Below you will see a copy of my professional disclosure which contains policy information as well

Welcome! I appreciate your trust and the opportunity to support you through this time. This document will provide you with information about treatment, confidentiality, and my practice policies. Please read it carefully, then sign where indicated. You will be provided with a paper copy of this document if you request it.

CONTACT INFORMATION

My practice includes in-person and virtual sessions. You may reach me by calling 910-604-6047 or e-mailing me at tori@thehopefulhour.com.

GOALS AND ROLES

My goal as your therapist is to help you identify and cope more effectively with problems you may be facing in your life and to help you learn how to deal with inner conflicts which may disrupt your ability to function. We accomplish this together by:

• Increasing your personal awareness of your behavioral/relational patterns
• Increasing ability to balance your sense of accountability and willingness to make changes with self-compassion
• Identifying personal treatment goals for your course of therapy
• Promoting hope for the future through “getting past your past”

Your role during therapy is to provide whatever information is necessary to facilitate effective treatment, and to collaborate with me in formulating your treatment goals and assessing your progress. You will be challenged to follow through with recommended treatment(s) and “homework” assignments if applicable. Progress tends to depend more on development of what is discussed in sessions than what happens during session. In sum, therapy is not a passive “cure,” you will have to be an active participant in the process.

APPOINTMENTS/FEES/PAYMENT

Appointments are generally scheduled for 53 minutes. Clients are generally seen once weekly initially and titrate to biweekly as progress occurs; your frequency of visits may be changed at any time by mutual agreement between us.

Your session time is reserved exclusively for you. If you arrive late, your session will be shorter, but you will still be billed the standard rate or what is deemed necessary by your insurance plan. I will wait 15 minutes after our appointment time, if you have not appeared by that time, it is considered a no-show. If you need to cancel or reschedule an appointment, I require 24 hours advance notice. Late cancellations incur a fee of $50 and no-show incurs a fee of $75. Exceptions are made on a case by case basis for late cancellations; no-shows will only receive exceptions in extreme emergent circumstances. The fee must be paid before a new appointment can be made.

My private pay fee is $165. The sliding scale form will be provided upon request. Payment is expected at the time of service, and you will either be billed through Headway (Cigna, UHC) or through my client portal (private pay, Aetna, BCBS, LC/NS). People with Cigna or UHC/Optum will be billed through Headway by debit or credit card or ACH transfer. If applicable, you will receive an invoice from Headway within 5 business days after our session has concluded.

I am currently in-network with Aetna, Cigna, BCBS and United Healthcare/Optum.

I offer 1 free phone consultation call for 15 minutes or less. Afterwards, I conduct counseling by appointment only. Once you are an established client, brief phone calls (5 min or less) are accepted, but if 5+ minutes are needed, we will schedule an appointment. You may text, email, or use the client portal to cancel your appointment, but I do not conduct counseling via text message, email, or any online platform.

AVAILABILITY

I will respond to all phone calls and emails within 24 business hours, but please be advised that my practice is not geared to provide emergency services. If you are having a severe emotional crisis and feel that immediate attention is needed, you should call your primary care physician, dial 9-1-1, contact 9-8-8, or go to your nearest emergency room.

I am often not immediately available by telephone. I do not answer my phone when I am with clients or otherwise unavailable. At these times, you may leave a message on my confidential voicemail and I will return your call once I’ve reviewed your chart, but it may take a day or two for non-urgent matters. Email is the best way to contact me. I will make every attempt to inform you in advance of planned absences, and provide you with the name and phone number of the mental health professional covering my practice. If I need to cancel an appointment at the last-minute, I will reach out as soon as possible and reschedule.

I like to inform my clients that I have a young son with epilepsy, so there is a higher potential for a cancelled session and/or interrupting phone call as we navigate his new diagnosis. We are all humans, and I highly value family.

CONFIDENTIALITY/PRIVACY

I regard the information you share with me during therapy with the greatest respect. In addition to my own personal values, issues discussed in counseling sessions are legally protected as both confidential and “privileged” by state and federal law, as well as my profession’s ethical standards.

However, there are limitations to confidentiality:

• Suspected abuse/neglect o a child, elderly person, or vulnerable adult
• If I believe you may be in danger of harming yourself or another person
• If you tell me you intend to physically harm someone else
• If I am ordered by a judge to release information from your records that may have pertinence to a legal proceeding in which you are involved
• If you sign a Release of Information
• In the event of a natural disaster whereby your records may be exposed or damaged

A clinical file containing your personal information and notes from our sessions will be maintained under double lock, just like any medical records. Your counseling records will never be released without your written consent or, as mentioned above, unless I am ordered by a judge to release them to a court.

