Jennifer Gross, MA, LMHC by isJvo8d0


									                              Jennifer Gross, MA, LMHC
                            1910 120th Place SE, Suite 103
                                 Everett, WA, 98208
                                 (425) 359-3061work
                                  (206) 300-6644cell

Personal Disclosure Statement
I am providing the following information about myself and the way I conduct
therapy to assist you in making a choice for therapy that benefits you. I
encourage you to ask me questions that would help you determine whether I am
the right therapist for you and/or to understand how I handle every day issues in
my private practice.

Treatment Philosophy
I believe successful therapy is one that enhances an individual’s quality of life.
This could be reflected in an overall increase in functioning in specific areas of a
client’s life, successfully overcoming dysfunctional or unhealthy behaviors, or by
increasing one’s self awareness and ability to live mindfully in the present
moment. When appropriate to the client’s treatment goals, I support my clients in
assessing past experiences on how they inform present day behaviors and
coping with grief, loss, and trauma. Mainly, my therapeutic focus tends to focus
on present day challenges, knowing that behaviors can be maintained by issues
unrelated to how they originated in the past and that learning to cope and finding
joy in the present day is what would best serve most of my clients.

I have found therapy to be the most effective when the foundation is a strong
therapeutic alliance between therapist and client. My goal in the beginning of a
course of treatment is to listen carefully and to ask clarifying questions in order to
understand the complex issues clients bring to therapy. I help the client outline
what outcomes they hope to achieve from the start knowing that having direction
and clarity is key to positive outcomes in therapy. My humor, practical approach,
and wide range of therapeutic experiences are strengths that aid me in this
process. When possible, I prefer to utilize treatment strategies that are supported
by research and best clinical practices. These treatments typically involve
behavioral, cognitive-behavioral, and dialectical behavioral therapies. I have
been extensively trained in these therapies and have many years of experience
in applying them with a diverse range of people. I see myself as a consultant to
the client, facilitating the self awareness, communication skills, and specialized
information and behavior training that helps clients achieve their goals.

I believe that success in therapy is defined by the client. I welcome your
feedback and questions on the process, especially if you are concerned that the
therapy itself is not helpful. I strongly value the client’s full collaboration and
participation in the therapeutic process. I also highly respect the diverse values
and cultural backgrounds of each client, believing that clients are best helped by

            Jennifer Gross, MA, LMHC 1910 120 Place SE, Suite 103, Everett, WA, 98208

learning to live by the values and expectations of the family and community they
live in.

Education, Training & Experience
I am a Washington State Licensed Mental Health Counselor #LH 00005653. I
earned a Bachelor of Science from Syracuse University in 1988, and a Masters
of Arts in Mental Health Counseling from Seattle University in 1998. I have been
a member of the American Counseling Association since 1998.

I began my career in mental health in 1988 as a residential counselor for
developmentally disabled youth with psychiatric disorders. Since that time, I
have worked with adults, youth, and, families who are challenged by mood
disorders, including anxiety and depression; self harm and suicidal behaviors;
eating disorders; learning disabilities and school/work issues; and disruptive
behavior disorders, including ADHD, and drug and alcohol abuse to name a few.
I have provided individual, group, and family therapy in residential treatment
programs, foster care, home-based services, and outpatient clinic settings. For
the 9 years prior to private practice, I was an outpatient therapist in the
Outpatient Psychiatry Clinic at Seattle Children’s Hospital. I specialized in
providing Dialectical Behavioral Therapy (DBT) to adolescents and their families.
I co-facilitated this outpatient program with my colleague, and together we
provided all aspects of DBT therapy: intake, individual counseling, group skills
training, and parent/family consultation. I have also been employed as Adjunct
Faculty in Seattle University’s graduate counseling program and in Argosy
University's graduate and undergraduate counseling programs between 1999
and 2007, teaching a variety of hands on counseling courses to college students.
I opened my private practice in August 2007, initially part time, and then to a full
time practice in 2009.

Fees and Scheduling
I have attached a separate Fee Schedule that lists all my fees. If the information
on my fee schedule were to change during your treatment, you will be given one
month notice prior to any increase. I prefer to be paid co-pays, co-insurance,
deductibles, etc. at the time of the appointment via cash, check, debit or credit
unless special arrangements have been made. If you have any questions
regarding payments, I encourage you to ask. I use a billing service to help
maintain and upkeep client’s records. The biller has no information about your
therapy or specific personal situation, and errors can occur at times. Please let
me know immediately if your bill or account has errors or if you are having
problems with your insurance. I do not want payment to become a barrier to

If you are intending to use mental health insurance benefits to pay for all or part
of your treatment costs, you should be aware that my contract is with you, not
your insurance company. If I am contracted with your insurance company, I will
bill them directly and we can figure out together the co-pays associated with your
            Jennifer Gross, MA, LMHC 1910 120 Place SE, Suite 103, Everett, WA, 98208

plan. You are responsible for knowing your co-pay, co-insurance, deductible,
your general coverage, and, if this applies, the number of sessions per year
allowed on your plan. This is important so we can collaborate together on how to
get the most therapeutic benefit from your sessions, especially if they are limited
by insurance. Most insurance companies can no longer restrict the number of
mental health sessions due to the Washington State Parity Law being passed
into law, which states that an insurance company has to compensate for mental
health services the same way they compensate for general medical services.
However smaller insurance companies or those that are based from other states
may be exempt from the law.

