Clinician Disclosure & Policy Statement

  • Colorado State Law requires me to provide you with the following information: Credentials: Doctor of Ministry in Pastoral Therapy, Graduate Theological foundation, 2014; Master of Social Work, University of Minnesota, 1988; BA, College of St. Catherine, 1981, Theology. My license number is 989689. Colorado Department of Regulatory Agencies regulates the practice of licensed and unlicensed psychotherapists, including clinical social workers. If you have a complaint we cannot resolve, you may contact the Grievance Board, 1560 Broadway, Suite 1340, Denver, CO 80202.

    I am required to distinguish for you, the different types of mental health providers regulated by the State: Licensed Clinical Psychologists have 4 years of post-college training in therapy, testing, and assessment; Licensed Marriage & Family Therapists have 2 year post-college Masters degrees in counseling families; Licensed Professional Counselors have two-year post-college Masters degrees in counseling or psychology; Licensed Clinical Social Workers have two-year post-college masters degrees in counseling and mental health based on understanding how systems in family and society affect well being, including 18 months of clinical training in counseling settings. Unregistered therapists are persons who may have no formal training or have a degree in any of these fields but have not passed licensing exams or accrued clinical hours of experience. I hold a Masters degree in Social Work (MSW) and am a Licensed Clinical Social Worker. My additional training is in psychiatric social work, interfaith pastoral psychotherapy and spiritual direction.

    Client Rights: You are entitled to information about my methods/techniques of therapy, anticipated length of therapy and fee structure. You can seek a second opinion or end therapy at any time. In a professional relationship such as ours, sexual intimacy between therapist and client is never appropriate and should be reported to the Grievance Board. Information you tell me is private and legally confidential, generally speaking. I cannot be forced to release your information without your consent, including in a court of law. There are exceptions to confidentiality, such as in a life-threatening emergency when my clinical judgment deems it essential for your or another’s safety. I will explain exceptions if they arise. See Colorado Statute section 12-43-218, C.R.S. for more information.

    Client Responsibilities: Payment of fees is expected at each session, cash or check only. My fee for one hour is $125, unless we have made other arrangements. I charge $75 for cancellations less than 24 hours before an appointment unless you are ill or have an emergency. I charge my hourly fee on a prorated basis for court or other appearances on your behalf, for preparation of documents you request, and for lengthy phone therapy.

    In an emergency: Call 911 or go to your nearest emergency department if you are in danger of death or injury. In other urgent matters, call me and leave your name and phone number. Allow an hour or longer for me to get back to you. If I will be on vacation, my phone greeting will name a back-up therapist you may call.

    Please sign below that you have received and agree to abide by my practice policy (if reading this online, you will be asked to bring a signed copy or sign one when we meet). Parents’/Guardians’ signature also required.
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