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   DISCLOSURE STATEMENT

 

Bill Grimsman MA - Healing Ally

619 N 35th St Suite 317

Seattle WA 98103-8659

 

Ph 206 919 1874

E-mail bgcounseling@live.com

 

It is a pleasure to welcome you as a new client or clients. When you choose to work with me you have an ethical right to be informed. This Disclosure Statement therefore outlines many aspects of my practice. The first few sections (1 – 6) describe my professional background, and healing approach.  The middle sections (7 – 11) outline fees and general office procedures.  This is a lengthy document which makes it important for you to take all the time you need to carefully review and understand the content. You will be given an opportunity to clarify anything you do not understand by asking me any questions you might have prior to signing an agreement form.

 

1.  BACKGROUND INFORMATION

    

     Effective Jan 1, 2025 I evolved my practice and began working as a Healing Ally to offer healing counsel utilizing Ancient Wisdom and Spiritual teachings. Please explore this website for details. I am now a well-educated and experienced, practitioner working without government regulatory oversight, which I openly declare. From 2004 – 2024, I was a master’s level psychotherapist, licensed by the State of Washington (#LH 60105476).  I received my master’s degree in clinical psychology from Antioch University Seattle in 2004.  Prior to this I received my Bachelor of Arts degree, also in clinical psychology in 1989 from Eastern Washington University.  I continue to engage in growth activities in varied ways ranging from continuing education classes to individual study. 

 

     Prior to opening my private practice, I was a registered vocational counselor (#8115) for 5 years in the private sector.  I have an additional 5 years' experience working at Eastern State Mental Hospital as a Mental Health Technician.  I interacted directly with patients on a locked legal offender unit.

 

2.  AREAS OF EXPERTISE   

 

     I work primarily with adults on an Individual basis.  Sometimes during the course of our work, you may want a significant person in your life to attend all or part of one or more sessions.  This is always a welcome possibility.  My areas of expertise center primarily around those who are experiencing concern, stress, or anxiety associated with life transitions, relationship difficulties, chronic illness, depression, loss & grief, sexual or gender orientation exploration, trauma, or various addictions (including excessive use of the Internet or electronic mobile devices).  I also have a strong interest in helping facilitate personal growth.  My former occupation as a vocational counselor provided me with experience to assist you during a job transition or to identify a new career path.

 

3.  THERAPEUTIC ORIENTATION

 

     My therapeutic orientation is one of compassion combined with a profound belief in your ability to heal and move forward, becoming ready to experience all life has to offer.  This website describes my current orientation to healing strategies. Historically I was and still am aligned with the teachings of Carl Rogers, who is known to be client (or person) centered.   It is his belief and mine that meaningful change comes from deep within.  It is not something that can be imposed by me as a healing ally, nor are you expected to do it alone.  I strive to provide a professional, caring, and nonjudgmental environment to help us address your stated intentions.  It is through joint participation that we can explore and work to resolve whatever is important to you.  Through our work together I hope to help you find a greater sense of inner peace by coming to better know and live in harmony with your authentic self. 

 

4.  STATEMENT OF TREATMENT

 

    I utilize an Intake Form to gather background information so I can know you better.  It can also be a useful tool to help identify and/or clarify how best to proceed.    A periodic review of our work and future directions will be discussed intermittently.  You are always welcome and encouraged to ask questions about anything that seems confusing or unclear. This website has useful information describing many of my treatment strategies.

 

5. IN-PERSON VS. VIRTUAL SESSIONS

 

    I offer by in-person and virtual sessions. For folks in Seattle some in-person contact is an expectation. For folks out of the area I want to make sure circumstances in your life are stable enough that virtual will be effective and provide adequate support. If you are in extreme distress, I will not offer a virtual option owing to safety concerns. I do not have 24 hr. support available. I do not use Wi-Fi to access the Internet owing to weak security. It is also important to acknowledge that any actions taken over the Internet cannot be guaranteed as 100% secure. I currently utilize the Zoom platform for virtual meetings. I conduct virtual sessions in a private and secure space and expect you will do the same.

 

6. SPECIFIC INFORMATION RELATED TO COUPLES WORK

 

     Couples work looks a little different than Individual work.  My strongest intention is to support both of you equally and to explore ways to strengthen your relationship. Specific support, interventions, and skill building strategies are determined as we work together.  Sessions are almost always scheduled in 1.5 hour blocks of time because there are more voices in the room than with Individual work. This means a session will last at least 1 hour and 15 minutes on the clock, with the final 15 minutes available as needed.  A core aspect of treatment is that as a Healing Ally, I am not a ‘secret keeper.’ This does not mean I will automatically share every piece of information I know about either of you, nor will I promise not to respectfully introduce something I believe is pertinent to the health and wellbeing of your relationship.  It requires love, courage, and commitment to maintain a healthy relationship. I will do my best provide a safe, professional and caring environment to promote this for both of you. 

 

7.  COMMUNICATION

 

Telephone Conversations:  There is an expectation that ongoing phone conversations are not an extension of the type of help I offer.  Occasional (less than once a week) short conversations (usually less than ten minutes) may be appropriate and necessary.  If you have an individual need to make calls more frequently or encounter a crisis in your life after we have started working together it is expected that we will talk about your situation and mutually decide how best to proceed.  I will do my best to meet your needs.  If you experience a crisis and cannot reach me by phone, please call national emotional help line by dialing 988 or 911 for more general help.

