PROFESSIONAL

DISCLOSURE STATEMENT

Patrick L. Childs, M.A.C.

Education

I obtained my Master of Counseling degree from Wake Forest University in August

of 2016. I graduated with a Bachelor of Arts degree in Psychology from Baylor University in
August of 2007. My formal education has prepared me to do individual counseling with
adults, children and groups. The type of counseling I offer is person-centered and solutionfocused. While I consider my theoretical orientation to be eclectic, I would consider myself
as favoring Cognitive-Behavioral therapy.
Experience

In my masters program and under supervision, I have conducted individual and

group counseling sessions with adults, adolescents and children. I have counseled clients in
settings that have allowed me to practice various skills, techniques and approaches. I have
been a practicing counselor for the past 2 years.
Treatment Philosophy

My counseling philosophy is integrative, which means I pull from a variety of

theoretical approaches. However, three theoretical approaches guide my counseling more

than others. They include person-centered, solution-focused, and cognitive behavioral
approaches. I believe that an atmosphere of trust is integral to the counseling process and I
promote trust through expressions of empathy, authenticity, and unconditional positive
regard. I also believe that negative thoughts and unhealthy behaviors can make a
significant impact on individuals overall wellbeing. Therefore, I emphasize the
replacement of negative thoughts and unhealthy behaviors with more positive thoughts
and productive behaviors.
Session Fees and Length of Service
Individual counseling sessions are 50 minutes in length. Sessions are charged at a
fee of $80.00 per session and due at the time of service. I also can see some clients on a
reduced fee based on a sliding scale depending on family size and amount of household
income.

Confidentiality
All of our communication becomes part of the clinical record, which is accessible to
you upon request. I will keep confidential anything you say as part of our counseling
relationship, with the following exceptions: (a) you direct me in writing to disclose
information to someone else, (b) it is determined you are a danger to yourself or others
(including child or elder abuse), or (c) I am ordered by a court to disclose information.
Use of Diagnosis
Some health insurance companies will reimburse clients for counseling services and
some will not. In addition, most will require a diagnosis of a mental-health condition and
indicate you have an "illness" before they will agree to reimburse you. Some conditions for
which people seek counseling do not qualify for reimbursement. If a qualifying diagnosis is
appropriate in your case, I will inform you of the diagnosis before we submit the diagnosis
to the health insurance company. Any diagnosis made will become part of your permanent
insurance records.
Complaints
Although individuals are encouraged to discuss any concerns with me, you may file
a complaint against me with my supervisor should you feel I am in violation of any of these
codes of ethics. I plan to be under supervision of a Licensed Professional Counselor in the
state of Tennessee (TBD depending on employment status).
I abide by the ACA Code of Ethics, available at
http://www.counseling.org/Resources/aca-code-of-ethics.pdf
To file a complaint against me with the state of Tennessee, please visit:
https://www.tn.gov/health/article/filing-complaints-against-health-care-professionals
You may also contact consumer affairs at 1-800-342-8385

Acceptance of Terms
We agree to these terms and will abide by these guidelines.
Client: _________________________________________________________________ Date:_______________________
Counselor:_____________________________________________________________ Date:_______________________