-Professional Disclosure Form for Deborah McGee, Resident Intern-Therapist
Student Counselor-in-Training Disclosure and Informed Consent
This form provides information relative to Internship/Practicum and the student counselor-in-training enrolled in our graduate program for Clinical Mental Health. This document provides the client with written information regarding the student’s (counselor-in-training) preparation, information about the counseling relationship, client rights and responsibilities, and the limits of confidentiality. This document must be signed by the client or by the client’s parent/legal guardian before counseling may begin.
Student Training
Prior to/concurrent with beginning his clinical experience at the practicum or internship site, the student has completed core counseling courses such as introduction to counseling and systems theory, helping relationships, psychopathology, group dynamics and ethics. The practicum and internship courses are a developmental sequence in which the student applies his knowledge under intensive supervision. This is the fourth clinical rotation for this counselor-in-training, who is pursuing a Master of Arts in Christian Counseling from Liberty University in Lynchburg, Va.
Counseling Relationship and Client Responsibility
Counseling is based on a relationship characterized by trust and respect. The resident intern (counselor-in-training) and the client work together to identify goals for counseling and approaches to meet those goals. The resident intern’s primary theoretical orientations are Cognitive Behavioral Therapy (CBT) and Emotionally Focused Therapy (EFT). Cognitive Behavioral Therapy is highly researched, often short-term, and places special emphasis on altering maladaptive thoughts and associated affect, feelings, and behaviors. CBT may also address healthy coping strategies and self-regulation and may include homework assignments. Emotionally Focused Therapy places special emphasis on emotion and integrates attachment and systemic principles, making it especially helpful for couples by helping couples recognize and address maladaptive interpersonal patterns and understanding one’s partner on a deeper emotional level.Therefore, counseling sessions may include exploring feelings, emotions, thoughts, beliefs, attitudes and behaviors regarding self and others, personal history, including family of origin, communication style and other personal needs. The success of the counseling relationship depends on your willingness to be open, honest, and involved in the process. The counseling experience can evoke changes in attitudes, beliefs, emotions, behaviors, coping skills and personal views. This can sometimes affect those close to you as they adjust to the new perspectives and positive behavioral changes that occur during counseling.
During the internship, the resident intern (counselor-in-training) receives an hour of supervision once a week from the clinical sites’ designated supervisor and one and a half hours every week from an assigned GCTS counseling department faculty member, and peers. Supervisors are qualified licensed mental health clinicians trained/experienced in counseling and supervision.
Confidentiality
To further the training needs and professional development of the resident intern (counselor-in-training) and to ensure that the client is receiving best practice and ethical services, under supervisory review, your counselor-in-training will audio and video record all your counseling sessions. Every effort is taken to protect confidentiality and the safekeeping of all recordings. All recordings are destroyed at the end of the semester in which services are provided. As a client, it is your right to receive counseling in which your dignity, worth, and uniqueness are respected. Your counselor-in-training will provide you with quality informed services under close supervision. Clients have the right to receive services that are confidential, HIPPA compliant and follow the ethical and legal codes of the state licensure board and the American Counseling Association.
Limits of Confidentiality
All Resident Interns (counselors-in-training), their supervisors, and group supervision members will not disclose information except under the following conditions, which include but are not limited to:
The Resident Intern (counselor-in-training) is a mandated reporter and must comply with laws and ethical code that require reporting harm to oneself or others, abuse to children, elderly or disabled persons, a court-order, and other conditions.
Informed Consent to Audio and Video Record
As a counselor-in-training, I audio and video record all counseling sessions (unless otherwise specified) for training purposes and to improve my clinical counseling skills. The counselor-in-training and the client(s) will be audio and video recorded. Confidentiality concerning such recordings is considered the same as the counseling sessions themselves. I take the utmost care to insure the safekeeping of all recordings. Recordings are properly destroyed after consultation and feedback from my clinical supervisor and my Liberty University group supervisor/advisor.
I, the client(s), give my consent for my counseling sessions to be Audio and Video recorded by Deborah McGee, MS, Resident Intern-Therapist, for clinical training purposes and supervision review. I understand that I may rescind this consent at any time.
This Resident Intern will provide services under the supervision of:
Chantelle Johnson |5501 Executive Center Drive Suite #215 Charlotte, NC 28212 |704-909-8025
This form provides information relative to Internship/Practicum and the student counselor-in-training enrolled in our graduate program for Clinical Mental Health. This document provides the client with written information regarding the student’s (counselor-in-training) preparation, information about the counseling relationship, client rights and responsibilities, and the limits of confidentiality. This document must be signed by the client or by the client’s parent/legal guardian before counseling may begin.
