Professional Disclosure Statement

Elizabeth Bost White, Counselor-In-Training

Degrees
MA in Clinical Mental Health Counseling, Wake Forest University, Winston Salem, NC- August 2015
BA in Psychology, Wake Forest University, Winston Salem, NC- May 2011
Experience
I have over one year of counseling experience at Wake Forest Baptist Medical Center in the Burn and Trauma
units. I completed a 165-hour practicum experience and a 750-hour internship there providing Post-Traumatic
Stress Disorder/Acute Stress Disorder and alcohol/drug screening and brief intervention, resources for
community mental health support, and emotional support for patients and their families.
Theoretical Orientation
My approach to counseling is person-centered, strength-based, and solution-focused. I believe that a client has
the tools and power within to overcome nearly anything. It is my job to help clients discover all they have to
offer themselves. I also believe that people do not exist in a vacuum; we are a product of a series of external
systems. I am mindful of the impact of these cultural, societal, and familial systems as I meet with clients.
Services Offered Under Clinical Supervision
Pediatric and Adult Burn Trauma Counseling
Individual and Group Crisis Counseling
Traumatic Stress Assessment
Coping with Disability/Mental Illness/Stress
Substance Abuse Screening and Brief Intervention
Pain Management
Mood Disorders
Teaching/Mentoring
Life Transitions
Gender and Sexuality Issues
Sessions
Our sessions will last 50 minutes. I charge $100 per session and accept check or cash at the conclusion of each
session. In special cases, I will work with you on a payment plan and/or use a sliding scale fee. This
arrangement will be determined on a case-by-case basis.
If you have insurance, you are responsible for submitting the reimbursement request.
Some insurance companies will require a diagnosis before they will reimburse clients for counseling services. A
clinical diagnosis is not appropriate for all individuals seeking counseling. If it is appropriate to make a
diagnosis in your case, I will inform you before submitting the diagnosis to the health insurance company. This
diagnosis will become part of your permanent record and be kept confidential.
Confidentiality

What you say in sessions with me will stay between us. There are a few instances where I may need to share
something you have said to me with others. If 1) you ask me to tell someone else, 2) you plan to harm yourself
or others, 3) I suspect elder, dependent adult or child abuse, 4) I am ordered by court, 5) you are a minor, or 6) I
am working with other professionals or supervisors and disclosure is needed to provide you with optimum care.
I like to share some general information about how you are doing in my rounds meetings with the doctors,
nurses, and other health professionals who are working on your case, particularly if I believe the information
will help shape the way they care for you.
I am currently supervised by Dr. Laura Veach, PhD, LCAS, LPC, CCS. As a part of my training as a counselor,
I am required to record some sessions and submit them to my supervisor. In order to record our sessions, I will
need your signed consent (or that of a guardian if client is under the age of 18). These recordings will remain
confidential and be used for training purposes only. Any case documentation and recordings provided will be
destroyed upon the conclusion of supervision.
Feedback or Concerns
If at any time, you feel like I am not providing you with an optimal therapy experience, I ask that you let me
know so that I can appropriately adjust. If you have concerns or complaints, you may file a complaint against
me with the organization below. I abide by the ACA Code of Ethics (http://www.counseling.org/Resources/acacode-of-ethics.pdf).
North Carolina Board of Licensed Professional Counselors
P.O. Box 77819
Greensboro, NC 27417
Phone: 884-622-3572 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 its guidelines.
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Client Signature

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Elizabeth Bost White

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