Professional Disclosure Statement for Sheena Marsh - Therapist
The decision to enter a counseling relationship is a serious commitment that can be a life-changing experience. Research has shown that individuals who understand the counseling process are more likely to achieve favorable results. This document is designed to inform you of the counseling process, the various therapeutic modalities that I use, the benefits and risks involved in counseling, confidentiality, our professional relationship, and my background. It will also document your understanding and consent to treatment.
Background and Training
I received my master’s in clinical mental health counseling from Liberty University in August of 2024. My bachelor’s degree, with a concentration in human service, was completed from Wingate University in December of 2011. I began my clinical training in the counseling program at Liberty University in March 2022. I am pursuing a license as a Clinical Mental Health Associate, LCMHCA in the state of North Carolina. I am also under the supervision of Chantelle Johnson, MA, LCMHCS, LCPC, and clinical director-owner of Soul Care PLLC. Chantelle Johnson, mycurrent supervisor, can be reached at (980) 613- 8312 or at [email protected].
The experience I have comes from working with individuals, couples, children, and families for the past year through my practicum/internship I and II courses at Liberty University. Chantelle Johnson, MA, LCMHCS, LCPC supervised me throughout my practicum and both internships at Liberty University.
Clients with whom I work generally seek counseling for difficulties associated with common life. This includesdepression, anxiety, grief, loss, adjustment difficulties, self-identity issues, life goals, relationship concerns, and substance abuse issues.
Counseling Services Offered
With respect to my theoretical orientation and worldview for counseling, I believe that we are whole persons, with physical, psychological, social, and spiritual aspects, so therefore, I am committed to an integrated approach ofpsychotherapy. These psychological perspectives of psychotherapy include Person- Centered Therapy, Family Systems approach, Cognitive-Behavioral Therapy, Dialectical-Behavioral Therapy, Gestalt Therapy, Solution Focused Therapy, Narrative Therapy, Emotionally Focused Therapy, Motivational Interviewing, and Play Therapy. These models are regarded as established, well-researched and effective methods of therapy. I respect your religious/spiritual orientation and therefore whether we include discussion of the spiritual dimension of life in our time together will be entirely up to you.
Guiding Principles and Practices
My approach to counseling is goal-oriented, experiential, multidimensional, and designed to enhance awareness andunderstanding. My approach also includes a collaborative relationship, continuous care, with empathy and spiritually/religiously sensitivity.
Client PopulationI will agree to meet with a potential client regardless of age, color, culture, disability, ethnic group, gender, race, religion, sexual orientation, marital status, or socio-economic status. I may decline meeting with a client if I feel, in myprofessional opinion, that I cannot help them or if they would be better served with the services of another professional. If a referral elsewhere is needed, I will provide information regarding services for the client’s consideration.
Therapist’s Responsibility
As a professional, I will uphold and abide by the standards of the American Counseling Association and the NorthCarolina LPC Board code of ethics. Our relationship is a professional one. Our contact will be limited to the sessions you arrange with me. I will not communicate with you through any social media platforms such as Facebook, Instagram, Snapchat, Twitter, Tik tok….etc. You will be best served while I am seeing you for counseling if our relationship stays strictly professional and if our sessions concentrate exclusively on your concerns. You may learn more about me as we work together, but it is important for you to remember that you are experiencing me to be a professional therapist.
Client’s Responsibility
The beginning sessions involve understanding your situation so that together we can develop specific, realistic goals,methods to accomplish them, and the approximate length of time needed. It is important for you to be as open and honest with me as possible, as well as work toward the goals we have agreed upon. The majority of the counseling session will consist of you talking about the issues you present and employing methods that can help make a positive difference in your life. This requires effort and active involvement on your part to understand and change your thoughts, feelings, and behaviors. It will include work in and out of the counseling sessions and may includehomework assignments, self-observation, and practicing new behaviors. It is important for you to attend all yourscheduled appointments on time. If you are unable to make your scheduled appointment, you can contact me by email, text, or phone.
Confidentiality
I regard the information you share with me with great respect. All information that you share with me including notes,records, and assessment results are confidential and will not be released to any outside person or agency without your written authorization and consent.
The following are circumstances in which I cannot guarantee confidentiality, either legally or ethically: The law requires the therapist to report it to the appropriate authorities.
- 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.
- If mandated by a court of law.
- You sign a release form authorizing me to disclose information to a given person, agency, or institution.
