DISCLOSURE STATEMENT
SUE E. COFFEY
LICENSED CLINICAL SOCIAL WORKER
P.O. BOX 784
Littleton, Colorado 80160
Both the state and I want to help you make informed decisions about your treatment. You have certain rights as
a patient of psychotherapy and as a consumer of my services. Therefore, I will explain the information you are
entitled to know.
1.
I have a M.S.W. (Master of Social Work), which I earned from the State University of New York at Albany,
Rockefeller School of Social Welfare in 1993. I also have a M.S. (Master of Science) in Psychology, Utmost
Distinction, which I earned from the Miami Institute of Psychology, Caribbean Center for Advanced Studies in
1999. I hold certification as a Registered Play Therapist-Supervisor from the Association for Play Therapy.
I am also licensed in the state of Colorado as a LCSW (Licensed Clinical Social Worker) currently and have
been since March 2002. My license number in the state of Colorado is 992799.
2.
3.
Regulatory requirements applicable to mental health professionals: A Licensed Clinical Social Worker (LCSW) ,
a Licensed Marriage and Family Therapist (LMFT), and a Licensed Professional Counselor (LPC) must hold a
masters degree in their profession and have two years of post-masters supervision. A Licensed Psychologist must
hold a doctorate degree in psychology and have one year of post-doctoral supervision. A Licensed Social Worker
(LSW) must hold a masters degree in social work. A Psychologist Candidate, a Marriage and Family Therapist
Candidate, and a Licensed Professional Counselor Candidate must hold the necessary licensing degree and be in
the process of completing the required supervision for licensure. A Certified Addiction Counselor I (CAC I)
must be a high school graduate, and complete required training hours and 1,000 hours of supervised experience.
A CAC II must complete additional required training hours and 2,000 hours of supervised experience. A
Licensed Addiction Counselor must have a clinical masters degree and meet the CAC II requirements. A
Registered Psychotherapist is registered with the State Board of Registered Psychotherapists, is not licensed or
certified, and no degree, training or experience is required.
As a licensed professional in the state of Colorado, my practice as a psychotherapist is regulated by the state. If
you have a complaint, let’s talk about it. However, another option is to contact the following agency:
Department of Regulatory Agencies
Mental Health Section
1560 Broadway, Suite #1340
Denver, Colorado 80202
(303) 894-7766.
The Colorado Department of Regulatory Agencies has the general responsibility of regulating the practice of
licensed psychologists, licensed social workers, licensed professional counselors, licensed marriage and family
therapists, licensed school psychologists practicing outside the school setting, and unlicensed individuals who
practice psychotherapy.
4.
Client Rights and Important Information:
a.
b.
c.
There are many approaches to psychotherapy. We will talk about the type of therapy I will use. My
approach helps some people. It may or may not help you. You are entitled to receive information from me
about my methods of therapy, the techniques I use, the duration of your therapy (if I can determine it), and
my fee structure. Please ask if you would like to receive this information.
You can seek a second opinion from another therapist or terminate therapy at any time (unless the court
orders therapy).
Although you will be sharing personal things with me during the course of your treatment, the tie between
us is not personal. In order for me to best help you, our relationship must remain professional. In a
professional relationship (such as ours), sexual intimacy between a therapist and a client is never appropriate
and it is illegal. If sexual intimacy has occurred in the past, you should file a complaint with the Department
of Regulatory Agencies, Mental Health Section, Grievance Board.
Should you wish for a copy of client paperwork, this clinician will copy initial packet (i.e., policy
statement, disclosure statement, client information sheet, consent form, release(s) of information, agreement
for payment, receipt of notice of privacy rights). Should you wish for information regarding treatment, this
clinician will prepare a summary of treatment provided at hourly rate.
d.
Generally speaking, the information provided by and to a client during therapy sessions is legally
confidential and considered privileged communication if the therapist is a licensed marriage and family
therapist, a licensed social worker, a licensed professional counselor, a licensed psychologist, or an
unlicensed psychotherapist. If the information is legally confidential, the therapist cannot be forced to
disclose the information without the client’s consent and cannot be disclosed in any court of competent
jurisdiction in the State of Colorado.
There are exceptions to the general rule of legal confidentiality. These exceptions are listed in the Colorado
statutes (see State Grievance Board Rule 12(e) and C.R.S. 12-43-218, in particular). You should be aware
that, except in the case of information given to a licensed psychologist, legal confidentiality does not apply
in a criminal or delinquency proceeding.