 

E-mail:  E-mail may not be used for ongoing communication between us or to schedule appointments.  There can be problems associated with the use of e-mail involving confidentiality as it relates to the Internet.  There are also legal, professional, and ethical concerns associated with using e-mail to convey sensitive information clearly both ways and in a timely manner.  I am happy to discuss this in greater detail if you ask me to do so. 

 

8.  SCHEDULING APPOINTMENTS

 

     All appointments must be scheduled by phone, text or in person during a session.  You can reach me by calling 206 919 1874.  Any calls received after office hours or on weekends will be returned the following business day unless a prior mutually acceptable arrangement has been made.   My phone greeting has the most current information regarding when I return calls.   If you experience a crisis when I am not available and need immediate assistance, please call the national emotional help line at 988 or for more general help, 911.

 

9.  FEES AND INSURANCE

 

Fees: My fee is based on a sliding scale of 0.1% of annual income ranging from $75.00 to $175.00 for each 50-minute session and will ultimately be determined based on a mutual agreement between you and me.  Couples Therapy has an additional $50.00 amount owing to the sessions being longer. You may use any form of digital payments.  Cash remains an ongoing option as well.  Payment is expected after each session.   If advance payment is made and you decide to discontinue therapy sessions your advance payment amount that is in excess of what has been used will be refunded. If you have a need other than this, please discuss it with me so that we can reach a mutually satisfactory agreement.   I can no longer create or sign reports or any forms of paperwork for outside authorities such as employers owing no longer being credentialed. 

 

Billing Your Insurance:  I do not accept any form of insurance.

 

10.  CANCELLATIONS AND MISSED APPOINTMENTS

 

      A 12-hour advance notice is required for cancellation of appointments.  If less than a 12-hour notice is given, ½ of the agreed upon fee will be charged unless it is an isolated incident that is clearly outside your control (such as unexpected car trouble or a serious health issue).  An isolated incident is defined to mean no more than one time per calendar year.  No call/no shows will be charged at the full therapy fee we agreed upon when starting our work together. If you are not present for the first half of a session (without prior arrangement) it is considered to be a missed appointment, and I am not obligated to remain at the office for the second half of it.   If I as your therapist miss or cancel an appointment without notifying you 12 hours in advance your next session will be ½ the agreed upon fee.  If I fail to meet you for our scheduled appointment and did not notify you, your next session is free.  If severe weather conditions occur and the news media advises that it is not safe to be outside, either you or I must call or text but can do so with less than 12 hours advance notice.  

 

11.  TERMINATING OUR MEETINGS

 

     I will support and respect your decision any time during our work together for you to take a break or discontinue our meetings. Please note that my door remains open for those who wish to return, regardless of after a short time away or an extended one.

 

12.  CONFIDENTIALITY

 

     All information revealed to me as your practitioner during a session is confidential and will not be disclosed without your, the client’s written consent with a few legal exceptions.  There are situations when Washington State law requires me to reveal information to third parties with or without your permission.  The following situations describe exceptions to confidentiality:

 

  1. If you intend grave bodily harm to yourself or another person

  2. If a court of law issues a court order requiring me to reveal information that I have about you

  3. If a situation involving current child abuse, elderly abuse or abuse to a developmentally challenged person is revealed by you to me.

 

Even though I am not credentialed I have a responsibility as a citizen to report any circumstances described above.

 

     There is always a possibility we may see each other outside the office.  Confidentiality remain in place between us should we meet.  You are welcome to acknowledge me and I will respond in kind.  I will not initiate a conversation between us outside the office because of respect for confidentiality.   

 

     If I confer with another professional about our work together, I will use vague language so as not to identify you to that professional. 

 

     I also have a colleague who is designated to intervene with my caseload if I should become incapacitated or unable to meet my obligations to you as your therapist.  My colleague would talk with you directly only if a circumstance arose that rendered me completely unable to coordinate with you directly myself.  He or she would text or send a letter to your last known address on file if you could not be reached by phone or text.  Please be aware that this is a highly unlikely circumstance, and no one has access to your file or any specific information that would in any way breech confidentiality between you and me. 

 

     It is important to note that the use of the Internet plus all forms of electronic mobile devices do not allow a 100% guarantee of confidentiality.  I would never knowingly do anything to jeopardize your privacy and confidentiality.  It is also important to note that I utilize standard security control measures on my computer and mobile device that I use for work related communication.  In the world today however, some privacy issues associated with technology are beyond any one person’s control.  Confidentiality and privacy are therefore best maintained by direct face to face meetings at my office. 

 

    

13.  RECORD OF SERVICES

 

     I am no longer bound by Record or Service requirements. I do however choose to keep a log sheet that includes the following: 1. Date of Service 2. Individual or Couples 3. In-person or virtual 4. Fee collected 5. total number of sessions (beginning Jan 1, 2025) 5. A Misc line for anything I need to track using vague language to support confidentiality.

 

14.  DUTY TO WARN OR REPORT

 

     I report instances of abuse (as described in the confidentiality section of this document).  These include any acts that are deemed to be harmful, dangerous, or involve criminal acts intended against another human being or oneself.  It is my ethical duty in these cases to warn individuals who may be directly affected by such intentions.  The following examples describe who may be informed in certain dangerous situations:

 

  1. A family member of a client who is likely to suffer grave personal harm

  2. A family member of a client who intends to harm himself/herself or someone else

  3. Law enforcement officials, hospitals, or child protective services are involved with the situations described above. 

 

     Before informing anyone, who may need to be notified or warned, I will first make every reasonable if deemed appropriate to share my intention to do so with you.

 

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