The law protects the relationship between a client and a psychotherapist, and information cannot be disclosed without written permission.
- Suspected child abuse or dependent adult or elder abuse, for which I am required by law to report this to the appropriate authorities immediately.
- If a client is threatening serious bodily harm to another person/s, I must notify the police and inform the intended victim.
- If a client intends to harm himself or herself, I will make every effort to enlist their cooperation in ensuring their safety. If they do not cooperate, I will take further measures without their permission that are provided to me by law in order to ensure their safety.
Marian Bauman, M.A., LMHCDISCLOSURE STATEMENT & CONSENT FOR TREATMENT
917 NE 73 rd St.
Seattle, WA 98115
917 NE 73 rd St.
Seattle, WA 98115
People usually begin therapy to relieve distressful symptoms and feel enabled to have greater satisfaction in life. Much of the work of therapy is in becoming more conscious and aware of thoughts, feelings, behaviors and motivations - resulting in accepting and meeting one's needs. Therapy is a collaborative process based on a supportive therapy relationship. Many feelings are evoked in the process; I encourage you to bring these up with me, & to discuss our relationship together as we go.
The assurance that I will honor your privacy is one of the foundations of safety in therapy. I will hold our conversations in confidence in accordance with a Washington law and ethical practice. The exceptions to confidentiality are when there is suspected child abuse, threat to harm self or other, a subpoena regarding our work, your permission to talk with a specific persona, or electing to use insurance
My fee is $120 for a 50 minute session, with a negotiable sliding scale.
I will regularly hold your appointment time for you unless we agree otherwise. If you need to cancel, please tell me as soon as possible. If you miss an appointment or cancel with less than 24 hours' notice, you will still be responsible for your fee.
Insurance: As a participating, not preferred, provider, I am insurance eligible. For those clients whose insurance coverage includes mental health, you are responsible for paying your fee regularly, and I will provide you with documentation necessary to be reimbursed.
Phone availability and vacation coverage
You may leave me a message on my voice mail, or preferably an email or text, which I check several times each week day. When I am away on vacation, I arrange to be available to you.
Training and Credentials
I am a Licensed Mental Health Counselor, and have a Master's degree in Counseling Psychology. I regularly participate in clinical seminars and continuing educational training.
Signatures verifying that the required disclosure information has been provided, read and understood:
Client Marian Bauman: Date:
State laws require the following disclosure:
WAC 308:"Counselors practicing counseling for a fee must be registered or certified with the department of health for the protection of the public health and safety. Registration of an individual with the department does not include a recognition of any practice standards, nor necessarily implies the effectiveness of any treatment." The department of health publishes a brochure for the education and assistance of the public. This details information re: the extent of confidentiality provided by RCW 18.19.180, as well as the acts of unprofessional conduct and contact numbers within the department of health. The purpose of the Counselor Credentialing Act is: 1] to provide protection for public health and safety; and 2] to empower the citizens of Washington by providing a complaint process against those counselors who would commit acts of unprofessional conduct.