2740 E WT Harris Blvd. Suite 100 Charlotte NC 28213

980.202.1183

counseling@ashaktiwellness.com

Last Revised: 09/16/2020

I want to start by acknowledging the courage it takes to comes to counseling. This is the first, important step in seeking help. This document contains information about my professional background as well as the services offered, prices, and your rights in this process. Please review the document carefully. If you agree to the terms below, please sign and return the form to me. If you have any questions about any of the information in this document, I will be happy to discuss them at our next session.  

My Education: I am a graduate student of the Mental Health Counseling Program in the Addictions track from The University of North Carolina at Charlotte. I will be graduating from the program in 2021. I obtained two bachelors degrees from The University of North Carolina at Wilmington in Psychology and Spanish in 2011. 

My Qualifications: I began working with clients in my internship during my graduate studies at The University of North Carolina at Charlotte in 2020. I have 1 year of professional counseling experience. Throughout this time, I have worked with adults particularly the female population on a variety of mental health issues. Some include, homelessness, addiction, grief and loss, and career concerns/job displacement. The population I am working with are addicts, couples, families, and the incarcerated population. 

Although it is not easy to seek professional help, it is my goal to provide a safe space to work through challenging issues while working to improve your quality of life. My theoretical orientation is not specific to one belief. I use a variety of techniques and concepts from various theories while staying true to my core orientation of Existential Therapy, Person-Centered and Reality Theory. From the Existential Theory, I believe that we all make personal choices in our lives that lead us to personal happiness. I believe we are in direct control of our lives and that we have the freedom to choose our path and ultimately our future. These will be issues of the self, personality, philosophy of the mind, meaning of life and personal development. These will be important particularly in individual sessions.

In my family, couples and group counseling I will use Reality Therapy techniques such as focusing on the here-and-now as well as problem-solving techniques and conflict resolution. I believe that connection is powerful and controls many aspects of our lives. This could be family, intimate relationships, friendships or any other relationship in your life. If those connections are weakened or struggling, it affects all other areas of our lives. 

I have core beliefs in these particular theories however I strongly believe that all people are different and unique. What is effective with one person may not hold true to the next. I will pull from different techniques and theories depending on the need of the particular client. 

Though you are seeking help from me, I want to be clear that this is a therapeutic relationship. I want you to feel empowered to tell me if there is something that you feel is not working or that could make the therapeutic relationship stronger. I cannot promise guaranteed results from our sessions but it is my hope that this process improves aspects of your life in some way. You will get out of this process what you put in and I commit to putting in the time and effort to conduct positive change and I hope that you will do the same.

Restricted Licensure: I am a 2021 Candidate for Master of Arts in Counseling (Addictions Concentration) intern. Therefore, I am under the supervision of a Licensed Professional Counselor Supervisor by the name of Ms. Asha Sims. Her License # is S4135. She is the owner of Ashakti Wellness &Yoga, LLC. Ms. Asha Sims, MA, LPCS, RYT-200 can be reached at ashaktiwellness@gmail.com or 980.202.1183.

 

 

Appointments: We can schedule our appointments via phone or in person at the end of a session. We can also schedule a standing appointment. I generally recommend that 50-minute sessions be scheduled at least biweekly to support the continuity and depth of our work together. If, however, this is not workable for you I am open to other arrangements based on your needs.

Payment: I accept cash and credit cards. Fees are due at the end of each session. I currently do not accept insurance.

Use of Diagnosis: I currently do not accept insurance. However, some health insurance companies will reimburse clients for counseling services and some will not. In addition, most will require that a diagnosis of a mental-health condition and indicate that you must have an “illness” before they will agree to reimburse you. Some conditions for which people seek counseling do not qualify for reimbursement. If a qualifying diagnosis is appropriate, a counselor must inform you of the diagnosis before it is submitted to the health insurance company. Subsequently, any diagnosis made will become part of permanent insurance records.

Confidentiality: All of our communication becomes part of the clinical record, which is accessible to you upon request. I will keep confidential anything you say as part of our counseling relationship, with the following exceptions: (a) you direct me in writing to disclose information to someone else, (b) it is determined you are a danger to yourself or others (including child or elder abuse), or (c) I am ordered by a court to disclose information.

Electronic Communications Policy: If you decide to email or text me at ashaktiwellness@gmail.com or 980.292.4018, please be advised that electronic mediums such as email and text messages are not secure. I cannot guarantee the confidentiality with these forms of communication.

Emergencies: In a crisis situation, you may need assistance before an appointed session. If this is the case, please call 911. You may also contact your local emergency room for assistance.

Termination: Termination of therapy should not occur by telephone. Completion is an essential part of the process. For this reason, I strongly suggest that we use one to three sessions to conclude our work in therapy. However, if at any time, you find that this therapeutic process is not meeting your needs, you have a right to request a change in direction or discontinue treatment. If more than 60 days have passed since our last contact and I have not received any word from you, I will accept that as your notice that you no longer wish to continue counseling and that our therapeutic relationship is terminated.

Complaints: Although clients are encouraged to discuss any concerns with me, you may file a complaint against me with the organization below should you feel I am in violation of any of these codes of ethics. I abide by the ACA Code of Ethics (http://www.counseling.org/Resources/aca-code-of-ethics.pdf).

North Carolina Board of Licensed Professional Counselors
P.O. Box 77819 Greensboro, NC 27417
Phone: 844-622-3572 or 336-217-6007
Fax: 336-217-9450
E-mail: Complaints@ncblpc.org

Acceptance of Terms: We agree to these terms and will abide by these guidelines.