Disclosure Form for Pastoral Counseling

							Anam Curam Counseling “Soul Care”                                                                            425-830-9614
Pastoral Counseling & Psychotherapy
John Baumann M.Div.

                                                  Disclosure Statement
Welcome to Anam Curam LLC, which means Soul Care in Gaelic. I look forward to our work together. The following
summarizes my approach to pastoral counseling, background and education, and your rights as a client. Please read this
information, along with my Office Policies, prior to our first session.

      Theoretical & Theological Orientation and Therapeutic Approach
My primary professional identity is that of Pastoral Counselor. Pastoral counseling is a ministry of care that integrates the
modern disciplines of psychology and psychotherapy with spirituality, faith, and religious practice. Integrating faith and
spirituality into our work together will be done only at your invitation. My practice is open to all expressions of faith and
spirituality. While I am grounded in a particular faith tradition, a goal of our work together is to discover how your faith
and spirituality can help sustain the healing you seek. However, there may be a set of beliefs not based on spiritual
practice or faith tradition that you may desire to bring to the process of therapy. We will include these should you wish to
do so.
I also welcome clients who are not seeking a spiritual focus as part of therapy. The therapeutic approaches with which I
choose to work are not dependent on spirituality, faith, or religious practice. I believe that therapy offers the opportunity
to focus on deep healing and transformation, as well as respond to specific problems. Therefore, I prefer to use a narrative
model that is adaptable. The first two sessions will focus on identifying the challenge to be addressed and developing a
plan for therapy that is appropriate for you and your situation.
The length and outcome of therapy varies greatly among clients, and depends on goals, motivation, one’s early and current
life situations, and the resources of the client. Some clients seek a process that addresses deeper, underlying issues that
will take longer to work through: six months to 2 years. Other clients seek to focus on a specific issue in a relatively brief
period of time: six to fourteen sessions.
Therapy can be a painful process, especially when focusing on one’s experiences of suffering or trauma. While this
process can be very difficult, I believe that, for many, therapy can be a safe and sacred place to explore one’s own
suffering and questioning—which are integral parts of our humanity. Indeed, often the honest, tender and respectful
processing of these difficult experiences becomes the most transformative part of the therapy process. The promise is that
you will have an active role in determining how this work evolves.
I work with individuals and couples. It is through the telling of your story that the wounds that need to be healed will be
uncovered and the means to heal will be discovered. We will look for patterns of interactions that have developed from
earliest relationships, the impact these relationships have on our internal psychic processes, as well as their impact on our
relationships and functioning in the present. Family relationships and patterns will be explored as part of this process.
Should you wish to focus on a specific goal or situation this narrative approach can be adapted to a narrative solutions-
focused process. I will also introduce and use cognitive-behavioral methods when appropriate.

      Education and Training
I received my Master of Divinity (M.Div.) degree Seattle University in 1998, and my Certificate of Postmasters Study in
Pastoral Counseling from Seattle University in 2009. My Bachelor of Science in Education (BS) was granted by Indiana
University in 1974. I am a Certified Pastoral Counselor in the American Association of Pastoral Counselors. I am a
registered counselor in the State of Washington, # RC00058516.

      Your Rights as a Client
Clients have the right and responsibility to choose the therapist and therapeutic approach that best meets their needs. It is
appropriate for clients to ask questions about their therapist’s background and education, therapeutic methods, the
therapeutic process, and progress. Clients have the right to request a change in approach, referral to another therapist, or
termination at any time. If you have concerns about our work together, it is important for you to raise these concerns so
we can discuss them. If you desire, I can assist you with referrals to other therapists or appropriate resources.



Rev. 12-29-2009
Anam Curam Counseling “Soul Care”                                                                            425-830-9614
Pastoral Counseling & Psychotherapy
John Baumann M.Div.

                                    Disclosure Statement continued (page 2 of 2)
        You Rights as a Client continued
Confidentiality is an integral part of the therapy process. The thoughts, feelings, stories, dreams and other deep
confidences of the heart and spirit that are shared by clients with me will be kept in strict confidence. I will not disclose
the content of your therapy, with any outside parties, unless you and I both believe this will be to your benefit, and then
only with your written permission (for example, if a client and I together determine it would be beneficial for me to
coordinate treatment with the client’s doctor). I do not disclose whether I do or do not see you as a client. Should we
meet in a public setting I will not take the initiative acknowledging we have met. Should you choose to initiate a
conversation with me, however, I will respond appropriately. The only exceptions to this strong commitment of
confidentiality may be the following:
        1)   If I believed that a child, elderly, or disabled person was at risk of abuse or neglect.
        2)   If I felt you were at risk of harming yourself (suicide).
        3)   If I believed others were at risk of bodily harm by you (homicide).
        4)   If there are issues related to my professional conduct.
        5)   I may discuss client cases, with identities concealed , with certain professional counseling colleagues, a
             supervisor of my therapeutic work, or a consulting therapist with areas of expertise which I believe will
             benefit my client. I do this to a) ensure that you receive the highest quality of care and b) honor my ethical
             commitment to be accountable to a group of peers for the way in which I conduct my practice. (I believe that
             these are mutually supportive goals.)
I will never disclose the fact that I see you, or the content of our therapeutic work, to any court of law or attorney, unless
my professional conduct is at issue, or I have been served a subpoena. If your need for therapy includes having a
therapist who will share information in court (e.g., in current or potential divorce proceedings, child custody cases,
sexual abuse litigation, etc.), or for other similar purposes, you will need to seek another therapist. I will be happy to
refer you to another appropriate resource when possible.

             Privacy and Security of Your Personal Information
As of April 14, 2003, new federal regulations for handling of your personal health care information are in effect. These
regulations, HIPAA, Health Insurance Portability and Accountability Act, specifically cover the electronic transmission
of personal health information via the internet, computer fax modem, and telephone keypad. At this time I am not a
covered HIPAA entity. This is because I do not transmit any personal health data via electronic method. My work
is not a medical process, though at times and with your permission I may interface with medical caregivers on your
behalf. State laws that are more stringent than the new HIPAA regulations cover storage and security of your information.
I stringently guard any personal information you share with me and maintain secure office practices. Specifically, I do not
share your information for any reason without your written consent. I follow secure storage procedures as outlined by the
state. I maintain client records electronically on an external hard drive that is encrypted and protected. My computer has
a password, firewall, and is virus protected. I do not correspond with clients by email. If a client emails me, I will not
respond and I will remove it immediately to preserve confidentiality.
You may protect your privacy further by requesting that your records be kept to the minimum administrative records only.
See Washington law, (RCW 18.19.050(1). 97-17-113, WAC 246-810-035), which in its intention is meant to protect your
privacy. You can request this further protection by signing the request on the bottom of the “Receipt of Disclosure”
form.     This means I would keep only an intake form, my calendar, financial records, and very limited notations
regarding the administration of your work in therapy.




Rev. 12-29-2009