Although I am happy to assist you with acquiring reimbursement from your
insurance company, if I am an out of network provider or not a contracted
provider with your specific insurance, you are financially responsible for all fees.
You should also be aware that there are certain treatment circumstances for
which insurance companies do not provide payment. For example, insurance will
not pay for scheduled sessions where you did not provide 24 hour notice to me to
cancel, and did not show for the appointment.

I will only bill one insurance company that you choose, if you are covered by
more than one insurance company. The client is expected to pay for whatever
co-pay, co-insurance, deductible, etc is the remainder from the primary insurance
company and seek reimbursement from your secondary insurance (and third
party) companies independently, making your own billing arrangements. I would
be happy to provide reasonable documentation to support reimbursement in
those circumstances.

PLEASE NOTE: When we make an appointment, I am committing to hold that
time for you. If you are unable to keep your scheduled appointment for any
reason, please provide 24 hours advance notice or you will be charged the full
amount for the time reserved for you. I make every attempt to stay on schedule
and be respectful of your time. My goal is to start and end the session on time. T

I typically schedule directly in session or via email or text (see below). I do not do
scheduling after 6pm Monday through Friday, during the weekend, or on holidays
and vacations. You are welcome to cancel your appointment during those time
periods, however, if you request to be re-scheduled, I will return your contact
between 9am-6pm Monday through Friday when I have the opportunity to do so.

Phone Calls
The voice mail on my work phone (425) 359-3061 is private and confidential. My
cell phone number 206-300-6644 is the best number for reaching me urgently,
for imminent scheduling, and is also private and confidential. I support and coach
clients in reaching their treatment goals via phone calls, when it is appropriate to
do so, in addition to performing scheduling or other housekeeping tasks. I do not
            Jennifer Gross, MA, LMHC 1910 120 Place SE, Suite 103, Everett, WA, 98208

charge for these types of phone calls. If the phone call is likely to be longer than
15 minutes, it is more appropriate to set up a face-to-face appointment. Therapy
is a complex process that involves both verbal and nonverbal communication.
Therefore, I do not typically provide therapy via telephone. If there were
circumstances where I provided consultation with another provider, with school
staff, or provided 30-60 minutes of therapy to a client who could not come in for
session at my discretion (ie client has highly contagious illness but needs
therapy), I will charge for those calls at my regular rate per the fee schedule. It is
unlikely insurance companies will reimburse or compensate for phone based
therapy sessions of any kind. I will make every effort to clarify when a phone
contact will result in a charge, please feel free to ask me when we are on the
phone. If you need to contact me between sessions and would like me to call you
back, please request that in your message. I check messages on my cell 206-
300-6644 multiple times a day. Please talk to me if you have questions or
concerns about these arrangements.

If you have a mental health emergency, you can also call 911 or the 24-hour
Crisis Clinic at 206.461.3222 or 866.427.4747 (866.4CRISIS).

I support and coach clients in reaching their treatment goals via texting, when it is
appropriate to do so, in addition to performing scheduling or other housekeeping
tasks. This is optional for me and the client, and will be suspended if it appears
to be ineffective or counterproductive to treatment. Therapy is a complex process
involving verbal and nonverbal cues and cannot be effectively provided via
texting. Therefore, if there is a crisis or a complex issue, I may choose to talk on
the phone or in person and avoid text. I will communicate that directly via text if
that situation were to arise. My cell phone is password protected and I am the
only person with access to it. Your texts are private and confidential on my
phone. Please be aware of who might have access or who might read your
personal texts prior to texting me personal information.

Email Communications
I support and coach clients in reaching their treatment goals via email at, when it is appropriate to do so, in addition to
performing scheduling or other housekeeping tasks. This is optional for me and
the client, and will be suspended if it appears to be ineffective or
counterproductive to treatment. Therapy is a complex process involving verbal
and nonverbal cues and cannot be effectively provided via email. Therefore, if
there is a crisis or a complex issue, I may choose to talk on the phone or in
person rather than email chains. I will communicate that directly via email if the
issue were to arise. My computer, email account, and smart phone are password
protected and I am the only person with access to them. Your emails are private
and confidential communications on my phone, computer, and by the security of
my internet email server (Comcast). Please be aware of who might have access
            Jennifer Gross, MA, LMHC 1910 120 Place SE, Suite 103, Everett, WA, 98208

or who might read your personal emails prior to emailing me personal
information. Internet communications can be hacked and I cannot guarantee the
privacy of your information via the internet.

