Amy Benton Moulds, MEd, LCMHCS, NCC, BC-TMH, DAAETS

I am pleased that you have selected me as your counselor. It is important that you read this document in its entirety to ensure that you have a thorough understanding of our professional relationship.

I hold a Masters Degree in Counseling from North Carolina State University (1999) and a Bachelor's Degree in Psychology from Wake Forest University (1994). I am a Licensed Clinical Mental Health Counselor Supervisor (License #3648S) with 22 years of graduate and post-graduate experience. I am also a National Certified Counselor (Certificate #56307), a Board Certified Tele-Mental Health Counselor and a member of the American Counseling Association. I hold Diplomat status with the American Academy of Experts in Traumatic Stress and am a member of the International Society of Traumatic Stress Studies. I have experience working with adults, children, and adolescents in individual, group, couple and family settings. My practice is currently limited to adults and older adolescents (both individuals and couples) who would like assistance with personal, behavioral, emotional, or relationship difficulties.

It is necessary that you understand that counseling entails both risks and benefits, and the practice of therapy is more of an art than an exact science. For this reason, it is impossible to guarantee success or provide a clear estimate of the time required for a client to reach his or her personal goals. I do believe that one of the best indicators of success in counseling is the level of motivation exhibited by the client. By motivation, I am referring to consistency in attending sessions, working on goals outside of sessions, and being open to challenge.

Appropriate professional boundaries are also an essential part of a counseling relationship. Even though counseling sessions may be very emotionally and psychologically intimate, it is important for you to realize that our relationship is professional rather than personal. I will honor these boundaries by maintaining a tolerant atmosphere free from judgment. We will work collaboratively to determine your personal goals and then, select a comfortable path leading toward your chosen destination.

There are many theories that seek to define the counseling experience. I generally operate from a Humanistic orientation, but also use Existential, Insight-Oriented, Somatic Experiencing, and Cognitive-Behavioral approaches when appropriate and helpful. Although I believe that human nature is far too complex to be explained by any one theory, these theoretical approaches to therapy are appropriate and effective for a wide range of problems, including anxiety and depression, trauma, abuse, behavioral problems, and adjustment difficulties. My approach is often somewhat educational and I will occasionally request that you do “homework”, such as logging certain behaviors or journaling, and we may spend time examining your thoughts and challenging irrational beliefs. When appropriate, I teach clients relaxation and imagery techniques.

It is important that you provide your consent for counseling. You always have the right to agree or to refuse any specific treatment or service. Therefore, if you have concerns or questions about your treatment plan or the progress of therapy, you are encouraged to let me know.

 

My regular fee for a 50 minute session is $120 ($135 for the initial assessment). However, for clients who do not have, or do not wish to use their insurance, I also offer sliding scale fees based on your income and ability to pay. The fee for each session is due at the beginning of the session. You may pay with cash, personal check, Visa or Mastercard. Your out of pocket cost should be reported to you by our staff prior to your first session. Fees and coverage for online counseling services may differ.

In the event that you must cancel or reschedule an appointment without a legitimate unforeseen reason, please notify me at least twenty-four hours in advance to avoid being charged $60 for the missed appointment. If you are late for an appointment, I will be happy to see you for the remaining time available, but you will be expected to pay your normal fee.

At this time, I am an in-network provider for most insurance panels. However, you should be aware of the implications of using your insurance versus paying out of pocket for counseling. When insurance companies pay for counseling, they require that a diagnosis be reported, and may only authorize a small number of sessions at a time. If you choose to avoid insurance billing, I am able to ensure that your diagnosis remains confidential, and we will be able to proceed with counseling for a length of time that is agreeable to you. If you choose to file insurance, I will advocate for your best interests and protect your confidential information to the extent that I am able regarding insurance claims filing procedures. I am an in-network provider for many EAP organizations, as well as MedCost, Aetna, United Behavioral Health, Cigna, and Blue Cross Blue Shield plans, and additional plans are pending. We are also happy to file your out-of-network mental health claims. If you have questions about your insurance coverage, please contact your insurance company and our administrative staff, at 919 303-0273 for clarification.

Trust and confidentiality is of the utmost importance in any counseling relationship. Everything we discuss will be kept confidential with only the following exceptions: 1. If I determine that you may be dangerous to yourself or others, 2. If you provide information that leads me to believe that a child (under 18), elderly person, or disabled adult is or has been abused or neglected. 3. If I am ordered by a court to release information about you from your clinical record, 4. If you request in writing that I release information about you. If at any time you have questions about confidentiality or your clinical record, I encourage you to ask.

At any time during business hours, you may reach me or leave me a message by calling 919-303-0273 or 919-272-1388. If you have an urgent need to speak with me, I may be reached more quickly at 919-272-1388. I check my messages often. Although I will try to return your call the same day, I do not provide emergency services. Therefore, if you need immediate assistance after hours and cannot wait for me to return your call, please go to your nearest emergency room, or call Wake County Human Services Emergency line at 919-250-3133. You may also call the Holly Hill Respond Line at 919-240-7000.

If at any time you are dissatisfied with my services, please let me know. I value your input and am committed to maintaining a mutually beneficial practice. If I am not able to resolve your concerns, you may report your complaints to the North Carolina Board of Clinical Mental Health Counselors by phone at 844-622-3572, or you may write to: NCBLPC, Post Office Box 77819, Greensboro,

This disclosure statement is intended to provide you with the information needed to gain your consent to begin counseling services. You always have the right to consent to treatment, and likewise, you have the right to withdraw that consent at any time. By signing below, you are acknowledging that you have read and understood this document. Your signature also indicates that any questions you have about this document have been answered to your satisfaction.

Counselor's Name:  Amy B. Moulds, MEd, LCMHCS, NCC