Patrick Jeffs, PhD
1506 E Franklin St. Suite 203
Chapel Hill, NC 27514
Professional Disclosure Statement
I am pleased that you have selected me as your counselor. This document is designed to inform you
of my background and to ensure that you understand our professional relationship.
Please sign this form after you have read it.
Education / Training
Doctorate of Philosophy (Counseling and Supervision), UNC Charlotte
Master of Arts (Community Counseling), Western Michigan University
Graduate Certificate in Alcohol and Drug Abuse, Western Michigan University
Bachelor of Arts (Business Mgmt), Minor in Psychology, Michigan Technological University
2013
2008
2008
2006
Credentials and Licensure
I currently hold LPC license, Licensed Professional Counselor.
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Experience
I have about five years of supervised counseling and counseling-related experience during
and after my Master’s degree in Community Counseling from Western Michigan. I have also
completed my PhD work and practice in counseling and supervision of counselors at UNC Charlotte.
Approach to Counseling
I have special interest in working with clients on the following issues: substance abuse,
depression, stress, wellness, self-esteem, male psychology, stress-management and anxiety, and career
counseling as well as helping children and adolescents with personal adjustment and behavioral
problems.
My counseling approach is based on the Adlerian counseling model, focusing on the
collaborative nature created in counseling. This form of therapy is based on four principle exercises:
(1) Establish solid therapeutic relationship. Growth potential is increased when there is a focus on the
relationship first between counselor and clients before starting on issues of concern. We will talk
about goals and expectations of our working relationship. (2) Explore client’s story. It is important
for optimal personal growth for me to have a broad knowledge of many aspects of your life including
relationship interactions and value base. I encourage as much disclosure about ones lifestyle choices
to properly identify possible risks. (3) Encourage self-exploration and understanding motivations.
Recognizing self-awareness acts as an essential base for personal growth. We will focus on insight
regarding current issues and how they relate to clients intentions. (4) Reorientation. Lastly, together
we will discuss opportunities to make changes in your life to positively affect your life.
I focus on a positive, strength-based approach that takes into account the many forces and
factors that make us holistic individuals. I believe that living takes courage and often we need
assistance to re-focus our life’s direction and support through difficult times. I believe that human
nature is to survive and grow while striving for balance throughout. Motivation and momentum are
also potential benefits that counseling can create in clients.
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To make or cancel appointments
Call 919-525-4559 or email patrickjeffsphd@gmail.com
Sessions
Fees vary by the service you are receiving. Posted and customary fees are $130 for initial
assessments, $100 for individual session, and $130 for family/ couple sessions. Sessions are 50
minutes in length unless otherwise negotiated. I accept credit cards, cash, and checks that can be
made out to Patrick Jeffs. If you are unable to reschedule your appointment more than 24 hours in
advance, I do need to charge for that time. Cancelations made more than 24 hours in advance are
asked to reschedule within a month of that appointment time in order to avoid being charged for a
missed session fee of $100.
Records and Confidentiality
Federal law (42 Code of Federal Regulations, Part 2) prohibits me from telling anyone
outside of this facility that you are here for counseling and/or alcohol and drug treatment, with certain
exceptions. One exception is when a crime has been committed on the premises or against a member
of the staff. Other exceptions are explained below.
Most of our conversation in counseling sessions and the information revealed there is
completely confidential, but there are the following exceptions: (1) I am bound by law to report to
appropriate authorities if you appear to be a danger to yourself or to someone else, or if you disclose
that you have abused, neglected, or exploited a child or an elderly or disabled person. (2) I will
disclose information if I am forced by the court to do so, after appropriate protests have been
exhausted. (A subpoena and a court order are required.) (3) I will disclose information to others if you
request, in writing, that I do so. In all cases only the minimal amount of information necessary will be
disclosed.
In the case of family or group therapy, confidentiality cannot be assured because the group
members’ behavior cannot be controlled. However, clients will be discharged from the program if it is
clear that they have broken confidentiality.
Though we keep records, they are for our own use. We will release information if you sign a
release for us to share your information with someone in particular or an agency. Part of that record is
at least one diagnosis (substance dependence, for example). If you choose to release this information,
the diagnosis (or diagnoses) may negatively affect whether you can get health insurance, life
insurance, or some licenses. Any diagnosis made will become part of your permanent insurance
records.
Complaints
If you wish to file a complaint against me as a North Carolina licensed professional
counselor, you may do so by placing that complaint in writing and sending it to the NCBLPC at this
address: North Carolina Board of Licensed Professional Counselors, P.O. Box 1369, Garner, NC
27529. According to the American Counseling Association's Ethical Guidelines, you should attempt
to resolve your complaint with the counselor directly. If this is not successful, you may place your
concerns in writing, citing the ACA ethical codes you believe to have been broken, and submit along
with a completed NCBLPC Complaint Form to the board. (The ACA Code of Ethics, the Complaint
Form, and the complaint procedures are available at the following website: ncblpc.org ) The board
will assign your complaint a number so no names will be known to anyone but the board attorney,
administrator, and ethics chair. Once the complaint has been received, notification is sent to the
counselor against which the complaint was filed allowing him or her to respond to the alleged
charges. If necessary, the board will investigate the complaint and issue a ruling after gathering all
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necessary information. Investigations will not be made unless complaints are in writing and signed by
the complainant.
By signing below, you indicate that you have read and understood this statement. My
signature below indicates my commitment to these statements as well.
Client: _____________________________________________ Date___________
Counselor: __________________________________________ Date___________
_________________________________
Patrick Jeffs, PhD, LPC
__________________
Date
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