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. Fees 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] Website: www.oregon.gov/oblpct For additional information about this intern, consult the Board’s website. Client Signature Counselor Signature Date ___________ Date ___________