Professional Disclosure Statement, Disclaimer & Privacy
Professional Disclosure Statement
Welcome
By deciding to seek out counseling to understand and correct areas of concern in your life, you have taken the first step on your journey towards a healthier, more fulfilling life. Therapy is not an exact science and I can make no guarantees about your outcome. I will, however, provide you with tools and insights that you may utilize to help you set goals and plan strategies that will assist you in reaching your desired emotional, relational, mental and physical destinations.
My Educational and Professional Counseling Experience
My name is Angela Sullivan and I am licensed by the State of Missouri as a Licensed Professional Counselor. I am also certified by the State of Missouri with the highest level of Substance Abuse Counseling, Certified Reciprocal Advanced Alcohol and Drug Counselor (CRAADC). I am also a certified Mediator in the State of Missouri. I received my baccalaureate degree in Psychology from Wichita State University in Wichita, Kansas. I then earned my Masters in Counseling and Guidance from the University of Missouri in Kansas City with an emphasis in Marriage and Family Counseling. I received my certification as a Mediator in Missouri in August 2014.
Ethics
I adhere to the American Counseling Associations Code of Ethics and the Code of State Regulations & Law- Chapter 337.500-337.540, as set forth by the Missouri State Legislature. I also adhere to the Missouri Substance Abuse Counselors Certification Board Code of Ethics and the Mediation Ethics for the State of Missouri.
Types of Therapy Offered
I work with individuals, couples and families who are looking for insight and help in dealing with the life challenges they face. Some of the issues addressed are: stress, anxiety, depression, family and relationship issues, weight/body image, career/education, marriage, substance abuse, divorce recovery, co-parenting, mediation, eating disorders, and spirituality just to name a few. The client-therapist relationship is a very intimate one, in that the client shares very personal information with the therapist. This can often lead to somewhat conflicting feelings, for the client. Therefore, to ensure that the client receives the maximum benefit from the therapy certain boundaries must be established. In order to maintain proper perspective and to avoid any perception of impropriety, it is important to remember that the therapist is here to be your health-care provider, not your friend. This does not mean that you may not like each other; it means that the relationship must stay on a professional level. While your thoughtfulness is always appreciated, gift giving should be avoided. Bartering is not an accepted method of payment for professional services in this region; therefore, payment must be made by the means discussed in the “Fees” section of the Practice Policies Heading. I would also like to address how meetings in public, such as in a store or at a community event will be handled. Because the nature of our relationship is confidential, should I see you out in public, I will not approach you. You are, however, free to acknowledge or speak to me and I will gladly greet you back. I will not make any reference to how we know each other. You may choose to or not to disclose to anyone else present the nature of our acquaintance.
Benefits and Risks of Therapy
Anytime you seek therapy to work with the difficulties in yourself or your relationships there are benefits and risks involved. The benefits can include the ability to handle or cope with your specific concerns and/or your interpersonal relationships in a healthier way. You may also gain a greater understanding of personal, interpersonal, and/or family goals and values. This understanding may lead the way to greater maturity and happiness as an individual, couple, or as a family. There may also be other benefits that come as you work at resolving your specific concerns.
Therapy can also be challenging and uncomfortable at times. Remembering and resolving an unpleasant event or relationship may cause intense feelings of fear, anger, depression and frustration. As you work to resolve personal issues or issues between family members, marital partners and/or other persons, you may experience discomfort and an increase in conflict. There may be changes in your relationships you had not originally intended.
I will discuss with you the benefits and risks involved in your particular situation as we go through the therapeutic process. I encourage you to discuss with me any concerns you may have as you progress.
Grievances
If at any time you are unhappy with the services that I am providing you, please feel free to discuss this with me, so that we might resolve the situation. If after this, you are still not pleased, we will discuss how to resolve and/or terminate services.
Practice Polices
Fees
Counseling services and Mediation services are to be paid at the time of service.
Employee Assistance Programs are 45 minutes in length. Insurance sessions are 45-60 minutes in length. Private Pay/Out-of-Pocket sessions are 60 minutes in length and the sliding fee scale is listed below. Unless prior arrangements have been made, you are personally responsible for your account and are expected to pay for services at the time of your appointment. I have packages for those that are Private Pay. The packages may be of financial benefit to you. All payments are to be made at time of service. Payment methods accepted are: cash, credit card or debit card. I no longer take checks. Please call if you cannot make your appointment or your credit card will be charged a $60 fee if 24 hours’ notice is not given. If after three missed appointments or late cancellations (less than 24 hours’ notice) I may choose to close your case. It is my responsibility to provide you with appropriate therapeutic services and resources. Your responsibility is to make the most of these services and to pay for them. In the unlikely event that you do not pay for services in accordance with our payment agreement, your account may incur late fees and/or be turned over to a collection agency or legal firm for collection. Any associated fees would be your responsibility.
