The following information is designed to inform you about my background and to ensure that you understand the nature of our professional therapeutic relationship and your rights as a client. I am a graduate of the Clinical Mental Health Counseling program at The Chicago School of Professional Psychology (TCSPP), online. I am currently under supervision of Romain Diaz who is a licensed mental health professional at my primary place of employment. I currently meet the educational requirements to complete my licensure by the Pennsylvania Board of Counseling and currently hold an Associate License in the state of Pennsylvania. I also hold a certification in Child and Adolescent Development from TCSPP.
Professional Services
I provide individual, couple, family, and group counseling for adults, adolescents, children, and elder adults. I have been trained to work with the following presenting issues: depression, anxiety, and other areas of interest that I am currently expanding my knowledge base and experience in. My therapeutic approach incorporates several major theories of counseling, including SolutionFocused, Cognitive-Behavioral, Gestalt, Existential, Adlerian, Person Centered, among others. I tailor my particular focus to the needs of the client(s). I believe that every individual possesses the strength and potential to work through life problems, and that most issues are developmentally and environmentally based. I seek to help my clients discover their potential and learn skills and strategies that will help them achieve their goals through empowering my clients and providing them with conditions for personal growth.
The counseling process involves a collaborative relationship between client and counselor in an open environment where clients are free to share their thoughts and feelings honestly. Thus, your active participation and personal work outside of sessions are essential for counseling to be effective. I may ask you to try various things outside of the counseling hour to help you reach your goal. In some cases, you will be given a mental health diagnosis as part of your treatment unless it is harmful or detrimental to your well-being. This diagnosis will be discussed with you and is used to plan the appropriate course of counseling.
Confidentiality
I respect your right to privacy, and anything shared in our sessions will remain confidential. There are three exceptions, however, to confidentiality: I am ethically bound to break confidentiality if :
• I believe you are in imminent danger of harming yourself or others.
• You report abuse or neglect of a third party who is considered to be a vulnerable population (a child, older adult, disabled individual, etc.).
• I come under court order to release information.
In accordance with professional ethics, I may consult with my direct supervisors, other counselors, and the peers in my supervision group from time to time about aspects of certain cases while revealing as little as possible about clients’ identities. My supervisor and all other consultees are mental health professionals held to the same standards of confidentiality as I am, and these consultations are designed to help me provide the best services possible. Other than the three exceptions to confidentiality and consultations, you must provide specific signed permission for me to reveal any aspects of our counseling relationship to an outside party.
Emergency Support
In the signature of all my professional emails, I include helpline information for clients that feel they are in need of urgent support for suicidality or other forms of harm.
I am not qualified to provide emergency support and if you believe you are in imminent danger of harming yourself or others, I can only direct you to the proper supports.
Length of Sessions and Fees
Services will be rendered in a professional manner consistent with accepted ethical standards of the counseling profession. Therapy sessions are typically 45-60 minutes in length. The therapy services I provide through my private practice have the following as their fees for service: $100 per individual session, $45-$70 for Open Path clients.
Cancellation policy & Late arrivals
To help me with providing timely care for all clients, I kindly ask that you reschedule or cancel your appointment at least 24 hours in advance by calling (267) 225-0351
• Cancellations made with less than 24 hours' notice may be subject to a $75 cancellation fee.
• Missed appointments (no-shows) will incur a $75 no-show fee.
• If you arrive more than 15 minutes late, your appointment may need to be rescheduled.
I understand that emergencies and unforeseen circumstances can happen. If an extenuating circumstance prevents you from attending your appointment, please contact me as soon as possible. Fee waivers may be considered on a case-by-case basis.
Service termination
To maintain a safe, respectful, and ethical therapeutic environment, I reserve the right to terminate services immediately under the following circumstances:
• Two consecutive no-show appointments.
• Inappropriate conduct toward the clinician, including but not limited to sexual comments or behavior, harassment, violence, or threats of violence.
• Repeated disregard for practice policies, including but not limited to refusal to pay for services.
If services are terminated, the client will receive written notification via email explaining the reason for the decision. Once services have been terminated under these circumstances, the client will not be eligible to reestablish care with the practice.
Complaint Procedures
If you are not satisfied with any aspect of your counseling experience, please discuss this with me immediately. If you think you have been treated unethically and are unable to resolve the problem with me, you may contact the Commonwealth of Pennsylvania for clarification of client rights or to issue a complaint (https://www.pa.gov/services/dos/file-a-complaint-against-a-pa-licensedprofessional).
If you have any questions or concerns about the information provided above, please discuss them with me. To indicate that you have read and understand this information and agree to the terms outlined in this professional disclosure statement, please sign and date the form below. A copy of the signed form will be returned to you, and one will be kept by this site in your confidential records.
Ishara Pinkney-Lee
Ishara Pinkney-Lee,
M.A. Clinical Mental Health Counseling