will know you are approaching the opportunity to terminate your counseling services as you meet your treatment goals and your life improves sufficiently. Often, a client may experience significant relief very early in counseling. However, this is usually due to gains in insight, but not sufficient gains toward meeting your treatment goals; as these goals will usually involve development of new skills and behaviors. Initially, sessions will be weekly (or oftener in crisis), with duration between sessions becoming greater as you approach your goals.

Finally, you will feel ready to stop scheduling routine sessions, knowing the opportunity for future counseling will be available to you if you require it. The number of sessions you will require will be determined by the nature of your problems, your treatment needs and goals, how hard you work in sessions and outside sessions (doing "homework"), among other things. Required sessions can run from only one, to as many as you need to be satisfied that you've reached your goals. As a good counselor, my job is to work myself out of a job!

Today is a beginning, for you made the right decision to take care of yourself. When life begins to overwhelm us, for those of us who value our wellness, counseling is a healthy choice.  

With Deepest Personal Regards, 

Granville Angell, Ed.S., L.P.C., N.C.C.

(Below modified and condensed for Web page.)

Having read this Client Handbook, I am satisfied with these terms of counseling treatment and offer my consent.

Date/Client Signature(s)

Copyright 1/91, 8/94, 6/96, 3/97, 10/99, 1/2003, 2/2004, 12/2005, 9/2007: TRANSITIONS/Granville Angell

SOMETHING TO THINK ABOUT: I WILL KNOW THAT I HAVE SUCCESSFULLY COMPLETED COUNSELING WHEN:

NEXT SESSION Date/Location; Assignments/Projects to work on (books to read; journaling activity; video/audiotapes; meetings; awareness exercises; communication exercises; etc.)

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• We can express no greater personal courage than that found in our willingness to sacrifice what we are for what we can become.