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Terms and Policy

LIMITS OF CONFIDENTIALITY
Contents of all therapy sessions are considered to be confidential. Both verbal information and written records about a client cannot be shared with another party without the written consent of the client or the client’s legal guardian. Noted exceptions are as follows:

Duty to Warn and Protect
When a client discloses intentions or a plan to harm another person, the mental health professional is required to warn the intended victim and report this information to legal authorities. In cases in which the client discloses or implies a plan for suicide, the health care professional is required to notify legal authorities and make reasonable attempts to notify the family of the client.

Abuse of Children and Vulnerable Adults
If a client states or suggests that he or she is abusing a child (or vulnerable adult) or has recently abused a child (or vulnerable adult), or a child (or vulnerable adult) is in danger of abuse, the mental health professional is required to report this information to the appropriate social service and/or legal authorities.

Prenatal Exposure to Controlled Substances
Mental Health care professionals are required to report admitted prenatal exposure to controlled substances that are potentially harmful.

Minors/Guardianship
Parents or legal guardians of non-emancipated minor clients have the right to access the clients’ records.

Insurance Providers (when applicable)
Insurance companies and other third-party payers are given information that they request regarding services to clients.
Information that may be requested includes, but is not limited to: types of service, dates/times of service, diagnosis, treatment plan, description of impairment, progress of therapy, case notes, and summaries.

I agree to the above limits of confidentiality and understand their meanings and ramifications.
( Type Full Name )
CANCELLATION POLICY
If you fail to cancel a scheduled appointment, we cannot use this time for another client and you will be billed for the entire cost of your missed appointment.

A full session fee is charged for missed appointments or cancellations with less than a 48-hour notice unless it is due to illness or an emergency. A bill will be mailed directly to all clients who do not show up for, or cancel an appointment.

Thank you for your consideration regarding this important matter.
( Type Full Name )
PROFESSIONAL DISCLOSURE STATEMENT
Philosophy and Approach:

I believe that therapy is a mutual effort between the individual members of a couple relationship and the therapist. My role is to aid couples in working towards their preferred future by identifying past successes, assessing current internal strengths, external resources, areas to be strengthened, and defining common goals.

The process begins with a thorough relationship assessment:
    
     80-minute Couples Intake Session
     Completing a online Relationship Checkup (based on over 40-years of couples research by the Gottman Institute)
     80-minute Individual Intake Session
     80-minute Feedback/Treatment Planing Session

The ultimate goal is to facilitate change that the couple can be excited about.

My approach is eclectic with a strong reliance on The Gottman Method of Couples Therapy, with solution-based and cognitive-behavior aspects. Together we will work towards a more gratifying way of communicating using a number of techniques including, but not limited to, Learn to be a Great Listener, 7-Weeks of Fondness an Admiration, 5-steps to repair after a regrettable incident or fight, how to self-sooth, developing rituals of connection, conflict resolution, genogram (family history), dialogue, writing, and some outside homework. I recognize and honor client's strengths, and believe that change can be facilitated.

Treating Trauma and Affairs:

If you have come to counseling to repair your relationship the intake and assessment process is as follows:
   
     80-minute Couples Intake Session
     Completing a online Relationship Checkup (based on over 40-years of couples research by the Gottman Institute)
     80-minute Individual Intake Session
     80-minute Feedback/Treatment Planing Session

When a couple is healing from an affair, betrayal or infidelity there are many steps to repair and rebuild the relationship. I will explain this process to you during your free 30-minute consultation. If you need more than the  30-minute consultation you will be responsible to pay for that time. ** See my rates below.

Formal Education and Training:
I have formal education in Early Childhood Development, Gerontology, and hold two Bachelor Degrees from the University of Oregon. My major course work was in the area the history of women and gender issues, human growth and development and advocacy. My Masters' (MA) degree is in Marriage, Couples and Family Therapy (MCFT) from George Fox University. My Major coursework includes, Principles & Techniques of Counseling, Psychopathology, Personality and Counseling Theory, Social and Cultural Foundations, Group Theory and Therapy, Professional Orientation, Play Therapy, Family Therapy, Advanced Couples Therapy, Advanced Family Therapy, Emotion Focused Therapy, Eating Disorders, Addiction and Sexual Orientation.

Post Graduate Education: Gottman Levels I, II, & III (Practicum) , Gottman's Bringing Baby Home Leader, Gottman's 7-Principles for Making Marriage Work, Gottman's Treating Affairs and Trauma, Gottman's Couples in Recovery, and I am currently enrolled in the Gottman Certification Track .

CONFIDENTIALITY:

In couples counseling the confidentiality situation is unique because in order to work together successfully must be honesty and trust. At the start of our treatment, we must all have a clear understanding of our purposes and my role then we can be clear about any limits on confidentiality that may exist.

