Professional Disclosure Statement. Nedra Glover Tawwab, MSW, LCSW

Transcription

1 Professional Disclosure Statement Nedra Glover Tawwab, MSW, LCSW My Background I am a clinical social worker. I am trained and experienced in doing individual, family, and couples counseling. Earlier in my career, I worked at a youth shelter where I counseled runaway youth and their families. Additionally, In the past I provided counseling to children and their parents involved in the foster care system. Licensed Clinical Social Worker since 2009 in NC (Licensed in MI )- License #C Education Master of Social Work, Wayne State University 2007 CertiNicate in Marriage and Family Therapy B.A. Sociology and Africana Studies, Wayne State University 2005 Counseling Experience Areas Relationship Issues, Anxiety or Fears, Borderline Personality, Chronic Impulsivity, Chronic Pain or Illness, Depression, Emotional Disturbance, Entitlement, Loss or Grief, Self Esteem, Trauma and PTSD Counseling Practice and Philosophy I strongly believe you should feel comfortable with the therapist you choose, and hopeful about the therapy. When you feel this way, therapy is more likely to be very helpful to you. Let me describe how I see therapy. My therapeutic style is primarily based on cognitive- behavioral and positive therapeutic approaches. I utilize a holistic approach to therapy that considers the impact of the systems in which an individual/family functions. My holistic style includes teaching how mind, body, and spirit connectedness is key to overall change and positive living. Additionally, I employ an eclectic approach that encompasses multiple theoretic models to accommodate the individual needs of clients. We give meaning to our beliefs, which in turn innluence our feelings and behaviors. Beliefs are formed from our life experiences both positive and negative. We often feel that our emotions are controlled by others. This is not true, we possess the power to control our thoughts, change our feelings and ultimately modify destructive behaviors and patterns. We learn most of what we know from our family of origin. At times in the therapy process, it is important to know how your family of origin has an impact on you. The goals of my treatment are helping you lower emotional turmoil, symptom reduction, and/or reframing the presenting problem. I will work in collaboration with your primary care provider or psychiatrist, if you are using psychotropic medications. I will provide psychoeducation to you regarding any mental health diagnosis you receive. I usually take notes during our meetings. You may Nind it useful to take your own notes, and also to take notes outside the ofnice. I expect us to plan our work together. In our treatment plan we will list 1

2 the areas to work on, our goals, and the methods we will use. From time to time, we will look together at our progress and goals. If we think we need to, we can change our treatment plan, its goals, or treatment methods. An important part of your therapy will be practicing new skills that you will learn in our sessions. I will ask you to practice outside our meetings, and will set up homework assignments for you to facilitate growth. I may ask you to do exercises, keep records, and read to deepen your learning. You will have to work on relationships in your life and make long- term efforts to get the best results. These are important parts of your personal change. Change is sometimes quick and easy, but more often is it slow and frustrating. You will need to work through your frustration in therapy, as there are no painless cures. You can learn new ways of looking at your problems that will be very helpful for changing your feelings and reactions. The BeneGits and Risk of Therapy As with any powerful treatment, there are some risks as well as many benenits with therapy. You should think about both the benenits and risks when making any treatment decisions. For example, in therapy, there is a risk that the client will, for a time, have uncomfortable levels of sadness, guilt, anxiety, anger, frustration, or other negative feelings. Clients may recall unpleasant memories. These feelings or memories may bother a client at work, home, or school. Additionally, clients in therapy may have problems with people important to them. Family secrets may be told. Sometimes, a client s problems may temporarily worsen after the beginning of treatment. Most of these risk are to be expected when people are making important changes in their lives. While you consider these risks, you should know also that the benenits of therapy have been shown by scientists in hundreds of well- designed research studies. People who are depressed may Nind their mood lifting. Others may no longer feel afraid, angry, or anxious. In therapy, people have a chance to talk things out fully until their feelings are relieved or the problems are resolved. Clients relationships and coping skills may improve greatly. They may get more satisfaction out of social and family relationships. Their personal goals and values may become clearer. They may grow in many directions- - as persons, in their close relationships, in their work and in the ability to enjoy their lives. I do not take on clients I do not think I can help. Therefore, I will enter our relationship with optimism about our progress. Consultations If you could benenit from a treatment I cannot provide, I will help you to get it. You have a right to ask me about such other treatments, their risks, and their benenits. Based on what I learn about your problems, I may recommend a nutritional evaluation, medical exam, credit counseling, use of medication, or some other service that may be benenicial. If I do this, I will fully discuss my reasons with you, so that you can decide what is best. If you are treated by another professional, I will coordinate my services with them. If for some reason treatment is not going well, I might suggest you see another therapist or another professional for an evaluation. As a responsible person and ethical therapist, I cannot continue to treat you if my treatment is not working for you. If you wish for another professional s opinion at any time, or wish to talk with another therapist, I will help you Nind a qualinied person and will provide him or her with the information needed. What to Expect From Our Relationship As a professional, I will use my best knowledge and skills to help you. This includes following the standards of the National Association of Social Workers(NASW). In your best interest, the NASW puts limits on the relationship between a therapist and a client, and I will abide by these. Let me explain these limits, so you will not think they are responses to you. 2

