My Degrees and Credentials: Michigan State University, BS 1980; Lesley College Graduate School, M.A. 1991; Colorado Licensed Professional Counselor, 1991, License #724
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, license school psychologists practicing outside the school setting, and unlicensed individuals who practice psychotherapy. All questions and/or complaints should be addressed to: Department of Regulatory Agencies, Mental Health Section, State Board of Licensed Professional Counselor Examiners, 1560 Broadway, Suite 1350, Denver, Colorado 80202, Phone: (303) 894-7800; Fax: 303-894-7764; Web: https://www.colorado.gov/pacific/dora/Professional Counselor Email: firstname.lastname@example.org
CLIENTS RIGHTS AND IMPORTANT INFORMATION
a. As to the regulatory requirements applicable to mental health professionals: a Licensed Clinical Social Worker, a Licensed Marriage and Family Therapist, and a Licensed Professional Counselor must hold a master’s 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 must hold a master’s 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 (CACI) 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 CAC ill must have a bachelor’s degree in behavioral health, and complete additional required training hours and 2,000 hours of supervised experience. A Licensed Addiction Counselor must have a clinical master’s degree and meet the CAC !!! 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.
b. 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 (see attached fee schedule). Please ask if you have any questions about my methods, techniques, or duration of therapy or my fee structure.
c. You can seek a second opinion from another therapist or terminate therapy at any time.
d. In a professional relationship, sexual intimacy between a therapist and a client is never appropriate. It is a crime as well as a regulatory wrong in Colorado. If sexual intimacy occurs, it should be reported to the Department of Regulatory Agencies, Mental Health Section, State Board of Licensed Professional Counselor Examiners.1560 Broadway, Suite 1350, Denver, Colorado 80202, Phone: (303) 894-7800; Fax: 303-894-7764; Email: email@example.com and / or your local law enforcement agency.
The information provided by and to you as the client during the therapy sessions is legally confidential. If the Information is legally confidential, I cannot be forced to disclose any of your information without your consent. Information disclosed to me is a privileged communication and cannot be disclosed in any court of competent jurisdiction in the State of Colorado without the consent of the person to whom the testimony sought relates.
There are exceptions to the general rule of legal confidentiality. These exceptions are listed in the Colorado statutes (C.R.S. 512-43-218). I will identify these exceptions to you as situations arise during treatment, or in our professional relationship. You should be aware that provisions concerning disclosure of confidential communications shall not apply to any delinquency or criminal proceedings, except as provided in C.R.S. $ 13-90-107. Confidentiality may also be waived in the event of physical abuse and/or neglect of a child, including any past or present sexual contact with a minor. All therapists are required by law to report such instances to the Department of Social Services and / or law enforcement. Additionally, in the event of imminent danger to yourself or another person, I am required by law, to protect you, which may result in you being hospitalized, and I have a duty to warn anyone who may be in imminent danger as a result of your threats or frame of mind.
I maintain treatment records for 7 years after the date of last treatment. After the 7-year period your records may no longer be available and will likely be shredded or destroyed. Upon executing an appropriate authorization for release, you may receive a copy of your records, have them forwarded to another provider, or I can prepare a summary for you instead. Because these are professional records recommend that you review them in my presence so that we may discuss the contents. Psychotherapy notes, as defined at 45 CFR 5164.501, are my personal, professional notes, and I do not provide copies of my psychotherapy notes.
If you have any questions or would like additional information, please feel free to ask. I have read the preceding information and understand my rights as a patient/client.