Professional Disclosure Statement for Matthew Schonberg - Resident Intern, Therapist
Counselor’s Professional Disclosure and Client’s Informed Consent
WelcomeThe decision to begin counseling is an important step that can lead to meaningful growth, improved emotional well-being, and greater life satisfaction. Research shows that clients who understand the counseling process are more likely to achieve positive outcomes. This document is designed to provide information regarding my background, counseling approach, your rights as a client, confidentiality, risks and benefits of counseling, emergency procedures, and the nature of our professional relationship.
Professional Status and SupervisionI am currently a Resident Intern Counselor at Soul Care PLLC and am pursuing a Master of Arts in Mental Health Counseling at Northwestern University. I earned a Bachelor of Science in Psychology from Northeastern University. As a Resident Intern, I provide counseling services under the supervision of a licensed mental health professional. My work is regularly reviewed to ensure quality care, ethical practice, and professional development. Clinical supervision is a standard part of counselor training and is intended to support the highest quality of care for clients. Information discussed during supervision remains confidential and is protected under the same standards of confidentiality that apply to counseling services.
Clinical Supervisor: Andrea Symes MSW, LCSW, CGCS
My Positive Transformation PLLC
(704)237-0881
[email protected]
Professional Background and Counseling ApproachMy experience includes working with individuals experiencing Homelessness and housing instability, Substance Use Recovery, Crisis Intervention, Anxiety and Depression, Life Transitions and adjustments concerns, Relationship and Couples issues, Trauma-related concerns, and Immigration counseling. I provide counseling services in both English and Spanish. I strive to provide counseling that is collaborative, respectful, culturally responsive, trauma-informed, and goal-oriented. My theoretical approaches may include Cognitive Behavioral Therapy (CBT), Motivational Interviewing (MI), Dialectical Behavior Therapy (DBT), Trauma-Informed Care, Existential Therapy, Adlerian Therapy, and Person-Centered Interventions. Counseling is tailored to each client’s individual needs, goals, values and cultural background. I welcome clients regardless of their race, ethnicity, national origin, religion, sexual orientation, gender identity, marital status, socioeconomic status, and disability status.
Client Rights and Responsibilities.As a client, you have the right to be treated with dignity, respect, and compassion throughout the counseling process. You have the right to participate in the development of your treatment goals, ask questions about counseling methods and recommendations, and receive information regarding the benefits and risks of treatment. You may refuse any intervention, request a referral to another provider, or seek a second opinion at anytime. You have the right to receive services free from discrimination based on race, ethnicity, national origin, religion, sex, gender identity, sexual orientation, age, disability, or socioeconomic status. You may review your records as permitted by applicable laws and agency policies and may withdraw from counseling services at any time. You also have the right to discuss any concerns or complaints regarding your treatment without fear of retaliation.
Counseling is most effective when clients actively participates in the therapeutic process. As a client, you are encouraged to attend scheduled appointments consistently, communicate openly and honestly, and collaborate in the development of treatment goals. Progress often requires effort both during and outside of counseling sessions, which may include practicing new skills, reflecting on personal experiences, or completing agreed-upon therapeutic activities. Clients are also responsible for communicating concerns about treatment, notifying the counselor of significant changes in symptoms or safety, and maintaining financial obligations related to services. Active engagement and commitment to the counseling process can significantly contribute to positive therapeutic outcomes.
Although counseling is often beneficial, it may involve certain risks. The counseling process can bring awareness to difficult emotions, memories, experiences, or patterns of behavior that may temporarily increase feelings of discomfort, sadness, anxiety, anger, grief, or stress. As clients work toward change, they may experience shifts in relationships, personal beliefs, or life circumstances. In some cases, symptoms may temporarily worsen before improvement occurs. While every effort will be made to support your growth and well-being, there is no guarantee that counseling will achieve specific outcomes. Counseling can provide numerous benefits depending on your individual goals, concerns, and level of participation in the therapeutic process. Potential benefits include increased self-awareness, improved coping skills, greater emotional regulation, enhanced problem-solving abilities, stronger interpersonal relationships, and increased resilience when facing life’s challenges. Counseling may also help reduce symptoms of anxiety, depression, stress, and other emotional difficulties. While many clients experience positive outcomes, counseling is a highly individualized process, and specific results cannot be guaranteed.
