& Professional Disclosure Statement
to the counseling opportunities offered by TRANSITIONS Personal &
Family Counseling Services. If you are beginning counseling for the first time, and you
are like most of us who have been down that road, you may be a little anxious. This is
okay and a little expected. It involved a lot of personal courage on your part to take
this first step a step which is a move to your being able to make the changes you
need in your life.
Even though I have been in clinical counseling work for
thirty years, I
increasingly feel a deep sense of respect and appreciation for each new client who decides
to enter counseling with the courage and commitment to discover and make the changes that
will give his or her life new meaning and direction. Having walked this road personally,
as well as professionally, I know how challenging it can be. The shared trust and the
opportunity to participate in, and witness, the growth of another is a sacred honor to me.
My experience in this work has taught me that there is no tragedy so great, no shame so
deep, and no pain so overwhelming but that the power of the human spirit can break through
to the light. May it be so with you, as I trust it will.
Before we begin, it is important to inform you about my background and orientation,
some things about the counseling experience, and the mutual responsibilities we are about
to undertake in the professional counseling relationship.
TRANSITIONS has a policy of
assured confidentiality, which ignores recent privacy-eroding
trends in behavioral healthcare and in our society and holds to original standards of
confidentiality as being the foundation of the counseling process. Everything we discuss
in counseling will be held in professional confidence. By policy, the only way any
information would be authorized to go outside my office is if you decide to sign a Release
of Information Form, if you want some information to go to another professional. Since
people typically do not understand the potential consequences of blanket release
statements (for example, from insurance companies and managed care organizations), I do
not honor such statements without written consent of the client after discussion
about potential consequences.
There are two exceptions under which the ethical principles of my profession and State
law cannot guarantee confidentiality: (1) when I believe you actually intend to harm
yourself or another person; and, (2) when I believe a child or elder person has been or
will be abused or neglected. There are rare circumstances in which a professional can be
ordered by a judge to release information. (However, court-ordered information leading to
potential client harm is extremely rare much rarer than data-loss due to computer
malfunction.) Finally, because use of insurance companies for third party reimbursement
involves some confidentiality risk (see below), signing of the Release of Information form
would be necessary in such instances.
COUNSELING PROVIDER INFORMATION
I have over thirty years in
post-graduate professional counseling. In 1974, I graduated
Phi Beta Kappa, with
Departmental honors, in Psychology, from the
University Of Florida; where I
went on to complete
(between master and doctorate) degrees in Counseling in 1977. I have practiced various aspects of the discipline of
professional counseling over the years, accumulating clinical experience in mental health
outpatient, family agency, psychiatric inpatient, correctional, and substance abuse
treatment settings, as well as private practice; the last six years being full-time
private practice. I am a member of the American Counseling Association, the International
Association of Marriage And Family Counselors, and the North Carolina Society of Clinical
Board Certified by the
National Board For Certified Counselors (N.C.C.) and am a
Professional Counselor in N. C.
In addition to my years of experience in individual, couples, and family therapy, I
have over two years experience and clinical training in multiple family therapy, with an
interest in exploring the use of that treatment modality on an outpatient basis with
families presenting a diversity of problems; from substance abuse, to families
experiencing catastrophic illness, to families making difficult transitions.
My continuing education over the post-graduate years has included either, or a
combination of: workshop/conference study, supervised practice, and personal study in the
above-referenced settings; with skill development relevant to the settings. These include
such areas as: family work, including marriage counseling; mental health counseling;
recovery from life crises and trauma; substance abuse counseling; clinical hypnosis;
developmental conflicts and issues from adolescence through late adulthood; relationship
conflicts; parenting skills; counseling for some specific disorders, such as ADD/ADHD;
counseling for catastrophic illness and other life transitions; sexual dysfunction
(psychogenic); psychoneuroimmunological counseling.
RANGE OF SERVICES
This range of experience has
been useful in developing a family-oriented, broad-based counseling service in a
predominantly rural setting. Many counseling needs present themselves, and besides family
and friends, a significant number of referrals to TRANSITIONS come from family
And, as in
the case of a family medical practice, this counseling practice will meet the needs of
However some clients may require referral to
other mental health professionals or specialists, as an alternative or supplement to
treatment in this setting. If it becomes apparent that you may need to be referred, please
be reassured that it is policy for us to discuss your options in detail prior to any
decision. The primary concern is that your needs will be met appropriately.
The unifying focus of this counseling
practice is helping clients make transitions: through a crisis; out of conflict; getting
"unstuck;" finding meaning; from being wounded to becoming whole; from being
emotionally frozen or blocked to becoming able to grieve and say goodbye to one stage of
life in order to be able to accept or embrace the next. A substantial number of persons
who come here are "normal" folks who do not require a psychiatric diagnosis for
Counseling approaches at TRANSITIONS are predominantly eclectic, client-centered and transpersonal; with modalities that
may include one or more of the following, depending upon the needs of the client:
individual counseling, marital/couples counseling, group counseling, family therapy, or
multiple family therapy.
