Williams Christian Counseling
Counseling Agreement,
Confidentiality Statement,
and Statement of Information Practices





Counseling Agreement



This is a document very similar to the one that you will read and agree to if you become a client of Williams Christian Counseling. If you have any questions, your counselor will be glad to answer them for you. Federal and State regulations require disclosures of this nature and length for licensed counselors. If you disagree with a term or condition, you will be given an opportunity to note it in the document with your initials. In addition, you will receive a copy of this entire document at the first session.



Williams Christian Counseling

Williams Christian Counseling is a private Christian counseling service founded by Joseph A. Williams on October 16, 1998. Mission Statement: "Williams Christian Counseling exists to meet the outpatient mental health needs of those who value Christianity. Counseling services will be provided with the highest levels of quality and confidentiality." We use a Christ centered counseling approach utilizing the most effective therapeutic approaches such as Brief Therapy, Cognitive Behavioral Therapy, and Perceptual Control Therapy. It is hoped that counseling will encourage your Spiritual growth in Christ. Your counselor will remember you in prayer at least once daily while you are seeing him. You will not be preached to in counseling. The focus of treatment will be on determining goals for successful completion of counseling and discussing strategies to help you achieve and maintain those goals. The duration of counseling is typically less than ten sessions. A session is 30 to 60 minutes, related to your needs and the paperwork required when insurance is involved.



Not Connected with an Agency or Church

Williams Christian Counseling is an independent service not connected or affiliated with an agency or church. Sometimes agencies or churches will graciously provide Williams Christian Counseling office space.



Joseph A. Williams' Credentials

Joseph A. Williams has been a professional counselor since September of 1997. Mr. Williams graduated with his Master of Social Work degree from Southern Illinois University in May of 1999. His concentration was Mental Health with a self- directed focus in Christian Counseling. Mr. Williams is a Board Certified Professional Christian Counselor (B.C.P.C.C.). Certified by the Board of Christian Professional and Pastoral Counselors. Mr. Williams is a Licensed Clinical Social Worker (L.C.S.W.), licensed by the Kentucky board of social work. In Kentucky this license is recognized as a Qualified Mental Health Professional (Q.M.H.P). He graduated in May of 1997 from Harding University, with two bachelor degrees in psychology and human resource management with a minor in computer applications. Harding University is a Christian university located in Arkansas. Mr. Williams was raised in Mayfield, Kentucky. Most important for eternity, Mr. Williams has been a Born Again Christian since January 13, 1980. These credentials, life experience, and a dependence on the Holy Spirit enable him to be an effective counselor.



Agreement to Treatment and Outcomes

I hereby give permission for any counseling, testing, or diagnostic evaluation seen as helpful by Joseph A. Williams of Williams Christian Counseling. I understand that counseling may sometimes lead to unanticipated emotional stress as well as emotional improvement, and that Mr. Williams does not guarantee any particular results or outcomes from the counseling process. I understand further that I am free to discontinue counseling at any time. Statistics of counseling reveal that one of three clients see real and significant lasting change in their lives. The other two out of three may or may not see change. Mr. Williams believes that with the Lord's help anyone can change if they make a commitment to change and if they are willing to do the work.



Understanding of Consultation

I understand that as needed Mr. Williams will consult with another L.C.S.W., her name is Pamela Gentry. Mrs. Gentry is a Christian who has been a professional therapist since 1992. If there is a problem with Mr. Williams' counseling or a violation of confidentiality and I do not feel comfortable discussing it with him, I understand that I can report it to Mrs. Gentry. Her telephone number will be provided to me on paper during the first session.



Understanding that Williams Christian Counseling is not an Emergency Service

I am aware that Williams Christian Counseling is not an emergency 24 hour service. In an emergency, I will call 911 or the mental health crisis line at 1-800-592-3980 to obtain emergency services.



Understanding of Fees, Tardiness, and Cancellation Responsibilities

CASH - Services are to be paid in full when they are provided. Counseling and consulting costs are $120 per session when paid in full by cash or check at the time of service. Payments accepted with a credit/debit/flex/insurance card have an additional charge of 5% due to increased overhead costs. Sessions paid in this manner are usually about 60 minutes.

