Professional Disclosure Statement

Welcome! I’m pleased you’ve chosen me to meet your counseling and psychotherapy needs. This document is designed to provide basic information about the counseling and psychotherapy process and myself. I completed a Master’s Degree program in Marriage and Family Therapy at East Carolina University in 1993 and a Master’s Program in Education at UNC-Chapel Hill plus a Certification Program in School Counseling in 1978. I am a Licensed Clinical Mental Health Counselor in North Carolina (#4471). I have been working in the counseling-related field since 1993.

Thank you for taking the time to read this document thoroughly,
Deborah A. Burns, MS, LCMHC

Counseling Background 

After 10 years as an elementary school counselor, it became evident, to truly help children that I needed to cultivate stronger families. Consequently, I pursued and received a Master’s Degree in Marriage and Family Therapy. Because I value lifelong learning, self-development and awareness, I continue adding professional dimensions to my work. My latest endeavor, completed last year, was a 2-year Mindfulness Meditation Teacher Certification Program.

I specialize in relationship issues, transitions, grief, loss, and working with individuals and couples. I work with adults of all ages, genders, sexual orientations, and multi-cultural backgrounds. I work with clients throughout the life stages-young adults to seniors.

My overall theoretical orientation is to recognize my clients’ strengths meaning I respect your experiences, your innate wisdom, and your capacity to heal. My theoretical orientation is eclectic (drawing from many different sources) but is primarily interpersonal, humanistic, and cognitive with a background in gestalt therapy and focusing techniques. The contemplative practices of Mindful Awareness and Self Compassion inform my approach to therapy.

Confidentiality


The session content and all relevant materials to the client’s treatment will be held confidential unless the client requests in writing to have all or portions of such content released to a specifically named person/persons. Limitations of such client-held privilege of confidentiality exist and are itemized below:

  1. If a client threatens or attempts to commit suicide or otherwise conducts him/herself in a manner in which there is a substantial risk of incurring serious bodily harm.

  2. If a client threatens grave bodily harm or death to another person.

  3. If the therapist has a reasonable suspicion that a client or other named victim is the perpetrator, observer of, or actual victim of physical, emotional, or sexual abuse of children under the age of 18 years.

  4. Suspicions as stated above in the case of an elderly person who may be subjected to these abuses.

  5. Suspected neglect of the parties named in items #3 and # 4.

  6. If ordered by a court of law.

Occasionally I may need to consult with other professionals in their areas of expertise in order to provide the best treatment for you. Information about you may be shared in this context without using your name or any identifying information.

With Marriage/Couples Counseling

 If you participate in marital, couple, relationship, or family counseling, I will not disclose confidential information about your treatment unless all adult person(s) who participated in the treatment with you provide their written authorization to release such information. 

Litigation Limitation

Due to the nature of the therapeutic process and the fact that it often involves making a full disclosure with regard to many matters which may be of confidential nature, it is agreed that should there be legal proceedings (such as, but not limited to divorce and custody disputes, injuries, lawsuits, etc.) neither you (client) nor your attorney, nor anyone else acting on your behalf will call on me to testify in court or at any other proceeding, nor will a disclosure of the counseling/psychotherapy records be requested unless otherwise agreed upon. Therefore, I will not voluntarily participate in any litigation or custody dispute. I will not communicate with a client’s attorney and will not write or sign letters, affidavits or reports to be used in a client’s legal matters. I will not provide testimony or client records unless compelled to do so by law (a subpoena). Should I be subpoenaed to appear as a witness in an action involving a client, the client agrees to reimburse me for time spent on preparation, travel, court appearances, etc. at the hourly rate of $500.

Fee Schedule and Payment

Initial consultation session fees: 

  • $150 for individual counseling/therapy (75 minutes)

  • $150 for couples counseling/therapy (75 minutes) 

Standard session fees: 

  • $110-$130 for individual counseling/therapy session (55 minutes) 

  • $110-$130 for couples counseling/therapy session (55 minutes)

Payable by cash, Venmo or Apple Pay. Payment or copay is expected on the date of the session.

All other standard professional time including; telephone conversations (other than routine scheduling or appointment changes, or conversations up to 10 minutes), site visits, report writing and reading, consultation with other professionals, release of information, reading records, reading or answering client emails, travel time, etc., are billable at the standard hourly rate, pro-rated in 10 min. increments unless indicated and agreed upon otherwise.

I accept Blue Cross Blue Shield Insurance and will file the claims for you. Please understand that when using an insurance company, a diagnosis will be given. This diagnosis becomes a permanent part of your record.

Cancellation Fee

I respectfully request a 48-hour notice when possible (two business days) when canceling/

rescheduling an appointment) or at least 24 hours’ notice so that I may offer the time to another client and I can avoid charging you a $50 cancellation fee. When a person cancels at the last minute or forgets his or her appointment, it means that someone else does not have a chance for a session.

Counselor Availability and Emergency Procedures

If you need to contact me, leave a message on my confidential voicemail (828) 713-1587. I will typically return your call within 48 hours (two business days). Leaving voicemails or sending texts are preferred options. I check texts more frequently. If you have an urgent need to speak with me, please indicate that fact in a text. On weekends and holidays and after hours, I check my messages less frequently and may only respond to true emergency calls.

In the event of a medical emergency or an emergency involving a threat to your safety or the safety of others, please call 911 to request emergency assistance or go to your nearest emergency room. You may also call the 24-hour Crisis Hotline: 211.

Complaints about my services or me may be filed with:

North Carolina Board of Licensed Clinical Mental Health Counselors
PO Box 77819
Greensboro, NC 27403.

Their phone number is: (844)-622-3572 or (336) 217-6007. 
FAX (336)-217-9450
Email:  Complaints@ncblcmhc.org

According to the American Counseling Association’s Ethical Guidelines, you should first attempt to resolve your complaint with the counselor directly.