Navigating Washington State's Therapist Requirements: Counselor Professional Disclosure Statement Example

Welcome, Washington State therapists!

As mental health professionals, we have a responsibility to ensure that our clients receive the best possible care and are well-informed about their treatment. To meet this goal, it's crucial to provide a comprehensive disclosure statement at the beginning of each treatment program. This statement helps clients understand important details about our practice and their rights as individuals.

We understand that sometimes legal jargon can be a bit overwhelming. But fear not! We've got your back. In this article, we will explore the required disclosure information outlined in WAC 246-809-710, providing clear explanations and practical examples to guide you in creating an effective disclosure statement. Let's empower our clients with knowledge and build trust from the very start.

You might be wondering, where can I find this required disclosure information? You can find it at this handy link: https://app.leg.wa.gov/wac/default.aspx?cite=246-809-710.

Crafting an Effective Disclosure Form: Washington State's Guidelines and Examples

Now, let's delve into each component of the required disclosure information and see how Washington State therapists can address them in their disclosure statements:

(1) The following information shall be provided to each client or patient at the commencement of any program of treatment:

(a) Name of Firm, Agency, Business, or Licensee's Practice:

Example: "Practice Name: Dunder Mifflin Counseling Services, PLLC"

Notice that the practice is a PLLC? Find out why.

(b) Licensee's Business Address and Telephone Number:

Example: "Business Address: 123 Oak Street, Seattle, WA 98001 | Telephone: (555) 123-4567"

(c) Washington State License Number:

Example: "Washington State License Number: LW12345"

(d) The Licensee's Name:

Example: "Licensee's Name: Pam Halpert, MSW, LICSW"

(e) Methods of Treatment Modality and Therapeutic Orientation:

Example: "Treatment Approach: I utilize a person-centered approach, integrating cognitive-behavioral techniques and mindfulness practices. My goal is to create a safe, supportive space where we can collaboratively work towards your well-being."

(f) The Licensee's Education and Training:

Example: "Education and Training: Pam Halpert holds a Master's degree in Marriage and Family Therapy from Pratt University and has completed specialized training in trauma-informed care and solution-focused therapy."

(g) Course of Treatment, When Known:

Example: "Course of Treatment: The duration and frequency of sessions will be determined based on your individual needs and progress. We will regularly assess and discuss the treatment plan together."

(h) Billing Information:

Example: “Payment is due at the time of service, and I accept cash, checks, or credit/debit cards."

(i) Client's Cost per Each Treatment Session:

Example: "Session Cost: Each therapy session is $100.”

(ii) Billing Practices, Including Any Advance Payments and Refunds:

Example: "Billing Practices: I offer the option for advance payment for multiple sessions, and refunds are available for session cancellations with a 24-hour notice."

(i) Clients' Right to Refuse Treatment and Choose a Practitioner and Treatment Modality:

Example: "Your Rights: As an individual, you have the right to refuse treatment and the freedom to choose a therapist and treatment modality that best aligns with your preferences and needs."

(j) Clarification on Client Rights and Professional Standards:

Example: "Important Note: This disclosure does not grant you new rights and is not intended to supersede state or federal laws, regulations, or professional standards that govern our practice."

(k) Department of Health Contact Information for Acts of Unprofessional Conduct:

Example: "Department of Health Contact: You have the right to obtain a list or copy of the acts of unprofessional conduct. For more information, please contact the Washington State Department of Health by phone at 360-236-4700 or online at fortress.wa.gov/doh/providercredentialsearch/ComplaintIntakeForm.aspx."

Please be sure to check that the Department of Health contact information is updated and correct.

(2) Associate status

Associates must provide each client or patient, during the first professional contact, with a disclosure form disclosing that he or she is an associate under the supervision of an approved supervisor. Associates may not independently provide clinical social work, mental health counseling, or marriage and family therapy for a fee, monetary or otherwise.

Example: "Disclosure Statement: I, Pam Beesly, am an associate therapist under the supervision of Michael Scott, an approved supervisor and licensed mental health counselor LW6789. I am licensed as a counseling associate and am actively working towards gaining full licensure. I provide counseling services under the guidance and oversight of my supervisor, ensuring the highest standard of care. Please note that as an associate, I am not authorized to provide clinical social work, mental health counseling, or marriage and family therapy independently for a fee, monetary or otherwise."

(3) Signatures

Signatures are required of both the licensee providing the disclosure and the client following a statement that the client has been provided a copy of the required disclosure information and that the client has read and understands the information provided. The date of signature by each party is to be included at the time of signing.

Example: "I, Pam Beesly, hereby confirm that I have provided a copy of the required disclosure information to the client, Jim Halpert, and have discussed its contents with him. I am available to address any questions or concerns regarding the disclosure statement. By signing below, Jim Halpert acknowledges that he has received a copy of the required disclosure information, has read and understood its contents, and agrees to the terms outlined therein."

[Signature of Pam Beesly] [Date]

"I, Jim Halpert, hereby confirm that I have received a copy of the required disclosure information from Pam Beesly, have read and understood its contents, and agree to the terms outlined therein. I have had the opportunity to ask questions and have received satisfactory answers. By signing below, I acknowledge my agreement with the information provided in the disclosure statement."

[Signature of Jim Halpert] [Date]

Please note that the use of characters from "The Office" in these examples is for illustrative purposes only and should not be used in an actual disclosure statement (besides, the dual relationships would make this scenario wildly unethical!). Replace the names with the appropriate names of the professionals and clients involved in your practice.

Remember, these examples are for illustrative purposes, and you should tailor your disclosure statement to accurately reflect your practice and personal style. Ensure that your clients feel informed, respected, and comfortable as they embark on their therapeutic journey with you.

Now that you have a clear understanding of the required disclosure information, let's create disclosure statements that empower our clients and strengthen our therapeutic relationships.

Conclusion

Therapists of Washington State, your dedication to providing quality care is commendable! Crafting a warm and inviting disclosure statement is essential to establish trust and showcase your expertise. Be transparent about your qualifications, counseling types, fees, and confidentiality limits. Emphasize your commitment to support and guide clients, even if you can't diagnose or conduct formal psychotherapy. Let your passion shine through, assure clients of your professionalism, and inspire confidence. Your disclosure statement is a powerful tool to connect, build trust, and provide exceptional care. Keep making a positive impact in Washington State!

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