In couples counseling, I have a  "no secrets" policy and will not keep secrets. If you tell me something your spouse or partner does not know, and not knowing this could harm him or her or your relationship, I cannot promise to keep it confidential. Please only tell me what you feel comfortable with your partner knowing. If you have something difficult to share with your partner I will work with you to decide on the best long-term way to handle situations like this.

If you and your spouse have a custody dispute, or a court custody hearing is coming up, I will need to know about it. My professional ethics prevent me from doing both therapy and custody evaluations, so I choose to not do custody evaluations, and will refer you to a different counselor if you need this service.

If you are seeing me for couples counseling, you must agree at the start of treatment that if you eventually decide to divorce, you will not request my testimony for either side. The court, however, may order me to testify and you will be responsible to pay my hourly couples rate plus travel time for each hour I am ordered to appear in court, even if they do not call me up to testify.

At the start of therapy each person in the couple relationship must sign that they have read and understand
the Limits of Confidentiality, HIPPA, and my Cancellation Policy forms for the common record I create in the therapy or therapies. And, finally, all participants in couples therapy must not disclose any knowledge gained during the course of therapy without the consent of the person to whom the knowledge relates.

CONFIDENTIALITY in GROUP THERAPY

In group therapy, the other members of the group are not therapists. They do not have the same ethics and laws that I have to work under. You cannot be certain that they will always keep what you say in the group confidential. However, if you are a participant in group therapy, you must NOT disclose any knowledge gained during the course of therapy without the consent of the person to whom the knowledge relates.

Associations:
National Board of Certified Counselors (NBCC) and abide by its code of ethics.

I am registered with the (OBLPCT) License: C5272 Oregon Board of Licensed Professional Counselors and
Therapists, and I abide by its Code of Ethics.

Fees:

Free: 30-minute consult face-to-face after completing forms via CounSol.com
      
        $130.00 - 50-minute individual session
        $160.00 - 80-minute individual session
        $160.00 - 80-minute couples session
           $2.00  - for each minute over the allotted session time.

Couples 4-Step Intake Package (see below) $800.00 if paid in full at first 80-minute Couples Session. This is discounted by $40.00

COUPLES 4-STEP INTAKE PROCESS INCLUDES:
      Step 1: Couples 80-minute intake session
      Step 2: Relationship Assessment completed online individually ( and my time to read through the results and create a treatment plan)
      Step 3: Individual 80-minute sessions
      Step 4: Feedback/Treatment Planning Session 80-minute session


I offer occasional marathon  sessions (extended 2-3 hour sessions) costs vary depending on length of these sessions and will be discussed at the time they are scheduled.

I offer a limited number of sliding scale fees, which I will be happy to discuss with you during the free 30-minute consultation.

Group TBD (To be determined depending on group and time commitment)


Bill of Rights:
As a client of an Oregon Registered Intern you have the following rights as established by the Oregon State Board of Licensed Professional Counselor and Therapists (OAR833-60-001)
- To expect that a licensee has met the minimal qualifications of training and experience required by state law
- To examine public records maintained by the Board and to have the Board confirm the credentials of the licensee
- To obtain a copy of the Code of Ethics
- To report complaints to the Board
- To be informed of the cost of professional services before receiving services
- To be assured of privacy and confidentiality while receiving services defined by the law, including the following exceptions:
1) Reporting suspected child abuse
2) Reporting imminent danger to the client or others
3) Reporting information required in court proceedings or by the client's insurance company, or other relevant agencies
4) Providing information concerning licensee case consultation or supervision

Defending claims brought by client against licensee
- To be free from discrimination on the basis or race, religion, gender, sexual orientation, marital status, socioeconomic status, or other unlawful category while receiving services.

You may contact the Oregon Board of Licensed Professional Counselors and Therapists
at: 3218 Pringle Rd SE Suite 120, Salem, OR 97302-6312. Telephone: (503) 378-5499,
Email: lpct.board@state.com Website:www.oregon.gov/OBLPCT
( Type Full Name )
HIPAA Notice of Privacy Practices
Revised April 7, 2016
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.

By law Westlake Counseling ~ J.Ilana Bradford Counseling is required to protect the privacy of your personal health information. Westlake Counseling /J.Ilana Bradford Counseling is also required to give you this notice to tell you how Westlake Counseling /J.Ilana Bradford Counseling may use and give our ("disclose" or "release") your personal health information held by the J.Ilana Bradford Counseling / Westlake Counseling.