MY EDUCATION AND LICENSURE

I hold a Master’s Degree from UNCW’s Clinical Social Work program. I am a Licensed Clinical Social Worker (LCSW). I have received Basic Training from the EMDR Institute. I am in good standing with the North Carolina Social Work Certification and Licensure Board.

In addition to traditional “talk” therapy, our work together may incorporate a variety of modalities, including but not limited to: CBT, DBT, EMDR, ACT, guided imagery/visualization, attachment-based, and Exposure Therapy.

OUR RELATIONSHIP

I view the client-therapist relationship as one of collaboration. By mutual agreement, we form a two-person team to work toward the goal of a more functional, more hopeful life for you.

You bring to the table your knowledge of your history and your ideas about what you’d like to accomplish throughout our time together. I bring to the table my professional training and a set of tools we can draw upon to help you make the desired changes.

Because the therapeutic alliance is so important to the success of therapy, we must keep our relationship strictly professional. Confidentiality is the foundation of that relationship. For that reason, if we happen to meet in public, I will not mention that you are a client unless you bring it up and I will not approach you before you approach me unless previously discussed in session. Honesty is another crucial component of our relationship and its underlying trust. I cannot help you effectively if you do not show up completely as you are. Accordingly, I pledge to be completely honest with you.

As a licensed professional, I abide by the Code of Ethics established by National Association of Social Workers and by North Carolina state statutes dealing with the practice of psychotherapy. Those standards include a prohibition of dual relationships of any kind between therapist and client.

Periodically, we will assess how your therapy is progressing, and whether you are pleased with the results. If at any time you feel dissatisfied or have concerns, please bring up those issues during your next session so we can work toward a solution that best suits your needs.

If you think you have been treated unfairly or unethically, you may contact the North Carolina Board of Licensed Professional Counselors at PO Box 77819, Greensboro, NC 27417 or (844) 622-3572 to clarify your rights and/or issue a complaint if that is the appropriate course of action. You may also contact the NC Social Work Certification and Licensing Board via PO Box 1043, Asheboro, NC 27203 or phone: 336-625-1679. They can also be reached online here: https://ncswboard.gov/complaint-form/ My license number is C017557. 

When accepting and treating clients, I do not discriminate on the basis of race, age, gender identity, sexual orientation, marital status, religious beliefs, ancestry, national origin, ethnicity, physical/mental disability, or veteran status.

DISCHARGE PROCESS

There are several reasons why we may eventually end our professional relationship. You may decide you would prefer to work with a different provider. I may reach the conclusion you would be better served working with someone else. Regardless of the case, I will first discuss with you the reasons for discharging, and if you request, provide you with a list of other qualified providers. I will also extend the discharge process length if necessary based on your treatment needs, including continuing to provide emergency support for a time-limited period after you have been notified of the end of our treatment relationship.

You may, of course, discontinue treatment at any time, but it is always a good idea to discuss the decision with your therapist to explore alternative paths. You also have the right to seek treatment from a different therapist. If you decide to do so, I will be happy to help provide you with outside referrals.

Please note that ongoing failure to pay for treatment, attend sessions, or communicate with me in a respectful and timely manner can also result in discharge from my practice. In these instances, to ensure you have continued access to care, I will still make every reasonable effort to get in touch with you and provide referrals to a new provider before I consider our relationship ended.

THOUGHTS ABOUT THERAPY

As with any kind of treatment, there are both benefits and risks associated with therapy. It is important that you are aware when undergoing therapy, you might feel worse before you feel better. At times, you may experience uncomfortable levels of feelings such as: sadness, anger, guilt, anxiety, frustration, loneliness, and happiness.

Difficulties with people close to you may arise and relationships may change as you change. Some changes may worsen problems for a time and some may even lead to losses (i.e. the decision to separate from a partner).

Despite this, I want you to also know that psychotherapy has been repeatedly and scientifically proven to be of benefit for most people and in most situations. Relationships and coping skills may improve dramatically; this just makes life more fulfilling. Depression may lose, fears and anxieties may subside. You may better understand your personal goals and values, and thus grow as a person and feel more hopeful. I am optimistic that together we’ll likely be able to produce those kinds of results for you.

CONSENT FOR TREATMENT

By signing this document, you state that you have read and understood this document and had your questions fully answered prior to signing. Your signature here also indicates that you consent to receive psychotherapeutic treatment from Tori Morgan, MSW, LCSW and that you agree to comply with the terms of our relationship as detailed in this document.