Professional Disclosure 

Counselors are ethically and legally required to provide certain information to client at the beginning of the counseling progress. This is referred to as informed consent and it's a process that protects both clients and counselors. Counselors use professional disclosure statements to communicate the policies and procedures of counseling to clients.  Your professional disclosure statement can be seen as a written document that identifies not only important policies and procedures of your clinical practice, but it is also an opportunity to express your professional identity. Before writing your professional disclosure statement, refer back to your professional identity statement video you made during COUNO 5580 (Introduction to CMHC). You may want to incorporate elements of your professional identity statement within your disclosure statement. Please refer to this reading, Professional Disclosure in Counseling Links to an external site., to expand your understanding of the purpose of professional disclosure in counseling.  

Purpose

The purpose of this assignment is for you to become familiar with the content of a professional disclosure statement through writing your own. This document will be the foundation for class activities designed to help you gain competence in the informed consent process with clients.

Guidelines

Imagine you were recently hired at a community mental health organization as a professional counselor. You will provide services to diverse clients across the lifespan, including kids, teens, and adults. You may also provide couples, family, or group counseling. Your supervisor has asked you to write a professional disclosure statement that you will use in the process of informed consent with your clients.   

Follow the outline below to create your hypothetical professional disclosure statement. If needed, please add sections that are relevant to the population or community you anticipate working with. You can consult your text and other resources for examples.    

Section 1: Clinician Contact Information  

First Name and Last Name, Degree  

Certification and Licensures   

Address and Contact Information  

Section 2: Required Disclosures:  

Disclosure Statement and Agreement for Services  

Section 3: Education, Training, and Experience  

Section 4: Therapeutic Orientation/Philosophy 

Section 5: Purpose and goals of treatment   

Section 6: Benefits, limitations, and potential risks of services 

Section 7: Clients Rights 

Section 8: Counselor Responsibilities 

Section 9: Confidentiality and Professional Records 

Section 10: Mandated Reporting  

Section 11: Communication Policies and Social Media Policies 

Section 12: Supervision   

Identify your supervisor information 

Section 13: Financial Policy Agreement  

Section 14: Anticipation of Litigation and what you will do if subpoenaed   

Section 15: Crisis Contact Information/Emergencies  

Section 16: State specific Complaint Process

Section 17: Termination 

Section 18: Consent for Treatment 

Section 19: Signature Section

Points: 40 ▼See rubric below.