"Personal health information" includes an record of service you received at Westlake Counseling /J.Ilana Bradford Counseling, including and limited to:

*Dates, times and lengths of your counseling sessions;
*Information you shared during counseling sessions or at other times
*Your counselor's observations of you;
*Results of psychological tests and diagnostic interviews;
*Treatment plans and homework suggestions;
*Billing and insurance information

Most of your personal health information is in written form. Information about you that is not written down but is remembered by Westlake Counseling /J.Ilana Bradford Counseling is also considered as part of your personal health information, and is protected by law the same way written information is protected. Information that cannot be traced back to you is not considered part of your personal health information. Examples include:

*Information about an experience you had that many people also had, and
*Information that is changed or made vague so that you cannot be associated with it.
*J.Ilana Bradford Counseling / Westlake Counseling must use and give out your personal health information to provide information:
*To you or someone who has the legal right to act for you (your personal representative),
*To the Secretary of the Department of Health and Human Services, when the degree to which your privacy is protected is being examined,
*Where required by law.

Westlake Counseling /J.Ilana Bradford Counseling has the right to use and give out personal health information to be paid for services provided to you, and to operate Westlake Counseling /J.Ilana Bradford Counseling. For example:

*Insurance companies may ask for your personal health information as a condition for paying for services you received at Westlake Counseling / J.Ilana Bradford Counseling.
*If your account is referred to a collection agency, the collection agency may ask for parts of your personal health information relevant to their task, such as dates of sessions.
* Westlake Counseling /J.Ilana Bradford Counseling may use your personal information to make sure you and other clients get quality care, to provide customer services to you, to resolve any complaints you have, or to contact you about research studies.

Westlake Counseling /J.Ilana Bradford Counseling may use or give out your personal health information for the following purposes under limited circumstances:

*To State and Federal agencies that have the legal right to obtain such information (such as a licensing board investigating and ethics complaint)
*For public health activities (such as reporting disease outbreaks)
*For government health care oversight activities (such as insurance fraud investigations)
*For judicial and administrative proceedings (such as in response to a court order),
*For law enforcement purposes (such as providing limited information to locate a missing person),
*For research studies that meet all privacy law requirements (such as research on effectiveness of a a counseling technique),
*To avoid a serious and imminent threat to health or safety,
*For the purpose of supervision, consultation, and training, and
*To create a collection of information that can no longer be tracked to you.

By law, Westlake Counseling /J.Ilana Bradford Counseling must have your written permission (an "authorization") to use or give out your personal health information for any purpose that isn't set out in this notice, such as a marketing or sale of your personal health information. You may take back ("revoke") you written permission at any time, except if Westlake Counseling /J.Ilana Bradford Counseling has already acted based on your permission.

By law, you have the right to:

*See and get a copy for your personal health information held by Westlake Counseling /J.Ilana Bradford Counseling:
*Have your personal health information amended if you believe that it is wrong or if information is missing, and Westlake Counseling /J.Ilana Bradford Counseling agrees. If Westlake Counseling /J.Ilana Bradford Counseling disagrees, you may have a statement of your disagreement added to your personal health information.
*Get a listing of those getting your personal health information from Westlake Counseling /J.Ilana Bradford Counseling. The listing won't cover your personal health information that was given to you or your personal representative, that was given out to be paid for the services you received or for operating Westlake Counseling /J.Ilana Bradford

Counseling, or that was given out for law enforcement purposes;

*Ask Westlake Counseling /J.Ilana Bradford Counseling to communicate with you in a different manner or at a different place (for example, by sending materials to a P.O. Box instead of your home address);
*Ask Westlake Counseling /J.Ilana Bradford Counseling to limit how your personal health information is used and given out in order to be paid for services you received or to operate Westlake Counseling /J.Ilana Bradford Counseling

Please note that Westlake Counseling /J.Ilana Bradford Counseling may not be able to agree to your request.

*Get a separate paper copy of this notice
*If you believe that Westlake Counseling /J.Ilana Bradford Counseling has violated these privacy rights, you can file a complaint with Westlake Counseling /J.Ilana Bradford Counseling attention J.Ilana Bradford MA, MFT (Intern) NCC
*The Secretary of the Department of Health and Human Services
*Contact the office for Civil Rights, 1 (866) 672-7748, 1(800) 537-7697 (TTY) http://www.hhs.gov/orc/

Filling a complaint will not affect the services you receive at Westlake Counseling /J.Ilana Bradford Counseling. By law Westlake Counseling /J.Ilana Bradford Counseling is required to follow the terms in this privacy notice. Westlake Counseling /J.Ilana Bradford Counseling has the right to change the way your personal health information is used and given out. If Westlake Counseling /J.Ilana Bradford Counseling makes any changes to the way your personal health information is used and given out while you are current client at the Westlake Counseling /J.Ilana Bradford Counseling, you will get a new notice, directly or by mail within 60 days of the change.
( Type Full Name )