Social Networking Sites
My current policy is that I do not communicate with clients, existing or previous,
on social networking sites, such as Facebook, for any reason.

Adjunct Services
There are some mental health conditions where engaging in other services in
addition to talk therapy are considered current best practice in the mental health
field. For example, for clients struggling with chemical dependency, random
urinalysis to screen for drug and alcohol usage, and support groups are
considered a typical aspect of comprehensive treatment. Another example is with
eating disorders where weight maintenance or purging is a serious safety
concern, and then nutritional support and medical oversight are necessary for
safe and effective outpatient treatment. If during the course of our assessment, I
identify the need for adjunct services in addition to the mental health counseling I
can provide, I will assist you in locating those additional providers who can
provide those services. I encourage you to identify additional providers that are in
your insurance network to mitigate cost. If as the client, you do not want to
participate in additional services or are not ready to have additional services of
any kind, we can discuss the pros and cons of the decision and how it might
impact the likelihood of you achieving your long term goals. There are situations
where refusing to participate in additional services potentially compromise my
ability to help you as a therapist, and I would discuss this with you in a kind and
open manner. If after a lengthy discussion, we cannot find common ground on
the treatment plan and how it will be achieved, I may choose to provide referrals
for new therapists and terminate treatment rather than provide ineffective
therapy. As a client, you always have the option of selecting a different therapist
who would not suggest or require any type of adjunct service to treat your
presenting issues. My goal is to provide a high quality treatment where every
client achieves their long term therapy goals. This is meant to be a collaborative
decision making process where I can provide the psycho-education and context
to help the client make informed decisions that will ultimately benefit them.

Therapy Dog (in training)
I have a therapy dog (in training) at my office most of the time. You are not
required in any way to interact with the dog, and she can easily be secured
comfortably out of sight. If you let me know in advance, I can be sure to have her
secured prior to your appointment times and even secured off site, if that helps
you be the most comfortable during therapy sessions. The dog is small (about 14
lbs), hypoallergenic, and non-aggressive. She is my responsibility to manage, so
please let me know at anytime if her presence makes you uncomfortable, and I
will take care of it without judgment or any negative impact on your services. Her
participation in any therapy session is 100% optional and not a requirement of
            Jennifer Gross, MA, LMHC 1910 120 Place SE, Suite 103, Everett, WA, 98208

receiving therapy services from me. As she is training, I may need to set limits
with her so that she learns to be a calm, soothing, non-intrusive presence in my

Your Legal Rights, Including Privacy & Confidentiality
You have the right both to receive appropriate care and treatment, and to refuse
any proposed treatment. You also have the right to confidentiality, including the
fact that you are or have been a client, except as explained below. This right to
privacy is your most important right as a client. All information that you discuss
with me is confidential and will not be revealed to any other person or agency
without your written permission. There are, however, certain situations in which I
am required by law to reveal information without your permission:

a) where there is reason to suspect the occurrence of abuse or neglect of a child,
a dependent adult, or a developmentally disabled person;

b) where there is a clear threat to do serious bodily harm to yourself or others;

c) in response to a subpoena issued by the Secretary of Health that is associated
with a regulatory complaint;

If you are being seen with another person present (such as a group or family
therapy session), a request will be made that each person respect the others'
rights to privacy, but I cannot guarantee that they will do so. I consult regularly
with other clinicians as part of my clinical development and to provide you with
high quality therapeutic services. If I were to discuss your specific therapy case
while consulting with other clinicians, I will only relate the general information
needed to receive consultation, while omitting the specific details of our work
together. A code is used in lieu of your name. I not share any details of your life
that might identify you. I value your privacy and confidentiality and would only
share the pertinent details that would aid me in providing the highest quality
therapy to you possible. If you have any concerns or questions about this please
let me know.

Contact Information for the Department of Health
Individuals practicing counseling for a fee in Washington State must be either
registered or licensed through the Department of Health. This state credential
does not include recognition of any practice standards, nor does it necessarily
imply the effectiveness of any treatment. The State’s intent in regulating
counselors is to provide a complaint process against those counselors who
commit acts of unprofessional conduct as described in RCW 18.130.180. You
may contact the Department of Health at 360-236-4902, or by writing to
Department of Health, Health Professions Quality Assurance Division, P.O. Box
47869, Olympia, WA 98504-7869. You can request a copy of the acts of
unprofessional conduct, or access this information online at
            Jennifer Gross, MA, LMHC 1910 120 Place SE, Suite 103, Everett, WA, 98208

Your Treatment Contract
Once you have had a chance to read this document and ask whatever questions
may occur to you regarding its contents, I will ask you to sign a copy which
acknowledges that you have received a copy of this document, that you have
had an opportunity to ask questions about it and that you understand it. That
signed statement is our written contract to enter into the therapeutic process.

           Jennifer Gross, MA, LMHC 1910 120 Place SE, Suite 103, Everett, WA, 98208

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