Find out about recent changes at
The essence of the counseling experience involves the creation of an environment and a relationship in which you
can feel safe to explore every aspect of yourself, your life and your relationships. In an
atmosphere which eliminates the dynamics of shaming and blaming, the counseling experience
presents a mirror in which you may see yourself and your life exactly as they are. As your
courage grows, you will be able to feel free to explore other options and discover new
aspects of yourself to try on new ways of being. You may find undiscovered
strengths in yourself and learn new skills that will allow you to resolve old conflicts
and heal old wounds to re-create old relationships or, when necessary, find the
courage to move on in peace.
By now, you may be aware that
successful counseling experience will involve a lot of work on your part. It
takes a great amount of courage and willingness to work through pain in order for us to
change our lives and make our lives work.
But the pain of the counseling process is never so great as the pain of
allowing our lives to continue on their present course. With commitment to this process, you will notice positive change
in how you think and feel, how you perceive and relate to others, and to life in general.
This process probably will involve more than participating in counseling sessions. You may
be invited to read books; listen to tapes; watch certain movies; keep a journal;
participate in specific exercises; attend special meetings; or work on special projects.
Of course, these activities will not be required of you, but they will enhance your
progress. And, while they are not a substitute for counseling, they can reduce the number
of necessary sessions and make the counseling process more cost-effective for you.
While some aspects of
change process in your life may be sudden and profound,
other changes will only come slowly and through deliberate, repeated effort. Therefore, it
is important to be patient and understanding both toward yourself and toward any
partner(s) who may be participating in the counseling process with you.
During our first session or two, we will begin by focusing in on the presenting
problems you are bringing to the counseling process. We will discuss your history and how
it might bear on those problems. Counseling treatment options will be discussed, along
with possible risks and benefits. Finally, we will develop a plan, which will include your
counseling treatment goals and the therapeutic modalities we will use to achieve them.
This plan will include an initial determination of the approximate number of sessions
involved, your costs per session and any other details relevant to your particular
Additional sessions will assist you toward meeting your treatment goals,
along with helping you adjust and grow through your changes. During the period you are undergoing
counseling, you may experience some intensification of negative emotions (for example:
sadness, anxiety, anger, guilt, confusion). This is normal and often a result of your
allowing yourself to experience feelings that were already there in you at deeper levels.
Also, you may temporarily experience increasing difficulties in relating to others as you
abandon old defenses and begin to develop more effective ways of relating to others. It is
likely that your personal growth and changes may evoke negative responses in some persons.
Family, especially, are used to relating to you in certain ways. As those ways change,
some family members may become uncomfortable and may tend to undermine your progress.
Under strong-enough circumstances, the introduction of some type of relationship
counseling (for example, marriage or family) may be indicated. Periodically, we will
review your progress and revise your treatment plan as necessary.
The successful counseling relationship involves the
development of a high degree of vulnerability and trust, as intimate and confidential
aspects of one's life are shared in detail. It is normal under such circumstances for
intense feelings of closeness and sharing to develop. For this reason, the counseling
profession has developed strict ethical guidelines to protect persons involved in
counseling relationships. It is essential in the professional relationship that you should
feel absolutely safe from even the remote possibility of exploitation of any kind in the
relationship. Our research and experience demonstrates that an effective professional
counseling relationship will focus only on your counseling needs; and part of my role is
to safeguard that. Therefore, meetings will be limited to scheduled counseling sessions,
arranged by you, and potentially role confusing aspects of the typical social
relationship, such as social gatherings, gift exchanging, etc., will be avoided.
Also, in relationship counseling (for example, marriage or family), it is essential
that all persons involved feel equally supported in the counseling process. Taking sides,
shaming and blaming, are not part of the counseling process, and I invite you to please
inform me if you ever feel less supported than your partner!
PAYMENT FOR SERVICES
TRANSITIONS is dedicated to providing competent,
quality, professional counseling at an affordable fee structure. The key
to this approach involves reducing overhead costs by making office
operation simpler and more manageable in our Western Carolina setting.
Services are available to a broad region by having the TRANSITIONS
counseling/retreat facility in a beautiful, natural, woodland garden setting in Northbrook
(Vale). This location offers greater privacy and costs less to operate,
thus allowing for the lower fees.
Other overhead costs are reduced, and privacy assured, by providing office facilities
that use confidential telephone answering resources in place of
secretarial answering services.
most instances, I will answer the phone, or I will attempt to call back within the hour.)