Student Training
Prior to/concurrent with beginning his clinical experience at the practicum or internship site, the student has completed core counseling courses such as introduction to counseling and systems theory, helping relationships, psychopathology, group dynamics and ethics. The practicum and internship courses are a developmental sequence in which the student applies his knowledge under intensive supervision. This is the fourth clinical rotation for this counselor-in-training, who is pursuing a Master of Arts in Christian Counseling from Liberty University in Lynchburg, Va.
Counseling Relationship and Client Responsibility
Counseling is based on a relationship characterized by trust and respect. The resident intern (counselor-in-training) and the client work together to identify goals for counseling and approaches to meet those goals. The resident intern’s primary theoretical orientations are Cognitive Behavioral Therapy (CBT) and Emotionally Focused Therapy (EFT). Cognitive Behavioral Therapy is highly researched, often short-term, and places special emphasis on altering maladaptive thoughts and associated affect, feelings, and behaviors. CBT may also address healthy coping strategies and self-regulation and may include homework assignments. Emotionally Focused Therapy places special emphasis on emotion and integrates attachment and systemic principles, making it especially helpful for couples by helping couples recognize and address maladaptive interpersonal patterns and understanding one’s partner on a deeper emotional level.Therefore, counseling sessions may include exploring feelings, emotions, thoughts, beliefs, attitudes and behaviors regarding self and others, personal history, including family of origin, communication style and other personal needs. The success of the counseling relationship depends on your willingness to be open, honest, and involved in the process. The counseling experience can evoke changes in attitudes, beliefs, emotions, behaviors, coping skills and personal views. This can sometimes affect those close to you as they adjust to the new perspectives and positive behavioral changes that occur during counseling.
During the internship, the resident intern (counselor-in-training) receives an hour of supervision once a week from the clinical sites’ designated supervisor and one and a half hours every week from an assigned GCTS counseling department faculty member, and peers. Supervisors are qualified licensed mental health clinicians trained/experienced in counseling and supervision.
Confidentiality
To further the training needs and professional development of the resident intern (counselor-in-training) and to ensure that the client is receiving best practice and ethical services, under supervisory review, your counselor-in-training will audio and video record all your counseling sessions. Every effort is taken to protect confidentiality and the safekeeping of all recordings. All recordings are destroyed at the end of the semester in which services are provided. As a client, it is your right to receive counseling in which your dignity, worth, and uniqueness are respected. Your counselor-in-training will provide you with quality informed services under close supervision. Clients have the right to receive services that are confidential, HIPPA compliant and follow the ethical and legal codes of the state licensure board and the American Counseling Association.
Limits of Confidentiality
All Resident Interns (counselors-in-training), their supervisors, and group supervision members will not disclose information except under the following conditions, which include but are not limited to:
- The client or guardian gives written consent to release information to (a) designated individual(s) or agency
- The client makes specific violent threats to harm him or herself or to harm an identifiable person
- The counselor-in-training and/or his supervisors are named as defendants in a civil, criminal, or disciplinary action, lawsuit or case arising from the counseling session
- The counselor-in-training receives an authentic subpoena backed by judicial authority that requires the disclosure of information
- The counselor-in-training has reasonable cause to believe that a child, elder, or an adult with a disability has suffered abuse or neglect
- The client is diagnosed with a life-threatening communicable disease and is not taking necessary precautions
- When reimbursement or laws necessitate disclosure
- The counselor-in-training will discuss the content of counseling sessions in individual and group supervision, which may include recordings and documentation, under the direction of a qualified supervisor who is held to the same professional standards of confidentiality and its limits
The Resident Intern (counselor-in-training) is a mandated reporter and must comply with laws and ethical code that require reporting harm to oneself or others, abuse to children, elderly or disabled persons, a court-order, and other conditions.
Informed Consent to Audio and Video Record
As a counselor-in-training, I audio and video record all counseling sessions (unless otherwise specified) for training purposes and to improve my clinical counseling skills. The counselor-in-training and the client(s) will be audio and video recorded. Confidentiality concerning such recordings is considered the same as the counseling sessions themselves. I take the utmost care to insure the safekeeping of all recordings. Recordings are properly destroyed after consultation and feedback from my clinical supervisor and my Liberty University group supervisor/advisor.
I, the client(s), give my consent for my counseling sessions to be Audio and Video recorded by Deborah McGee, MS, Resident Intern-Therapist, for clinical training purposes and supervision review. I understand that I may rescind this consent at any time.
This Resident Intern will provide services under the supervision of:
Chantelle Johnson |5501 Executive Center Drive Suite #215 Charlotte, NC 28212 |704-909-8025
