Triangle Family Services
Lifescapes Counseling Associates, PLLC
1091 Pemberton Hill Road, Suite 102
Apex, NC 27502
919-303-0273
CONSENT FOR TREATMENT BY INTERN
The best way for an aspiring counselor to develop sound therapeutic skills is to provide counseling services under the watchful eye of a more seasoned, licensed counselor or therapist. In fact, direct supervised counseling experience is required of all accredited clinical graduate school programs, and additional supervised experience is required for acquisition of a license to practice.
Occasionally, the clinical staff at Lifescapes has the opportunity to work with and train a qualified intern or recent graduate seeking appropriate licensure. We feel very strongly that this process is necessary and helpful, and regard the supervision process as a fundamental aspect of counselor training and a serious responsibility. We also appreciate the fact that interns can provide quality, supervised services to consumers at a lower cost than would otherwise be available.
As you consider beginning treatment with a supervised intern or recent graduate, please keep in mind that while experience is invaluable, an effective counseling experience depends more heavily on the quality of fit between therapist and client. Please also note that your intern therapist will be involved in consistent individual supervision with a primary clinical supervisor (licensed mental health professional), bimonthly peer supervision staffed by our licensed clinical team, impromptu individual supervision and consultation by other licensed staff clinicians, as well as appropriate supervision within their academic community. All interns and recent graduates also carry individual professional malpractice insurance, and are happy to discuss with clients their experience, credentials, and status as a student of counseling. Your therapist’s supervisor is: ______.
If you choose to begin treatment with an intern counselor or recent graduate, please also understand that you might be asked to allow your session(s) to be either audio taped, video taped, or directly observed by an appropriate licensed supervisor. If you choose to allow your therapist to be observed or your session to be recorded, be assured that the person observing/reviewing the session must maintain your confidentiality, and is obligated to abide by the relevant code of ethics and HIPAA privacy guidelines.
Your signature below indicates that you have read the above information about treatment provided by interns and recent graduates, and that any questions about your treatment have been answered to your satisfaction. You may withdraw your consent for treatment by an intern at any time. Please feel free to direct any questions or concerns about your treatment to our Practice Director, Amy Moulds, MEd, NCC, LPC.
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Client signatureDate
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Parent/guardian signature (if client is a minor)Date
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Counselor signature (Intern or recent graduate)Date