Expensive billing and
bookkeeping procedures are also avoided by receiving fees immediately after services are
Every effort is made to increase the availability of counseling to you, including: an
appropriate adjustment of fees as well as home, hospital or site visits for certain types
of crises and handicaps; assured confidentiality; as well as prompt scheduling of
appointments. This philosophy, with the above-noted innovative office management methods,
allows the following SLIDING FEE SCALE:
SLIDING FEE SCALE: OFFICE VISITS
(NON-USE OF HEALTH INSURANCE
Find out about recent changes at
INCOME RANGE: Gross Family
Income / Fee Per Session Hour
Amount of Fee Upon Delivery of
BASED UPON GROSS FAMILY INCOME
SESSION HOUR RATE APPLIES, WHETHER AN INDIVIDUAL, COUPLE, OR FAMILY IS
BEING SEEN. (COMBINED INCOME FEE-SETTING, NOT TO EXCEED $60.00, WILL BE
APPLIED FOR SESSIONS INVOLVING PERSONS LIVING IN SEPARATE HOUSEHOLDS).
$60.00 Per Session Hour
$50.00 Per Session Hour
$40.00 Per Session Hour
$35.00 Per Session Hour
$30.00 Per Session Hour
$20.00 Per Session Hour
$20.00 Per Session Hour
Clients who wish to use health insurance
coverage which, by policy, would compensate for my services will be charged the usual
$60.00 per session fee, up front, and I will sign the appropriate documentation for the
client to file with the insurance company.
At the present time, our society is undergoing many changes with regard to
health policy; and particularly, mental health policy. I tend to discourage the use of
health insurance and managed care for mental health purposes for the following reasons:
(1) Many counseling services are not
covered (for example, marital counseling) and different companies tend to have
different and changing policies regarding coverage, based on the service(s) provided and
the qualifications of the provider.
(2) In order to receive
third party payment from a health insurance company, or managed care endorsement, the
person receiving counseling services MUST have a DSM-IV psychiatric diagnosis, denoting
"mental illness," which will become a permanent part of his or her
medical/insurance records. However, counseling services for many situations can be
provided without requiring a psychiatric diagnosis.
company (and HMO, PPO) policy can create more complication in the client's life than
the possible reimbursement or savings are worth; for example, by designating an earlier
brief counseling intervention as being for a "prior-existing condition"
thereby refusing payment for a later, more intensive intervention.
(4) Confidentiality is
not as reliable as we would hope, considering the insurance and managed care information
network. There is risk of diagnostic/treatment information leakage to
present/potential employers, insurance companies, and finance organizations.
Persons often sign blanket releases, unaware of the extent to which their
personal information can be disclosed. Signing such releases may be
required for coverage.
Jobs have been lost and
promotions denied; insurance policies refused and critical healthcare denied, as a result
of such "managed" information. Feel free to review further information I have
written on this topic by going to: The Risks Of
Managed Care and Health Insurance. Also, check out the Web cross-links at
transitions-counseling Online Services.
(5) The majority of health
insurance companies, managed care (HMOs, PPOs), and EAP companies are self-serving
business concerns, first. They make more income the less service they have to pay for,
manage, or provide. Operating under the guise of ensuring appropriate and competent
professional care, they use record review and telephone supervision to manage and limit
the professional care of clients and patients with whom they have no first-hand, personal
knowledge or experience. As a consequence, the consumer or employer pays higher and higher
premiums for potentially reduced adequacy of care.
My concerns about the
direction of the health care industry, with its potential for forcing compromise of the
professional ethics of healthcare providers, are a large part of my inspiration to develop
counseling services which can financially survive while providing good services outside
the big business-based managed care environment.
The goal of TRANSITIONS is to provide optimum and affordable professional
counseling care without risking compromise of clients' confidentiality or counseling needs
under pressure of outside concerns. I
appreciate your being willing to wade through this weighty and detailed
section. My ethics regarding disclosure policy required my writing this.
With this information, if you are eligible to receive a percentage of
health insurance coverage for my counseling services, and wish to use that
method of payment, I will be happy to work with you.
The first session is scheduled for at
least 90 minutes and the first half hour of the first session is free.
It is important that you
feel safe to come here and explore the possibilities of counseling for the
first half hour without any sense of obligation.
Feel free to ask questions, check credentials and discuss terms. (Better
yet, ask those questions during your first telephone call, which involves
no fee.) Then, if you don't want
to pursue counseling with me, I can help refer you elsewhere. If you
do decide to use insurance or engage in any other activity involving
electronic transmission of your counseling records, you will come under
HIPAA Law. Please be sure to
read my HIPAA policies provided to
After the first session, our sessions will last 60 minutes. On occasion, sessions
may go over an hour, depending on your need for closure and available time but you
will not be charged for additional time unless prior agreement has been made for a special
extended session. Some of my clients require "double" or extended time sessions
due to long travel distances, special procedures, and/or time constraints. In such
circumstances, fees will be discussed and mutually agreed upon in advance.
program offers a completely innovative approach to services and fees.
