DISCLOSURES

LCMHC ProfessionalDisclosure Statement

RachelSydney Garfield, MA. LCMHC

Office: 919-522-2976

Qualifications

Antioch University New England, MA- CounselingPsychology- 1994

Fielding Graduate University.
Rachel Sydney Garfield, the licensee, is a licensed clinicalmental health counselor in North Carolina and her license number is 5398.
Rachel Sydney Garfield has 25 years of professionalcounseling experience.

Counseling Background

Rachel Sydney Garfield has worked with a diverse clientelefrom all racial and socioeconomic backgrounds (adults and adolescents.) She has experience with a wide range of issues including past trauma, chronic pain and illness,
addictions, depression, anxiety, and psychosis.
Rachel Sydney Garfield offers services in psychodynamic“talk” psychotherapy. Her theoretical orientation is psychoanalytic (object-relations,and attachment-based.) She incorporates elements of cognitive-behavioral theory
(CBT) and the use of sports related metaphors when appropriate. Rachel Sydney
Garfield’s area of competence is in depth, talk-therapy with the goal of achieving
a balance between insight and action. The focus of psychoanalytic therapy is to
resolve unconscious conflicts that have manifested as symptoms in the present.
Resolving past conflicts and reenactments may allow the client to gain insight,
raise self-esteem, heal losses, achieve goals, and move forward with a greater sense
of peace in the future.

Session Fees and Length of Service

Rachel Sydney Garfield holds 60-minute talk-therapy sessions.The fee is based on a sliding scale and ranges from $100.00 to $180.00 per
session based on income and ability to pay. You agree to pay_______per session.

Rachel Sydney Garfield accepts payment methods which includechecks and cash. She also accepts reimbursement from third parties such as insurance companies. All copayments are due at the time of session.

Use of Diagnosis

Some health insurance companies will reimburse clients forcounseling services, and some will not. It is important to note that most
insurance companies will require a diagnosis of a mental health condition and
indicate that you must have an “illness” before reimbursement. Some conditions
do not qualify for reimbursement. If a qualifying diagnosis is appropriate, you
will be informed prior to submitting it to the insurance company. The diagnosis
will become a permanent part of your record.

All client materials and charts are kept confidential. All communication will be part of the clinical record and accessible to you upon
request. I will keep confidential anything you say as part of the counselingrelationship with the following exceptions: (a) you direct me in writing to disclose information to someone else, (b)it is determined you are a danger to yourself
or others, including child or elder abuse, or (c) I am court ordered to
disclose information.

Complaints

Although clients are encouraged to discuss any concerns withme, you may file a complaint against me with the organization below should you feel I am in violation of any of these codes of ethics. I abide by the ACA code
of ethics. http://www.counseling.org/Resources/aca-code-of-ethics.pdf

NorthCarolina Board of Licensed Clinical Mental Health Counselors
P.O. BOX 77819
Greensboro, NC 27417

Phone: 844-622-3572 or336-217-6007

Fax: 336-217-9450

E-mail: Complaints@ncblcmhc.org

Acceptance of terms

We agree to these terms and will abide by these guidelines.

Client:________________________________ Date:__________

Counselor:____________________________ Date:___________

RACHEL SYDNEY GARFIELD, MA, LCMHC

Collaborative, Depth Psychotherapy

RACHEL SYDNEY GARFIELD, MA, LCMHC

Collaborative, Depth Psychotherapy

RACHEL SYDNEY GARFIELD, MA, LCMHC

Collaborative, Depth Psychotherapy