Professional Disclosure Statement

and Consent for Mental Health Counseling Services

~ Tamela M. McGhee, LCPC ~

Licensed Clinical Professional Counselor in Illinois--License #0000

Please read this document carefully, before selecting me as your counselor. The Professional Disclosure Statement is required by the Illinois Department of Financial and Professional Regulations. Within it, you will find a description of my credentials, experience, my counseling philosophy and approach, and fee information. You will also find important information concerning confidentiality in keeping with Illinois state laws. All of this information is given to you, so that you can make an informed decision concerning my services.

Training

B.S. in Psychology, Capella University - Summa Cum Laude - 2015

M.S. in Mental Health Counseling, Capella University - 2019

Internship at Logan County Women's Correctional Facility, Lincoln, IL - 2018

Clinically-supervised field work at Chestnut Health Care Systems, Bloomington, IL - 2020-2022

Experience

Addiction/Substance Abuse Co-dependency

Individual, Family, Group Counseling Psychodynamic Approach to Career Counseling

Dual Diagnosis & Co-occurring Disorders Bereavement Counseling

Depression & Anxiety Behavioral Intervention

Community Contributions

Facilitator and Chair person of Co-dependents Anonymous, Lincoln, IL - 2016 to present

Volunteer mentor with McLean County Youth-Build, Normal, IL - 2016 to present

Founder of Empowered Futures: a short-term psychodynamic approach to career counseling for the underprivileged, Lincoln, IL - 2023 to present

Professional Memberships

American Counseling Association

Illinois Counseling Association

Association for Spiritual, Ethical, and Religious Values in Counseling

My Counseling Philosophy

I believe that counseling is a journey. This journey may require looking into the past, to identify why you think and behave as you do. Often times these patterns stem from oppressed, dysfunctional, and/or traumatic experiences. However, by becoming self-aware and taking responsibility for current thinking and behavioral patterns, a transformation can begin. Though it may seem frightening and even impossible at times, we will be taking this journey together. Through our trustworthy and honorable relationship, you can experience empowerment in your life. You can become all that I believe you were meant to be. We must work as a professional and dedicated team. I need your proactive engagement for this empowering transformation to occur. I will also need your honesty every step of the way. Without that, I cannot properly identify your needs, or make adjustments where necessary. I am here to be your helper, but you will always be the captain of your own counseling experience.

Counseling Approach

For your journey to begin, we will need to engage in a thorough assessment process. These culturally-sensitive assessments will help me understand you and your environment, so that we can form a treatment plan that will work best for you. I will utilize a wellness model assessment approach, as this will give me insight into all integral aspects of you and your life. I may conduct other assessments to form diagnoses or incorporate your own brand of spirituality into your counseling experience if desired. We may discover that you need additional professional and community services. Consultations will be arranged to help you with this. During this initial phase, open communication will begin growing our counseling relationship, as we move forward into the work which lies ahead of us.

I take a psychoanalytic and cognitive behavioral approach to counseling. While my professional goal is to help you revise your thinking and behavioral patterns, I also believe it is necessary to understand why and how these patterns formed to begin with. By doing this, more complete healing and transformation can be experienced. There will be times when I will give you assignments to do at home, such as worksheets and behavior logs. I may encourage creative approaches such as journaling, coloring, or breathing and meditation techniques. Always remember that you are the captain. These are only suggestions, but I ask you to have an open mind. The more you put into your counseling, the more you will receive from it to carry forward into a happy and fulfilling life.

Each individual is unique in their needs, and the length of time it will take to address them. I want you to leave feeling equipped and empowered to manage your life once again. Your trusting cooperation will assure you of progress in a more timely manner. Together, we will re-assess your progress and treatment plan, to make sure goals are being addressed and improving. We may or may not, need to make adjustments. Most importantly, I want our professional relationship to be built on trust, honor, integrity, and thorough communication.

I will assure you of ethical services, however if you wish to terminate at any time, this will be honored and a referral made if desired. Any additional concerns or complaints, can be filed with the following:

Professional Counselor Licensing and Disciplinary Board320 W. Washington Street, 3rd FloorSpringfield, IL 62786217/785-0800217/524-6735 (TDD)217/782-7645 (fax)

Confidentiality

As your counselor, I will honor all confidentiality and regulations as set forth by Illinois HIPPA laws, the Illinois General Assembly, and the American Psychological Association's Code of Ethics. Your written consent will always be required before counseling procedures or release of information is conducted. However, there will be state-mandated exceptions required by the Illinois General Assembly's Professional Counselor and Clinical Professional Counselor Licensing and Practice Act (225 ILCS 107/75) including, but not limited to:

1. When a communication reveals an intended act to harm others, or jeopardize public safety.

2. In the course of formally conferring with superiors, colleagues, or consultants who share

professional responsibility.

3. In legalities pertaining to adoption, child abuse and/or child neglect.

4. Legal exemptions pertaining to minors.

Complete confidentiality information and copies of all confidentiality forms will be given for you to review and sign, before counseling will take place. You will be given copies for your personal records as well. Further questions can be directed to:

Illinois General Assembly

705 Stratton Building

Springfield, IL 62706

217-782-3944 or 217-782-2050 (TTY)

Fees and Payments

Counseling sessions are approximately 50 minutes long, with each session costing $100.00. I require a minimum of 24 hour notice for cancellations and re-scheduling. Same-day cancellations and no-shows will be charged in full. I accept cash, personal check, and credit/debit cards. A $35.00 fee will be applied for returned-checks. I work with most major insurance companies, as well as some out-of-network companies. Insurance companies require a diagnosis to process claims. However, a diagnosis will permanently remain on your insurance record. Insurance forms will be given to you, and your written consent required before put into motion. I additionally offer services on a sliding scale, based on show of low income, if necessary.

Emergency Contacts

In the event of an emergency and I am not in my office, please leave me a message, then contact your primary care physician, or call 911.

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Client Signature Date

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Therapist Signature Date