3 First, I am licensed and trained to practice clinical social work- - not law, medicine Ninance, or any other profession. Therefore, I am not able to give good advice on other professions. Second, state laws and the rules of NASW require me to keep what you tell me connidential. You can trust me not to tell anyone else what you tell me, except in certain situations. I explain what those situations are in the connidentiality section of this document. If we meet on the street or socially, I may not say hello or talk to you very much. My behavior will not be a personal reaction to you, but a way to maintain the connidentially in our relationship. Third, in your best interest, and following the NASW s standards, I cannot engage in dual relationships. I cannot have any other role in your life. I cannot, now or ever, be a close friend to or socialize with any of my clients. I cannot be a therapist to someone who is already a friend. I can never have a sexual or romantic relationship with any client during, or after, the course of therapy. I cannot have a business relationship with any of my clients, other than the therapy relationship. If you ever become involved in a divorce or custody dispute, I want you to understand and agree that I will not provide evaluations or expert testimony in court. You should hire a different mental health professional for any evaluations or testimony you require. This position is based on two reasons: (1) My statements will be seen as biased in your favor because we have a therapy relationship; and (2) the testimony might affect our therapy relationship, and I must put this relationship Nirst. Professional Memberships National Association of Social Workers Counseling Fees The cost for the intake/initial session is $110. I agree to provide counseling services in return for the fee stated below per session. If your insurance company is billed he insurance company may reimburse at a different rate then the billed amount. This would not release you from your Ninancial responsibility. The number of sessions and how often you come will be based on your needs. Payment or co- payment for each session is collected prior to the beginning of each session. You will be charged $30.00 for missed appointments unless you cancel within 24 hour notice. Appointments can be canceled via or phone. Credit card, debit, cash or personal checks are acceptable methods of payment and I will provide a receipt for all fees paid. A fee of $35.00 will be charged for bounced checks. A sliding fee scale is available upon request and is based on household income level. Individual Family/Couple 50 minutes $80 $90 75 minutes $100 $110 ConGidentiality I will protect the connidentiality of information discussed in our counseling sessions as specinied by federal and state laws, written policies and ethical standards. For any of the following reasons, legally and ethically, I may violate our agreement of connidentially: 1. If mandated by a court of law; 2. if disclosure is required to prevent clear and imminent danger to yourself and/or others : 3. if I am made aware of the potential or actual occurrence(s) of physical/sexual abuse of minors, persons with disabilities or senior citizens; 3

4 Billing and Insurance Health insurance companies require that a mental health diagnosis be made to bill insurance. The mental health diagnosis will become a part of your permanent medical record. See handout on managed care. Professional Records Both law and the standards of my profession require me to keep appropriate records. You are entitled to receive a copy of the record, but if you wish, I can prepare an appropriate summary instead. An exception to this record keeping law is that I am entitled to withhold records if I believe that seeing them would be emotionally damaging to you. Due to the content, these professional records, may be misinterpreted and/or may be upsetting to a lay reader. If you wish to see your records, I recommend that you review them in my presence so that we can discuss the contents. I am required to maintain records for 7 years. Records should be requested 72 hours in advance. Clients are responsible for paying fees associated with copying records. Consent for Evaluation and/or Treatment: The decision to begin counseling is one which may have important consequences for the rest of your life. It is generally believed that when individuals enter this type of treatment with a good understanding of what they are about to undertake, they are likely to achieve more favorable results. Your Rights as a Client You have the right to refuse or discontinue counseling and the right to choose a therapist and treatment modality which best suits your needs. If you decide to discontinue counseling, I will make appropriate attempts to refer you to a therapist who may be a more appropriate Nit.. Emergencies If you feel you are a danger to yourself or to someone else, please contact the nearest emergency room, or call 911. During business hours, contact the ofnice, If I am unavailable, please call 911 or to go to the nearest emergency room. Closure and Termination At the beginning of each session, we can always discuss how your therapy is progressing. At some point, all therapy will probably come to an end. I will make every attempt to make this a smooth transition for you. This will include prepping you for that moment when our relationship will change. This may happen when you have achieved the goals that we have established in therapy or if you or I felt that therapy is causing you more harm than good or for any number of unforeseeable circumstances. When this occurs and if therapy is believed to be in your best interest, I will make every attempt to refer you a therapist that can better meet your needs. You will also have that option of terminating therapy as you will also. Ethical Standards I subscribe to the code of ethics of the National Association of Social Workers National Association of Social Workers 750 First Street, N.E. Washington, DC

5 Kaleidoscope Counseling Social Media Policy The following statements outlines my ofnice polices related to the use of social media. Friending I do not accept friend request from current or former clients on any social media sites such as Facebook or Linkin In. Friending clients as friends compromises connidently and treatment boundaries. Following I do not follow former or current clients on any social media sites such as Twitter or Pinterest. I am concerned with your privacy, therefore following would compromise your connidentially. Use of Search Engines Under normal circumstances, I do not use search engines or facebook for to search for clients. In cases of emergency, if I suspect you are in danger and cannot contact via the contact information you provided, I might use a search engine to locate your contact information or someone close to you. I use for arranging and modifying appointments. Please do not me content related to your therapy sessions, as is not completely secure and connidential. Also, s that I receive from you and any responses I send become a part of your legal record. Consumer Review Sites My practice information may show up on various websites. The is not a recommended way to critique my services, as it opens you up to violations of connidentiality. If you have any questions about the Social Media Policy please don t hesitate to ask. Thank you for reviewing and adhering to the social media policy. By your signature below, you are indicating that you have read and understand this statement, and that any questions you have abut this statement have been answered to your satisfaction. Please sign both copies of this form and the HIPAA information form. Your signature indicates agreement and compliance with the aforementioned conditions and receiving client rights information. Client Witness Name Name Signature Signature Date Date 5