Print This Page

Introduction

I am required by law to provide clients with the following information. Please take time to read this document carefully so that you may better understand your rights and responsibilities; and ask me to clarify anything that you don't understand prior to your signing it.

It is your right and your responsibility to choose the provider and treatment modality that you believe best suits your needs; and you have the right to refuse or terminate treatment at any time.

I will utilize my experience, education and professional training to work with you in an ethical and competent manner respecting your feelings and goals. You can expect me to listen carefully, to help you explore and define your concerns, and to discuss with you ways to approach them. Continuing to work together is a mutual decision.

Effective therapy requires openness, an attitude of collaboration, and your willingness to invest both time and effort between sessions in working toward personal change. The success of treatment cannot be guaranteed because the outcome depends significantly upon your actions.

Professional Qualifications and Experience

I am a Washington State Licensed Marriage and Family Therapist and I have been in private practice since 1979. I was the Director of Counseling Services at Cornish College of the Arts for 12 years. Prior to that I counseled and provided psychological evaluations for veterans who were in inpatient treatment for substance addictions. I also provided Clinical Supervision to counselors and interns at a shelter for battered women and their children.

Education

I hold a Masters of Science degree in Counseling Psychology from the University of Oregon and a Bachelors degree in Psychology from the University of Washington. I have additional specialized training in depression, anxiety, trauma, sexual abuse, grief and loss, mindfulness stress-reduction, domestic violence, substance abuse, and eating disorders.

Therapeutic Orientation

My work with clients is based on specific therapeutic theories, methods and techniques including: reality-based, present-oriented, developmental, cognitive-behavioral theories, insight oriented psychotherapy, mindfulness practice, guided imagery, dream work, and use of the expressive arts. In recent years my psychotherapeutic approach has been influenced by a blend of Western theories and Eastern philosophies.

I view my role as a facilitator in your growth. Together, we will explore your present and past in ways to help you gain insight to your feelings, beliefs, and behavior. My approach to therapy and its length will depend on your particular needs and goals. I believe that problems can be identified and solutions defined in a straightforward and understandable manner; and that most change resulting from counseling has to do with a combination of revealing oneself to another person in a trustworthy, mutually respectful relationship, increasing self-awareness, identifying one's beliefs and altering negative and judgmental thoughts, and learning and practicing new behaviors that support one's goals.

An individual treatment plan will be developed with you using an approach that best fits your concerns. The plan may be modified as necessary. I encourage you to ask any questions you may have regarding your treatment. You have the right to discontinue your therapy or ask for a referral to another therapist at any time.

Appointments

Individual therapy sessions are 50 minutes in length. Couples counseling appointments are 90 minutes long. Your appointment time is held exclusively for you so it is important to be on time because your appointment will not be extended beyond the scheduled time as a result of your late arrival. If I am late in beginning our session I will make up the time with you.

When we schedule an appointment I am committing to hold that time for you. If you are unable to keep your appointment for any reason please give me at least 24 hours advance notice or you will be charged the full amount of the time reserved for you. Please note: health insurance providers do not reimburse for late cancellations or missed appointments.

Telephone Contact and Crisis Response

My 24-hour confidential voice mail phone number is 206.633.3289. I check my messages daily (except on Sundays and when I am out of town) and I usually return calls within 24 hours. If you need crisis assistance when I am unavailable you can call the Seattle Crisis line at 206.461.3222 for support and resources 24 hours daily. If you are also seeing a psychiatrist or an ARNP for medication management please contact that professional if they have crisis availability by phone or pager. If you feel you cannot keep yourself safe please call 911 immediately.

Payment Policies and Insurance Reimbursement

My fee is $100 per individual 50-minute session and $150 per 90-minute couples session. I prefer to be paid at each appointment unless other arrangements have been made. Please have your payment ready prior to the beginning of our session to avoid ending the session early to allow time for you to write a check.

Occasionally, I will need to increase my fee due to inflation. You will be given a month's notice of what my new fee will be. Collateral services such as letters, reports and consultations are prorated and billed at $125 per hour.

Most medical insurance plans cover mental health services when you see a Licensed Marriage and Family Therapist. I am a Preferred Provider for Regence Blue Shield. I am also covered by several other insurance companies including Premera and Group Health Options. Please check with your insurance company for information regarding your mental health benefits. You are responsible for any unpaid balance that your insurance does not cover.

Confidentiality

All information you disclose in therapy sessions is considered confidential and will not be released without a Release of Information form signed by you. However, if you choose to use health insurance for partial payment of your therapy I am required to submit a treatment diagnosis and dates of your appointments with billing.

The law requires disclosure of confidential information and reporting to authorities in certain situations: (1) you are at imminent risk of doing grave harm to yourself or someone else; (2) your ability to care for yourself has deteriorated to the point where you are at risk of grave harm; (3) you have provided information that suggests recent, current, or continuing abuse, neglect, or exploitation of a minor or vulnerable adult; (4) a court requires release of counseling information; or (5) you are HIV positive and are putting uninformed sexual partners at risk.

Ethical and Professional Standards

As a Washington Licensed Marriage and Family Therapist I am accountable for my work with you. I am committed to the Ethical Standards of the National Board Certified Counselors and the state of Washington Licensed Marriage and Family Therapists. If you have any concerns about the course of your treatment please discuss them with me.

Should you believe that I have been unethical or unprofessional you may initiate a Licensing Board complaint by writing to the Washington Department of Health, Counseling Department, P.O. Box 47869, Olympia, WA 98504-7869, or by calling 360.236.4700, where you can also request a copy of the "Acts of Unprofessional Conduct" (RCW.18.130.180).

If you have any questions that are not answered in this document, or if anything above is not clear to you, please discuss it with me prior to signing. For additional information about my practice please visit my website at www.jeanettemeagher.com.

I acknowledge that I have received a copy of this document and I have had the opportunity to ask questions about it, and I understand it.

Client's signature _________________________________________ Date __________

Counselor's signature _____________________________________ Date __________

Release of Information for Insurance Companies: I authorize Jeanette Meagher, LMFT to provide information to my medical insurance company as necessary to support claims for reimbursement that I may request.

Client's signature _________________________________________Date___________

Revised March 2009