I will not share the things you tell me. However, I can be forced to reveal things you have said if:
 I suspect child abuse.
 I feel there is a threat of you harming yourself or others.
 You become unable to take care of yourself and additional help is required.
 There is a Grievance Board inquiry.
 Legal matters are involved, for example custody proceedings and court-ordered clients.
I do consult with colleagues regarding treatment procedures so that I can provide you with a high quality of
service. I do respect your privacy and do not disclose your name or any information that would disclose
your identity.
5.
There may be psychological side effects from treatment. This risk comes with any therapy. You may share
painful things with me. Our goal is to confront these issues and develop solutions. With time, we hope these
potential side effects will lessen and our work together will benefit you. You should know that there are
different types of therapy (such as support groups). Each will have their own risks and benefits.
6.
If you have an emergency, talk with myself at (303) 794-7008. If I am not available, then please go to the
nearest hospital emergency room or call “911.
7.
Please be aware that I do consult with other professionals within the Believing in Kids & Families Counseling
Group without identifying your name for the purpose of providing you an improved quality of services.
8.
If you are a child, I do consult with Dr. Byron Norton concerning therapy to ensure quality of services.
9.
Please inform me of any upcoming court hearings and/or court reports needed that you are aware of presently, or
as you become aware.
10.
If you are a minor, then please inform me of who has custody of you, and if your parents are separated or
divorced then whether one of your parents has sole custody or if there is joint custody.
11.
If you have any questions or would like additional information, please feel free to ask.
I hereby acknowledge that I have received the Notice of Privacy Rights from my therapist. I have read
the preceding information and understand my rights as a client.
____________________________
Client and/or Guardian Signature
_____________________
Date
____________________________
Therapist Signature
_____________________
Date
Updated 3/07
STATEMENT OF THERAPEUTIC ORIENTATION
ECLECTIC STYLE
SUE E. COFFEY
Licensed Clinical Social Worker
Master of Social Work; Master of Science, Psychology
Registered Play Therapist-Supervisor
I have over seventeen years of experience working with children, adolescents, and women. The
majority of my experience has occurred after attending graduate school, however I did hold direct-care
positions beginning in 1990 in human service agencies. These direct-care positions add to my frame
of reference and assist me in viewing a problem for a client. I draw from therapeutic approaches that
are relationship-based because I believe that the relationship between the person and clinician is
important in addressing any concerns. Some of the approaches that I draw from are experientialmetaphorical, cognitive-behavioral, family systems, integrative solution-focused, object relations, and
psychoanalytic. I believe that people possess the strengths and abilities to resolve difficulties in their
lives and often need someone to assist them, as well as someone to believe that he or she possesses
these strengths and abilities. I earned my Master’s of Social Work in 1993 and my Master’s of
Science in Psychology in 1999. This unique combination of diverse experiences with multi-cultural
groups of people from varying stages in life permits me to view and think of situations and
circumstances in a variety of ways, as well as assist people in accessing resources.
I assess what is occurring for the client prior to choosing a technique or intervention. I tend to pull
from several approaches due to the needs of each client varying and having uniqueness. I have
attended a variety of educational classes encompassing psychoanalytic, object relations, experiential,
and cognitive-behavioral theory and practice through both the graduate and doctoral schools I have
attended, as well as my attendance at continuing education workshops. In my being educated and
supervised by trained clinicians in a variety of approaches, I have developed my abilities to use what
works with the client not what works best for me.
I also search for clients’ resources and strengths to facilitate change. I focus upon clarifying what is
occurring presently so as to have a clear understanding of the presenting concern, then look to discuss
solutions to the problem(s) and the present situation or circumstances. I help clients recognize how to
use their own resources to deal more effectively with their problems, as well as assist the client(s) in
focusing upon the exceptions to the problem, to find times that they are doing well, and then to do
more of this “solution” behavior. Focusing on strengths may result in clients feeling more hopeful and
may also result in changes occurring more quickly. The client is encouraged to do more of what
healthy behavior works (strengths) for them and less of what doesn’t work (unhealthy behavior). The
approach tends to be brief and focused upon what led the client(s) to enter therapy.
I continue to attend educational workshops that encompass treatment for children and adults that are
victims of abuse to assist in the resolution of the traumatic experience(s), grief & loss issues, substance
abuse recovery, anger management, relationship enhancement, and parenting issues. I currently hold
the designation of Registered Play Therapist-Supervisor.
P.O. BOX 784, LITTLETON, CO 80160
303.794.7008