Phone Contact
There may be times when you may need to contact me by phone to give me an update or ask a question. This is fine; however, these conversations need to be kept brief, so as not to interfere with the schedule of other clients or cross the boundary into “phone counseling”. Phone and/or FaceTime counseling may be used in times of a Pandemic and you may still be billed for these services. Please know that if you have information you need to share, you may write, endlessly, to my email. I will let you know I received it and will review it before your next session. I will not be writing a lengthy email back in response; however, we will discuss your email in the next session. You may leave messages on my voice mail 24 hours a day, 7 days a week at no charge. I will get back to you by the next business day. You may also text me at 816-229-2760 to confirm, make or change your appointment time. Please only text regarding setting up and confirming appointments and who may be attending.
Internet/ E-mail/Facebook/etc
Remember this is a professional relationship. I am unable to add you as a friend on Twitter, Facebook, etc. due to the Therapist/Client relationship and due to The Association of American Counselors Ethics Regulations.
Now using Zoom for those that prefer Counseling, Mediation, Co-Parenting through this method. I have purchased a Zoom product that is encrypted and password protected to ensure confidentiality.
Other Services Rendered
In the event that I am requested to write a report, consult with another professional. (i.e. school staff, Children’s Division, GAL, lawyer or other legal representation), or similar activity, including phone and email conversations with you or another professional, I will charge $200 per hour. If I am asked to testify at court, I require a $1,000 payment per day as I will have to reschedule clients for the day in court and will have to take time to prep for testimony. Insurance does not pay for this type of service. There will also be a charge for duplication of records. You will receive a statement with such charges fully outlined.
If you need an invoice for services rendered in the past there may be a charge, especially if there have been several sessions it can become very time consuming for me. If you need to keep track of past appointment dates, charges, etc. I would suggest keeping a calendar or log.
Confidentiality
The law protects the privacy of all communications between client and healthcare provider. I can only release information about your treatment to others if you sign a written authorization form that meets certain legal requirements imposed by HIPPA and state law.
Emergencies
If you have a life-threatening emergency, including feeling like hurting yourself or others, call 911 or go to the closest hospital emergency room, then call me. You may call me at 816-229-2760, 24 hours a day, and 7 days a week. I will return your call as soon as possible in the case of an emergency. If it is not life-threatening, I will return your call the next business day.
Termination
As we work together, we will set goals, which you wish to accomplish through our work together. We will track your progress and when your goals have been achieved, we will discuss the termination of your therapy. Also, in the event that our work together does not seem productive, it is likely that I may recommend a referral to another therapist. In either case, we will review the therapeutic process that you have gone through and end our sessions in a manner that is healthy for you. You are under no obligation to see me for a specific number of sessions. You are free to terminate at any time. However, I do request that you give me at least one session notice before termination. This will allow us to properly wrap up our work together and avoid a situation that might be therapeutically unhealthy for you. If you have any questions from what you have read on this form please feel free to ask me to clarify. Thank-you for choosing me as your counselor and I am looking forward to working with you!
Other Important Disclosures and Notices
The information at this site is subject to change without notice. Although we try to keep our site current and accurate, you should not rely on this information or its applicability to any specific circumstances without first speaking with a doctor. Changes Counseling and Mediation cannot promise that the information on this site is applicable to your circumstances, correct, complete, and up-to-date, that your access will be uninterrupted, or that material accessible from this site is free of viruses.
Changes Counseling and Mediation does not intend links to be referrals to, or endorsements of, the linked entities or information that they make available. Changes Counseling and Mediation will remove any link from this site upon request from the linked entity. This site is not sponsored or associated with any particular linked entity unless so stated in truth by that entity.
Privacy Policy Statement
Changes Counseling and Mediation has adopted the following privacy policy statement applicable to our web site.
Changes Counseling and Mediation does not currently collect personal identifying information (the "Information") through our web site except:
- for Information that your Internet service provider automatically provides to our web server, such as its web site address and possibly your e-mail address,
- for Information that you send to us in an e-mail message, and
- for Information that you submit to us in a CGI form (for example, when you submit a search request on our web page).
E-mail sent to us may not be secure. If you choose to send us an e-mail message, we may retain the content of the e-mail, your e-mail address and our response, and it becomes the property of Changes Counseling and Mediation.
Changes Counseling and Mediation will use Information for our own proper purposes, but we will not sell Information to third parties.
We encourage you to review the Changes Counseling and Mediation Privacy Policy Statement periodically for updates that will be posted on our web site.