Group Therapy and Multiple Family Therapy sessions usually will be charged one half the
Individual/Family rate established for a particular client, couple or family. (For
example, a client who pays $50.00 per hour for individual counseling will pay $25.00 per
hour for group participation or multiple family therapy.)
STANDARD OF CARE
Counseling, like every
clinical profession, has recognized standards of care for various types of problems, based
upon research findings, accepted clinical criteria for providing treatment, and
established methodologies based upon experience over time. As a routine, the resources we
will use in your treatment will be based upon established standards of care. However,
because some of my counseling work is "cutting edge," and holistic, some clients
have the opportunity to experience emerging methodologies as part of their therapeutic
work. In these cases, I have been in been in collaborative work, training/study or
supervision in such areas (see examples above) and am qualified as far as the emerging
area of exploration can allow at the time. The
program uses many of these approaches.
If methods beyond currently accepted standards of care appear indicated in your case, I
will offer them for your consideration and approval: that approval being formalized in
some cases by your signing an appropriate authorization form.
SOME OTHER IMPORTANT THINGS TO KNOW
If you call and the
answering system replies,
feel safe to leave a message. The answering system is confidential. I will return your call as soon as
possible. On nights and weekends, your call will be call-forwarded to where I may be
reached in an emergency or crisis. In such circumstances, please feel free to call if you
cannot wait until the next scheduled session.
At the end of each session, fee payment will be due (in cash or personal check), unless
other arrangements have been made in advance. At that time, we will schedule our next
IMPORTANT: Please consider that there are a limited number of time
slots, with most clients wanting to schedule appointments during the
"prime" period of the day most in demand. Unlike a doctor's office,
where they call the next waiting patient, your scheduled appointment
session is in an extended time slot reserved exclusively for you.
It cannot be made available for anybody else unless: (A) You decide to
cancel or reschedule, AND (B) You call to cancel or reschedule with a
reasonable amount of notice. Since my
income also is based upon scheduled sessions, if you need to reschedule or
cancel a session,
PLEASE GIVE AT LEAST 24 HOURS NOTICE (MORE, IF POSSIBLE), so I might
have a chance to reschedule in that time slot.
Except in unforeseeable, crisis-type situations, clients
who don't give at least the 24 hour notice in canceling a session will be
responsible to pay for the session. Folks who don't cancel and don't show will be billed for
the missed session.
When you have questions,
concerns, or apprehensions about any aspect of your counseling, please feel free to share
them with me. Everything about your sessions is for your recovery, growth and development
and you have a right to expect to experience this process at some point into the sessions.
Please share any complaints with me immediately to insure an efficient and effective
counseling process. If you experience that you have been treated unfairly or unethically,
such that you cannot resolve the problem with me, you can contact the North Carolina Board
Of Licensed Professional Counselors at PO Box 21005, Raleigh, NC 27619-1005; (914)
TERMINATION OF COUNSELING SERVICES
Whether your counseling
needs call for a few sessions or many, you will know you are approaching the opportunity
to terminate your counseling services as you meet your treatment goals and your life
improves sufficiently. Often, a client may experience significant relief very early in
counseling. However, this is usually due to gains in insight, but not sufficient gains
toward meeting your treatment goals; as these goals will usually involve development of
new skills and behaviors. Initially, sessions will be weekly (or oftener in crisis), with
duration between sessions becoming greater as you approach your goals.
Finally, you will feel ready to stop scheduling routine sessions, knowing the
opportunity for future counseling will be available to you if you require it. The number
of sessions you will require will be determined by the nature of your problems, your
treatment needs and goals, how hard you work in sessions and outside sessions (doing
"homework"), among other things. Required sessions can run from only one, to as
many as you need to be satisfied that you've reached your goals. As a good counselor, my
job is to work myself out of a job!
Today is a beginning, for you made the right decision to take care of yourself. When
life begins to overwhelm us, for those of us who value our wellness, counseling is a
With Deepest Personal Regards,
Granville Angell, Ed.S., L.P.C., N.C.C.
(Below modified and
condensed for Web page.)
Having read this Client Handbook, I
am satisfied with these terms of counseling treatment and offer my consent.
Copyright 1/91, 8/94, 6/96, 3/97, 10/99, 1/2003, 2/2004, 12/2005,
9/2007: TRANSITIONS/Granville Angell
SOMETHING TO THINK ABOUT: I WILL KNOW THAT I HAVE SUCCESSFULLY COMPLETED COUNSELING
NEXT SESSION Date/Location; Assignments/Projects to work on (books to read;
journaling activity; video/audiotapes; meetings; awareness exercises; communication
We can express no greater personal courage than that found in our
willingness to sacrifice what we are for what we can become.