ConfidentialityYour privacy is of the utmost importance, and information shared during counseling sessions will be treated with the highest level of respect and confidentiality. Counseling records, session content, assessment results, treatment plans, and other information related to your care will be maintained in accordance with applicable federal and state laws, professional ethical standards, and Soul Care PLLC policies. Information will not be released to any person or organization without your written authorization except in situations where disclosure is required by law, ethical obligation, or as outlined in this informed consent. As a mandated reporter, confidentiality must be broken by law in the following circumstances:
- If there is abuse (potential or actual) of children, persons with disabilities, and/or senior citizens
- If disclosure is required to prevent clear and imminent danger to yourself and/or others
- I am ordered by a court to disclose information
- I am working collaboratively with other professionals where disclosure of personal information is necessary to provide optimal care (release of information will be required by all parties)
Whenever possible, I will discuss any necessary disclosure with you before taking action.
Records and DocumentationAs part of the counseling process, records will be maintained to document services provided and support continuity of care. These records may include intake information, treatment plans, progress notes, assessments, correspondence related to treatment, and other clinically relevant documentation. Records are stored in a secure manner consistent with legal, ethical, and agency requirements. Access to records is limited to authorized individuals involved in your care and supervision. You may request access to your records in accordance with applicable laws and agency policies, although certain portions of the record may be restricted if disclosure could be harmful or otherwise prohibited by law.
Telehealth ServicesAll counseling services that I provide are through telehealth. Telehealth counseling involves the use of secure electronic communication technologies that allow counseling services to be delivered remotely. Telehealth offers increased accessibility and convenience; however it also carries potential risks, including technological failures, interruptions in service, unauthorized access to electronic communications, and limitations in responding to emergencies compared to in-person counseling. By participating in telehealth services, you acknowledge these potential risks and agree to participate from a private location whenever possible. At the beginning of each session, you may be asked to provide your current physical location and emergency contact information in case emergency intervention becomes necessary. If telehealth services are determined to be clinically inappropriate or insufficient to meet your needs, referrals to alternative services may be recommended.
Emergencies and Crisis SituationsCounseling services provided through Soul Care PLLC are not emergency services and should not be relied upon during crises requiring immediate intervention. If you are experiencing a mental health emergency, having thoughts of harming yourself or others, or are otherwise in immediate danger, you should call 911, contact the 988 Suicide and Crisis Lifeline, or go to the nearest emergency room. If you attempt to contact me during a crisis and I am unavailable, please seek immediate emergency assistance rather than waiting for a return call. Non-emergency messages will generally be returned within one business day whenever possible.
Appointments and FeesCounseling sessions are generally 45-60 minutes in length and are scheduled by appointment. As a Resident Intern Counselor at Soul Care PLLC, I provide counseling services under clinical supervision. Because Resident Intern services cannot be billed directly to insurance companies, Soul Care PLLC utilizes specialized billing procedures for clients receiving services from Resident Interns. Clients with Medicare or Medicaid coverage may receive services under Soul Care’s Pro Bono Program, while clients with commercial insurance may be responsible for the Resident Intern Rate, which is currently $35 per session or the amount of their typical office visit copayment, whichever is less. In some cases, the exact copayment amount may not be known until insurance processing occurs, particularly when plans require percentage-based copayments. Clients will be informed of any known financial responsibility before services begin and will be updated as additional information becomes available. Payment is due at the time services are rendered and may be made by approved credit or debit card. Questions regarding billing, insurance verification, payment arrangements, or financial concerns should be directed to Soul Care PLLC’s administrative or billing staff. Appointments canceled with less than 24 hours’ notice or missed without notification may be subject to a cancellation or no-show fee in accordance with Soul Care PLLC policies. Consistent attendance is encouraged, as regular participation often contributes significantly to therapeutic progress and treatment outcomes.
Complaints and ConcernsYour feedback is an important part of the counseling process. If you have concerns regarding your treatment, counseling relationship, fees, ethical issues, or any aspect of services provided, I encourage you to discuss these concerns directly with me so that we may work collaboratively toward a resolution. If you feel that your concerns have not been adequately addressed, you may contact my clinical supervisor or Soul Care PLLC administration. Clients also have the right to file a complaint with the appropriate state licensing board or regulatory agency responsible for overseeing mental health counseling services. Seeking clarification, expressing dissatisfaction, or filing a complaint will not affect your right to receive respectful and professional treatment.
Client Rights Committee:
Soul Care
5501 Executive Center Drive
Suite #225
Charlotte, NC 28212
Tel: 980-613-8312
North Carolina Legal Assistance:
2113 Cameron Street
Suite #218
Raleigh, NC 27605
Advocacy and Customer Service Department at the Division of MH/DD/SAS
3724 National Drive, Suite 100
Raleigh, NC 27612
Toll-Free: 877-235-4210
