Professional Disclosure Statement Wendy Meisenbach, MA, LPC-I

Professional Disclosure Statement
Wendy Meisenbach, MA, LPC-I
TransActive Gender Center
1631 NE Broadway, #335, Portland OR 97232
Philosophy and Approach
I employ a Cognitive Behavioral Approach to therapy in my work with clients. I
believe that our thoughts and actions heavily influence the events in our lives, both
positive and negative. Identifying and utilizing personal strengths along with learning
new ways of coping and facilitating change can help individuals improve their overall life
and health. Therapy is a collaborative process created in a safe environment with
emphasis on identifying goals, learning new skills, gaining insight and working towards
making positive changes a reality.
Formal Education and Training
I hold a Master’s Degree in counseling from Lewis and Clark College. My major
course work included life span development, group counseling, couples counseling,
treatment planning for children and adults, diversity and social justice, theories and
philosophy in counseling, human sexuality, assessment and diagnosis of mental and
emotional disorders.
I also hold a Bachelor’s Degree in Dental Hygiene from Eastern Washington
University. I have been a registered dental hygienist practicing in Oregon and
Washington for the last twenty-two years.
I have spent the majority of my adult life volunteering for organizations supporting
the LGBTQIA community and providing access to dental care for minority and
disadvantaged populations.
As an intern registered with the Oregon Board of Licensed Professional
Counselors and Therapists, I abide by its Code of Ethics. As an intern, I am
supervised by Sheryl Rindel, M. Ed., L. P. C., N. C. C., which I will be happy to explain.
I understand that I (the client) am fully responsible for the payment of all fees for
services. Checks and cash are accepted forms of payment and are payable at the
beginning of the session. Sessions are $50 for fifty minutes in length or $100 for 100
minutes, unless otherwise agreed upon with the TransActive counselor (and written
below). Sliding scale fees based on income are available.
As a client of an Oregon registered intern, you have the following rights:
To expect that a licensee has met the qualifications of training and experience
required by state law;
To examine public records maintained by the Board and to have the Board
confirm credentials of a licensee;
To obtain of copy of the Code of Ethics (Oregon Administrative Rules 833-100);
To report complaints to the board;
To be informed of the cost of professional services before receiving services;
To be assured of privacy and confidentiality while receiving services as defined
by rule or law, with the following exceptions: 1) Reporting suspected child abuse;
2) Reporting imminent danger to you or others; 3) Reporting information required
by court proceedings or by your insurance company, or other relevant agencies;
4) Providing information concerning licensee case consultation or supervision;
and 5) Defending claims brought on by you against me;
To be free from discrimination because of age, color, culture, religion, sexual
orientation, marital status, or socioeconomic status.
You may contact the Board of Licensed Professional Counselors and Therapists at:
3218 Pringle Rd SE, #250, Salem, OR 97302-6312
Telephone: (503) 378-5499
Email: [email protected]
For additional information about this intern, consult the Board’s website.
Client Signature
Counselor Signature
Date ___________
Date ___________