In order to improve my clinical skills and obtain additional training, I may audio/video tape counseling sessions. These sessions may be discussed with and reviewed by my supervisor, Chantelle Johnson, MA, LCMHCS, LCPC.Confidentiality concerning such tapes is considered the same as the counseling sessions. themselves. Following the feedback of my supervisor the audio/video tape recordings will be destroyed.
Session and Fees
I can assure you that my services will be provided in a professional manner and will be consistent with acceptedethical standards. After we decide on the frequency of appointments (generally once a week) and the appointment time, I will reserve this time for you. Sessions are usually 45 – 50 minutes long. It is possible to adjust the length of asession if necessary and should be agreed upon in advance. The length of treatment varies depending on the therapist, the client (s), and the nature of the problems. Typically, treatment will last8-12 sessions for relatively specific problems, but may be longer or shorter depending upon the nature of treatment.
The leadership of Soul Care PLLC determines the counseling fee structure. The base fee charged is $150 for Assessments and $125 for follow-ups. An income-based sliding scale is available and is based on licensure level. Clients may use their insurance if applicable. Please note that your insurance company may require information regarding diagnosis, symptoms, treatment goals, and methods. Any diagnosis provided to your insurance company becomes a part of your permanent medical record.
Please understand that you, the client, are fully responsible for payment of fees for services provided regardless of any insurance coverage you may have. Payment is due at the end of each session. This includes co-payments, co-insurance, and unmet deductibles. You may need to contact your insurance provided to gain details about your behavioral health coverage. Rates and fees are discussed and mutually agreed upon before treatment begins. Pleasekeep in mind the total cost of your treatment will not be known until your treatment ends.
Counseling fees are accepted in the form of cash, check, debit, and/or credit card(s). Please note that if your check is returned for insufficient funds, you will be responsible for the bank charges incurred. Cancellation of appointmentsmust be made 24 hours prior to your appointment. If the appointment is not canceled within this time period, or if you do not show up for your appointment, you will be charged a $35 missed appointment fee.
In Case of Emergency
If you try to contact me by phone at (704) 412-8736 and I am not available, please leave a message on my voicemail. Iwill return calls within 24 hours. If you are unable to reach me in an emergency, contact 911, or go to the nearest hospital emergency room. If you are out of town, sick, or need additional support, phone sessions are available. I will not be able to guarantee 24/7 availability and will do my best to work with you concerning support sessions. The Suicide and Crisis Lifeline is available 24/7 by calling 988 or texting the crisis line at 741741 to reach a crisis counselor.
Social Media and Electronic Communications
Social media is neither private nor confidential. Therefore, I will not seek out or accept “friend” requests or “follow” any current, or former client on any social media platform. I will not engage you in any public forums over the internet, because to do so could blur the professional nature of our relationship and could compromise the privacy that I seek to guard. Electronic communications (E-mail, texting (SMS), etc.) are not encrypted or secure and may not be received in a timely manner. The best method is to contact the office, or the phone number given.
Complaint Procedure
If you are dissatisfied with any aspect of my work, the most effective and productive way to deal with the situation and hopefully resolve it is to discuss it in our sessions together. Please feel free to ask any questions or clarify any confusion you may have about my work. Although clients are encouraged to discuss any concerns with me, you may file a complaint against me with the organization below should you feel I am in violation of any of these codes of ethics. I abide by the ACA Code of Ethics (http://www.counseling.org/Resources/aca-code-of-ethics.pdf).
If you think that you have been treated unfairly or unethically by me, contact the Clients Rights Committee:
Soul Care PLLC - Chantelle Johnson, MA, LCMHCS, LCPC, - Clinical Director and Owner
5501 Executive Center Drive Suite #215
Charlotte, NC 28212
Tel: (980) 613-8312
Fax: (888) 972-4998
Email: [email protected] www.mysoulcare.org
North Carolina Legal Assistance -
2113 Cameron Street
Suite #218
Raleigh, NC 27605
Tel: (800) 821-6922 (Voice) or
(888) 268-5535 (TDD)
Disability Rights North Carolina -
3724 National Drive, Suite #100
Raleigh, NC 27612
Tel: (919) 856-2195
Toll-Free: (877) 235-4210
https://www.disabilityrightsnc. org.
North Carolina Board of Licensed Clinical Mental Health Counselors
P.O. Box 77819
Greensboro, NC 27417
Phone: (844) 622-3572 or (336) 217-6007
Fax: (336) 217-9450
E-mail: [email protected]