Professional Disclosure Statement - DOC by cPitDSc


									                                           Professional Disclosure Statement

                                            Virginia Terhaar, Ph.D.
                                      1830 NW Riverscape St. #608
                                          Portland, OR. 97209

Credentials: Certified Psychoanalyst (2006)
             National Academy of Certified Clinical Mental Health Counselors (#1525)
             National Academy of Approved Clinical Supervisors (admitted, 1992)
     Oregon Licensed Professional Counselor (#C0044)

Education: Ph.D. Institute of Contemporary Psychoanalysis, Los Angeles, CA., 2011
           Certificate in psychoanalysis, Northwest Center for Psychoanalysis, 2006
           M.S. Counseling, Western Oregon University (summa cum laude), 1978
           B.A. Psychology, Willamette University (Collins Scholarship), 1976

Philosophy: to participate with clients in the experience of developing self, relationships with others,
and making changes in the ways they think, feel or behave. The primary theories I follow are
contextualism, family systems, and contemporary psychoanalytic. As a member of each of the
credentialing organizations listed above, I agree to abide by their Codes of Ethics. As a condition of
licensure renewal, a minimum of 20 hours professional continuing education are completed annually.

Fee: $150. per individual or couples session; $75. per group session

                                                   Client Bill of Rights
Consumers of counseling and psychotherapy services offered by Oregon licensees have the right to:
1) expect that the licensee has met minimal requirements of education and experience as established
by law;
2) examine public records maintained by the Board of Counselors and Therapists, and to have the
Board confirm credentials of licensee;
3) obtain a copy of the state Code of Ethics;
4) report complaints to the Board;
5) be informed of the cost of professional services before receiving those services;
6) privacy, as defined by Oregon rule and law. The exceptions to confidentiality of information
obtained in the course of services include the following: reporting suspected child abuse; reporting
imminent danger to the client or others; licensee consultation and supervision; reporting information
required in court proceedings or by client’s insurance company or other relevant agencies; and defense
of claims brought by client against licensee.
7) be free from being the object of discrimination on the basis of race, religion, gender, sexual
orientation or other unlawful category while receiving service.

                    Board of Licensed Professional Counselors and Therapists
                            3218 Pringle Rd. S.E. #250, Salem, OR 97302

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