Student Health and Wellness Services: Counseling Services Elizabeth H Davant, MA, NCC, LPC PROFESSIONAL DISCLOSURE STATEMENT Qualifications: Masters in Arts (MA) in Community Counseling from Appalachian State University, Boone, NC awarded December 2004 National Certified Counselor (NCC # 95100) and have a Certificate in Expressive Arts Therapy from Appalachian State University Licensed Professional Counselor in the state of North Carolina (LPC # 7061) Queens Health and Wellness Counselor since 7/16/2007 Human Services Clinical Counselor on an Assertive Community Treatment Team (ACTT) serving adults that have been diagnosed with a server and persistent mental illness (3/06-12/06) Child and Youth case manager providing supportive counseling, coordinated mental health services and advocated for needed services Completed (600 hours) counseling internship at a non-profit organization providing support and advocacy to LGBT (lesbian, gay, bisexual and transgender) youth 100 Hour Counseling Practicum at Appalachian State University’s counseling center Graduate Assistant in the ASU Women’s Center (2 years) Professional Associations: American Counseling Association (ACA) American College Counseling Association (ACCA) Licensed Professional Counselors Association of North Carolina (LPCANC) Population served As a counselor at Queens University of Charlotte, I provide counseling services, outreach on mental health issues and provide needed referrals to fulltime traditional undergraduate students who pay the comprehensive fee The Therapeutic Process: As a counselor, I should be used as a consultant that helps guide one through the therapeutic process The first session will begin by assessing one's therapeutic needs My counseling approach is founded in interpersonal theories, cognitive behavior approaches, and expressive arts therapy techniques, but together we will determine a course of action to help bring peace and clarity to the current issue As a client, one must be interested in the therapeutic process and commit time and energy to that process It is hard to reach one's goals without effort and hard work Personal histories will be explored in order to understand the construct of an individual’s subjective reality In exploring individuals historical premise the counselor and client become more fully in touch with the reality that exists for the client This knowledge of the past can help the counselor meet one where he or she is at that moment Exploring the past enables the counselor to understand the cognitive process of the client, which aids the counselor in directing appropriate questions Learning and exploring personal history can give one confidence in moving forward in his/her own life Understanding the past may enable one to move forward without the fear of repeating unwanted events of the past Exploring the past is just the beginning of the process Putting one’s current subjective reality in the present and understanding it’s meaning in a rational manner can help ground the individual and provide clarity A counselor’s subtle actions, such as questions, insights, observations and expressive arts direction, can bring about a change in one’s reality Page of Student Health and Wellness Services: Counseling Services Effects of Counseling: At any time you may initiate a discussion of possible positive or negative effects of entering, not entering, continuing, or discontinuing counseling While benefits are expected from the counseling process, specific results cannot be guaranteed Counseling is a personal exploration and may lead to major changes in your life perspectives and decisions These changes may affect significant relationships, your job, and your understanding of yourself Some of these life changes could be temporarily distressing The exact nature of these changes cannot be predicted Together we will work to achieve the best possible results for you Counseling Relationship: Although our sessions may be very intimate psychologically, ours is a professional relationship rather than a social one Our contact will be limited to the counseling sessions that you arrange with me except in the case of an emergency Please not invite me to social gatherings, offer me gifts, ask me to write references for you, or ask me to relate to you in any other way than in the professional context of the counseling relationship You will best be served if our sessions concentrate exclusively on your goals and concerns Fees and Length of Therapy: All counseling services are provided free to all currently enrolled students at Queens University of Charlotte who pay the comprehensive student fee Individual therapy sessions will last approximately 50 minutes Group sessions will usually last between 60-90 minutes The first few individual sessions may be longer to allow time to be better acquainted, complete intake documentation and to identify counseling goals The number and frequency of sessions will be determined by both the client and counselor Involvement in individual or group therapy sessions is voluntary Records: All of our communication and diagnosis information becomes part of the clinical record Records are my property or the property of the organization I work for, but you have a right to the information within your record Adult client records are disposed of seven years after termination of the counseling relationship Client rights: Counseling is a voluntary act, and you have the right to choose a counselor that best suits your needs I will my best to accommodate your needs within my scope of practice, but if long-term or specialized therapy is indicated, I will make every reasonable effort to find a referral source in the community You have the right to be treated ethically by your counselor If you have any questions concerning your rights and/or ethical treatment, or if you wish to file a complaint, please contact the following: National Board of Licensed Professional Counselors at www.ncblpc.org or (919) 661-0820 Please Ask Questions: You may have questions about me, my qualifications or anything not addressed in the previous paragraphs It is your right to have a complete explanation for any of your questions at any time Please exercise this right Page of Student Health and Wellness Services: Counseling Services Confidentiality Statement It is extremely important to understand that information shared with your counselor is confidential That being said, your counselor may at times discuss aspects of his/her practice with other mental health professionals in order to ensure the highest quality of counseling services In order to coordinate care, counselor may also consult with other Queens Health and Wellness Center professionals who also are bound to maintain confidentiality regarding health care information (Nurse, HWC Director and Internist) In those cases, only general or vague details of your situation will be discussed Identifying personal health information will not be given to parents, friends, outside medical doctors, partners, roommates, university facility or staff and employers unless: Written permission and/or a release to disclose health information has been signed by you When there is serious and foreseeable harm to you or others You indicate that there is reasonable cause to believe that a child or a dependent adult has been abused A court orders the counselor to disclose confidential information about you If this happens, the counselor will first ask that the court drop their order If they refuse to drop their order, the counselor will disclose only the minimum amount of information we deem necessary to satisfy the court’s order You waive the privilege by bringing charges against me Counseling is a voluntary act, and you have the right to choose a counselor that best suits your needs We will our best to accommodate your needs within our scope of practice, but if longterm or specialized therapy is indicated, we will make every reasonable effort to find a referral source in the community If a counselor determines that a student is not making progress with a counselor at the HWC, or is non-compliant with counseling recommendations/referrals, the counselor may refer that student to an off-campus mental health provider Emergency after-hours care is provided by campus police and resident life staff (Duty Phone) If you are in need of emergency services contact 704-337-2911 or contact your RA or Resident Coordinator The Dean of Students has the ability to contact counselor during an after-hours emergency if necessary Lastly, there is also an expectation of you: that you will keep private any information that you may learn through the course of coming to the Health & Wellness Center An example would be seeing another student at the center You are expected to respect and protect the privacy of others to the same extent that your own privacy is protected Acknowledgement of receipt: This client has been provided/offered a copy of the required disclosure statement and has read and understands the information provided Signature of Student Date Counselor Date Page of ... protected Acknowledgement of receipt: This client has been provided/offered a copy of the required disclosure statement and has read and understands the information provided Signature of Student