INSURANCE - I will be responsible for paying $120 per hour until it has been determined by my counselor that my yearly deductible has been met. After my deductible has been met, I will be responsible for paying $30 per quarter hour that goes beyond the covered time, plus co-pays. The dollar amount that my insurance actually pays my counselor, determines the actual length (or covered time) of my counseling meetings. For example, if my insurance pays $60 per meeting, I receive 30 minutes of covered time including paperwork. Services are to be paid in full when they are provided.

I accept the responsibility for the fees and recognize that they do not automatically include services such as written reports, responding to subpoenas, third party consultations, telephone calls, answering emails or other electronic communication, or other related services, which are charged separately, and may not be a part of this agreement. I further understand that it is my obligation to notify Mr. Williams in advance when I must cancel or reschedule an appointment. In the event that I fail to give advance notice to Mr. Williams, I will face a service charge that may be as much as my session rate for counseling. In addition, I understand that if I am tardy for a session, the time will be lost, I will be responsible for the full fee amount, and the session will end at the regularly scheduled time. This section may be confusing and I will ask Mr. Williams for clarification if needed.



Client Bill of Rights

Rights are those things people deserve to have, no matter who they are or what they have done. I have the following rights as a client of Williams Christian Counseling:





Statement Of Information Practices

and Confidentiality Procedures



This statement describes how confidential information about you may be used and disclosed and how you can get access to this information. Please review it carefully.



Use of Confidential Information

I understand that my confidential information will be used by Williams Christian Counseling for two purposes. Those purposes are: (1) to help me reach goals in counseling and (2) to improve the counseling process.



Understanding of Confidentiality

Williams Christian Counseling practices the Golden Rule(Do Unto Others as You Would have Them Do Unto You) when it comes to maintaining confidentiality of client records. No information about me will be released to anyone except when specifically required by law, or with my specific written authorization. I understand that my counselor will keep my records electronically as well as on paper. Most assuredly paper records are secured in a locked file cabinet and electronic records are password protected. My counselor is the only person who will have access to my records. Upon completion of treatment, after a minimum six year period for adults or after reaching the age of majority for minors, my records will be electronically deleted and physically shredded.



Exceptions to Confidentiality

While my therapeutic record is confidential, I realize that there are times when my counselor may be legally or ethically required to release information against my wishes. I understand that my counselor is required by professional ethics and law to report evidence or suspicion of abuse or neglect, with or without client consent, including evidence or suspicions formed in the course of treatment. I further understand that my counselor is required by professional ethics and state law to report threats to physically harm others or ourselves that I, my companions, or members of my family may make, regardless of my or our wishes. I recognize that in rare circumstances my counselor is legally obligated to release information when ordered by a court of law. If I am active in the military, my records may be requested for review by a commanding officer in my unit.



Summary of Exceptions to Confidentiality

If confidential information is released, only a minimum amount of information will be released to comply with Federal or State law. I understand that the following list of uses and disclosures are the only exceptions to my confidentiality that might be made without my prior authorization.



Disclosure Information

I understand that at anytime I may ask for a report from Williams Christian Counseling regarding when and to whom uses and disclosures of my confidential information have been made. In addition, I may ask verbally or in writing for a client copy of my confidential record. These reports or records will be mailed to me within 14 days of my initial request.



Understanding of Surveillance

I am aware that Williams Christian Counseling may have closed circuit video surveillance in all rooms except for the bathroom. I understand that any video recorded while I am on the premises will be saved on a computer, password protected, and maintained confidentially. It is understood that video surveillance is for security, to enable parents to watch their children while in counseling, and to make counseling less likely to be interrupted whenever someone enters the waiting room. Audio surveillance will not be conducted unless notification is given.


Email: joseph@williamscc.org

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Christian Counseling Services

Copyright © 2015, Joseph A. Williams

Williams Christian Counseling
209 E SUNSET DR
MAYFIELD KY 42066-3265
270-247-5667