Professional Disclosure Statement &
Informed Consent for Treatment
Maggie Farrington, MA, LPC #4906
Education & Experience:
In 1998, I began my career in the human services as an intern at the Hospitality House of Boone. From that experience, I knew that serving the needs of others as they search for meaning and purpose. I graduated from Appalachian State University in 1999 with a Bachelor of Arts degree in Psychology and a minor in art. I graduated in 2003 from Gordon Conwell Theological Seminary with a Master of Arts degree in Counseling and was licensed in 2005 as a Licensed Professional Counselor in NC. For the past 10 years, I have worked in a variety of community mental health and social service agencies serving the needs of those that are at risk of “falling through the cracks” and struggle to get the help and support they need to create healthy lives for themselves and their families.
Counseling Philosophy:
I utilize a variety of counseling theory and models depending on the needs of the individual. I primarily though come from a Cognitive-Behavioral model having witnessed the huge impact of how adjusting one’s behavior can have great success in changing one’s thought process. Force yourself to smile for sixty seconds and take note of how you feel at the end of that minute. And what makes sense to most is that in the reverse, changing the way you think can directly affect how you behave. I take a Solution Focused Approach, certainly gathering social history and background information about how your past affects your today- but being more focused on today and what goals and solutions can be sought after to gain future healing. Having worked for 10 years with families in a variety of difficult life situations, I have experienced the dynamics of the Family System- an individual is affected by everyone around him or her. Therefore, if a child or teenager is involved in individual counseling I will expect the family unit to be involved in their treatment as well while still respecting that child or teen’s privately shared information with confidence unless it is information that they intend to harm themselves or someone else.
I will make clinical recommendations regarding the intensity and length of treatment but it will be up to you to decide if participating in counseling is a worthwhile personal commitment. I firmly believe in a holistic approach to wellness and will share referral information with you about other resources such as medical professionals, support groups, etc. that can aid you in your treatment.
Counseling sessions are one hour in length or can be prorated for additional time requested by the client. Sessions will be held within the counseling office only. For your best interest and to protect your personal rights, our relationship must remain professional at all times; this means that even though our relationship may seem very intimate, you must remember that I am only sharing with you as a professional and focusing on the goals you have indicated you desire to reach. To preserve the therapeutic relationship, there cannot be a social relationship outside of the counseling office.
Fees and Insurance Reimbursement:
I am able to accept several insurances. Please call your insurance company to confirm benefits, find out about co-pay responsibilities, or get preapproval. Also be aware that any personal information or diagnosis provided to an insurance company can no longer be held to the same standard of confidentiality, and may well become part of your permanent insurance record. Counseling sessions are also available for $60 cash/check and receipts are available to submit to your insurance for reimbursement of out-of-network benefits if needed.
Appointment cancellation must be made at least 24 hours in advance to avoid personally being charged the full fee.
Confidentiality:
All information shared will be kept confidential with the following exceptions;
a) If I believe you are a danger to yourself or someone else
b) If you give me written permission to disclose information
c) In the case of abuse to a child or an elderly person confidentiality will be waived
d) If the information is court ordered
e) If you desire to seek reimbursement from a managed care company, the disclosure of confidential information may be required for reimbursement
f) In case of a Medical Emergency
g) These rights are waived if accusations of misconduct are brought
Even under these circumstances only essential information will be revealed and as much as possible you will be informed before confidentiality is broken. In the event the client is a minor, parents or legal guardians may be included in the counseling process as is appropriate, however measures will be taken to safeguard confidentiality, always acting in the best interest of the client.
As a counselor I may be receiving supervision (by an individual who is bound by the same code of ethics as I am) to continually improve my counseling skills, any information shared during supervision will be discussed for professional purposes only and every effort will be made to protect your identity.
Client Rights:
All records are my property; however they are kept for your benefit and are available to you at your request, if deemed therapeutically valuable. As stated earlier, you have the right to be informed of your counselor’s qualifications as well as the right to decline or accept any suggestions or therapeutic strategies. I will remind you of these rights and choices periodically throughout our therapeutic relationship. Termination of the counseling relationship will be made by you or by a collaborative decision between us both.
Emergencies:
If you have an urgent situation, which you feel needs immediate support and I am not available by phone, please contact your local 911 system or go to the nearest emergency room.
Complaints:
If, at any time, you feel my behavior or my counseling approach is inappropriate or troubling to you, please let me know. If, however, you do not feel your concerns are being addressed appropriately, feel free to contact:
North Carolina Board of Licensed Professional Counselors
PO Box 1369
Garner, NC 27529-1369
(919) 661-0820 Fax: (919) 779-5642
Client Responsibilities:
· As a client you have the responsibility to set and keep appointments. Let me know as soon as possible, at least within 24 hours, if you cannot keep an appointment.
· Pay your fees in accordance with the schedule we have pre-established and let me know if you have difficulty paying so that we can work together to make a manageable plan.
· Help plan your treatment goals and follow through with agreed upon goals. You are responsible for your actions when you refuse treatment or do not follow clinical recommendations.
· You are responsible for being considerate of the rights of other clients and personnel. This includes holding in strict confidence other clients’ mental health/substance abuse information which may be obtained during group therapy and socialization. It is also your responsibility to keep me informed of your progress towards meeting your goals and to terminate your counseling relationship before entering into arrangement with another counselor.
Please list any questions you have and bring them with you to your next visit. I will be sure to address all of your questions and concerns.
Please list any questions you have and bring them with you to your next visit. I will be sure to address all of your questions and concerns.