Katherine Sloan, MA, LPC, LCAS
Pridetherapy.com
Professional Disclosure Statement
Informed Consent
I am pleased to have the opportunity to work with you in a counseling relationship. This
document is designed to inform you about my background and ensure you understand our
professional relationships. Please feel free to comment or ask questions.
Qualifications/Experience
I earned my Masters Degree in Professional Counseling from Ottawa University in
Phoenix, AZ in 2004. I am currently a Licensed Professional Counselor in NC (#7042)
and a Licensed Clinical Addictions Specialist (#1496) in NC.
I have counseled individuals, couples, and families since 2002. My area of special
interest and experience is working with individuals suffering from mood disorders,
anxiety disorders, and substance dependence. I have two years of post graduate
experience working in a residential treatment center for the dually diagnosed. I have 8
years of post-graduate work experience working in an addiction treatment center which
served clients with a variety of addictive disorders, mood disorders, personality disorders.
Graduate internships included Intensive Outpatient Counseling for Addictive Disorders. I
have three years of pre-graduate work experience providing support for people with
chronic mental illness.
Counseling Philosophy
I believe that each person has within them a natural ability to eliminate self-defeating
patterns and increase their capacity for joy. There are benefits and risks associated with
counseling and results are not guaranteed. Some changes lead to what seems to be
temporary worsening of circumstances, however ultimate results include gaining insight
into yourself, feeling empowered, and developing coping skills to deal more effectively
with life.
I use an eclectic approach to counseling that incorporates a variety of theoretical
orientations. I incorporate cognitive behavioral aspects of counseling as well as family of
origin and a humanistic approach. You can expect to learn specific skills intended to
change behaviors and enhance relationships. I may suggest homework assignments
which provide an opportunity to apply theory and practice skills. I may also make
referrals to 12-step meetings or other support groups. Remember that you are in control
of your own therapy and you should let me know which approach works best for you.
Online Counseling
Online counseling is not recommended for those struggling with the following: suicidal
thoughts/intent, thoughts of harming yourself or others, acute psychiatric episodes such
as psychosis, intoxicated or drugged states, or for youth under 18 years old.
If it is determined that you have the issues listed above, I will gladly refer you to a
counselor who can meet with you in person.
You understand that telephone/online psychotherapy with me is not a substitute for
medication under the care of a psychiatrist or doctor. You understand that online
and telephone therapy is not appropriate if you are experiencing a crisis or having
suicidal or homicidal thoughts. If a life-threatening crisis should occur, you agree to
contact a crisis hotline, call 911 or go to the hospital emergency room. You also
understand that I follow the laws and professional regulations of the State of North
Carolina (USA) and the psychotherapy treatment will be considered to take place in the
state of North Carolina (USA).
Length of Sessions/Fees
Individual online/skype counseling sessions are 50 minutes in length. I will remind you
when there is 5 minutes left in the session. Cost of online/skype session is listed on my
website. Each session should be paid prior to the appointment via Pay Pal. If you pay for
your session but are unable to complete the session, your money will be refunded by
check. Please allow 2 weeks for a check to be written and mailed to you.
Cost of e-mail exchange is listed on my website. Once your problem has been described
to me and enough information is gathered from you, I will begin writing a thoughtful
response, which I expect to take about 30 minutes. The response may include options to
resolve your conflict, links to community resources, links to internet articles regarding
your specific issues, or directions on how to use a specific coping skill. Please allow 48
hours for me to respond by e-mail once you have paid for this service.
I am able to offer a generous sliding scale for those who are unemployed or
underemployed. Please contact me regarding this scale. I will need proof of your income
in order for you to receive a reduced fee. Please be prepared to show a W2 for the
previous year or a pay stub.
CANCELATIONS
Please contact me 24 hours in advance if you are unable to keep your appointment. I will
gladly reschedule your appointment. If you miss your appointment and there was no
notification, I will not be able to refund your money.
Confidentiality of Skype, e-mail and cell phone exchanges:
Therapeutic emails are delivered via HushMail. You agree to work with me online using
HushMail or another encrypted email/chat service determined to be suitable by Katherine
Sloan. If you choose to email me from your personal email account, please limit the
contents to housekeeping issues such as cancellation, or change in contact information. I
will not respond to personal and clinical concerns via regular email. If you call me, please
be aware that unless we are both on land line phones, the conversation is not confidential.
Likewise, text messages are not confidential. Any computer files referencing our
communication are maintained using secure and encrypted measures. You understand
that emails between sessions that contain confidential information will be sent via
encryption.
I make every effort to keep all information confidential. Likewise, If we are working
online together, I ask that you determine who has access to your computer and
electronic information from your location. This would include family members,
coworkers, supervisors and friends. I encourage you to only communicate through a
computer that you know is safe wherein confidentiality can be ensured. Be sure
to fully exit all online counseling sessions and emails. If we are unable to connect or
are disconnected during a session due to technological breakdown, please try to
reconnect within 10 minutes. If reconnection is not possible, email to schedule a
new session time.
Litigation Limitation
Due to the nature of the therapeutic process and the fact that it often involves making a
full disclosure with regard to many matters which may be of a confidential nature, it is
agreed that should there be legal proceedings (such as, but not limited to divorce and
custody disputes, injuries, lawsuits, etc), neither you (client) nor your attorney, nor
anyone else acting on your behalf will call on me to testify in court or at any other
proceeding, nor will a disclosure of the psychotherapy records be requested.
Consultation: I consult regularly with other professionals regarding my clients; however,
the client’s name or other identifying information is never disclosed. The Client’s identity
remains completely anonymous, and confidentiality is fully maintained.
· Considering all the above exclusions, if it is still appropriate, upon your request, I will
release information to any agency/person you specify unless I conclude that releasing
such information might be harmful in any way.
TELEPHONE & EMERGENCY PROCEDURES
If you need to speak with me between sessions to alert me of an emergency, please
call 828-772-6716. Your call will be returned as soon as possible. Messages are
checked daily (but never during the night time). Messages are checked less
frequently on weekends and holidays. If an emergency situation arises that requires
immediate attention, you may go online at www.suicidal.com or call the emergency
National Suicide Hotline at 800-784-2433 or dial 911. If a life threatening crisis
should occur, you agree to contact a crisis hotline, call 911, or go to a hospital
Records and Confidentiality
All information shared will be kept confidential with the following exceptions:
A) If you are evaluated to be a danger to yourself or others.
B) If you gave written permission to disclose information.
C) In the case of abuse to a child or elderly person.
D) If a court order or other legal proceedings or statutes require such disclosure.
E) Your insurance company requires information in order to pay claims.
Insurance
At this time, insurance companies do not cover online counseling. I am unable to file
with any insurance companies.
Complaints
If at any time, you are dissatisfied with my services, please let me know. Should you
and/or I believe that a referral is needed, I will provide you with possible referral sources.
If you have a complaint which you believe needs to be registered with my governing
board, feel free to contact the following:
North Carolina Board of Licensed Professional Counselors.
PO Box 1369
Garner, NC 27529-1309
919-661-0820
By signing below, you are indicating that you have read, understood, and agree to the
information contained in this statement; that you have been given a copy of this form for
your records; and that any questions you have about this statement have been answered to
your satisfaction.
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Client Name (Print)
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Client Signature
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Counselor’s signature
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