Amber Rose Daughrity LMFT 139137/LPCC 18261
406 Chinn St., Santa Rosa CA, 95404
(707)800-9965
amberroselmft@gmail.com
Informed Consent for Psychotherapy
General Information: The Therapeutic Process You have taken a very positive step by deciding to seek therapy. The outcome of your treatment depends largely on your willingness to engage in this process, which may, at times, result in considerable discomfort. Remembering unpleasant events and becoming aware of feelings attached to those events can bring on strong feelings of anger, depression, anxiety, etc. There are no miracle cures. I cannot promise that your behavior or circumstance will change. I can promise to support you and do my very best to understand you and repeating patterns, as well as to help you clarify what it is that you want for yourself.
Confidentiality: The session content and all relevant materials to the client’s treatment will be held confidential unless the client requests in writing to have all or portions of such content released to a specifically named person/persons. Limitations of such client held privilege of confidentiality exist and are itemized below:
If a client threatens or attempts to commit suicide or otherwise conducts themselves in a manner in which there is a substantial risk of incurring serious bodily harm.
If a client threatens grave bodily harm or death to another person.
If the therapist has a reasonable suspicion that a client or other named victim is the perpetrator, observer of, or actual victim of physical, emotional or sexual abuse of children under the age of 18 years.
Suspicions as stated above in the case of an elderly person who may be subjected to these abuses.
Suspected neglect of the parties named in items #3 and # 4.
If a court of law issues a legitimate subpoena for information stated on the subpoena.
If a client is in therapy or being treated by order of a court of law, or if information is obtained for the purpose of rendering an expert’s report to an attorney.
Occasionally I may need to consult with other professionals in their areas of expertise in order to provide the best treatment for you. Information about you may be shared in this context without using your name.
If we see each other accidentally outside of the therapy office, I will not acknowledge you first. Your right to privacy and confidentiality is of the utmost importance to me, and I do not wish to jeopardize your privacy. However, if you acknowledge me first, I will be more than happy to speak briefly with you, but feel it appropriate not to engage in any lengthy discussions in public or outside of the therapy office.
Alternatives to Therapy: Therapy is not the only option for healing. If you are interested in the exploration of alternatives to talk therapy or feel that talk therapy is not enough on its own to support you in achieving your goals, I am happy to support you in exploration of alternatives. Furthermore, I welcome feedback regarding your experience in session with me, if you at any point in the treatment feel uncomfortable or the need to transition to an alternative provider I am happy to either engage in repair or support you by referring you to alternative providers.
About This Therapist:I offer individual sessions for $160 per hour and couples sessions for $200 per hour. If you experience an unexpected life event or hardship I am happy to offer a sliding scale to support your ability to continue access support services. I work from an integrative approach. My specialties include depression, anxiety, substance abuse, relationship issues, and life transitions. I utilize an integrative approach, but with a foundation in Person Centered and Existential Therapy.
My educational journey started at Sierra College in Rocklin, California where I took my time exploring the field of Psychology and contemplating how I wanted to integrate it into my life. I eventually transferred to Sonoma State University where I discovered home in Sonoma County and stayed. I later pursued a Masters in Clinical Mental Health Counseling at Sonoma State University and went on to obtain licensure as a Marriage and Family Therapist as well as a Professional Clinical Counselor.
I started working in Crisis Residential in 2014 where I provided counseling services to predominantly houseless individuals suffering from dual occurring substance and mental health disorders. From there I moved into Clinical Case Management providing services for adults being released from California Prisons to aid in their successful integration back into society, while also providing therapy for CPS clients, veterans, teens, couples and adults. Eventually I found. my way to Teen Substance Abuse Residential Treatment where I started as an Associate Therapist and eventually became the Clinical Director providing individual, group, and family therapy for teens ages 12-18 while also managing a program and its staff. Along this journey, I spent 30 days in the Alaskan backcountry training as an Outdoor Leader with NOLS which allows me to bring experiences of resilience, teamwork, leadership, and wisdom of the wilderness into my practice.
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