Colorado state law requires that I provide you with a disclosure statement outlining my credentials as a therapist and your rights as a client. The following statement covers the points on which you should be informed according to Colorado Revised Statute (C.R.S.) 12-43- 214. If you have any questions about the material contained in this statement or about any aspect of your work with me, please do not hesitate to ask.

Education and Training

Art Psychotherapy Intern
Anam Cara Home – Boulder 2004-2005

BA Psychology, Art Studio
University of Kentucky, 1998- 2000
MUDEC Luxembourg 1998
Miami University, 1996-1998

Post Graduate Education

Gottman Relationship Training: MRW
Meg Tuohey, April 2021

Suicide Prevention
Intensive Summit (Pesi), Sept 2021

Elite Mentorship Forum
Peter Sage Academy, Oct 2023

Chakra Intuitive Mastery (and EFT)
Margaret Lynch Raniere, Oct 2023

Sue Wallingford, LPC, ATR-BC

Professional Experience

Expressive Psychotherapist/ Case Manager
Tennyson Center for Children, 2005-2006

Art Psychotherapy Intern
Children’s Hospital Day Treatment 2004-2006

Professional Credentials and Certifications

Licensed Professional Counselor, State of Colorado #4792

Registered Art Therapist #07-023

EMDR Certified

Chakra Intuitive Mastery Program Certified

II. Client Rights and Important Information

The Colorado Department of Regulatory Agencies has the general responsibility of regulating the practice of licensed psychologist, licensed clinical social workers, licensed professional counselors, licensed marriage and family therapists, certified school psychologists, and unlicensed individuals who practice psychotherapy.

The agency within the Department that has responsibility specifically for licensed and unlicensed psychotherapists is the State Grievance Board, 1560 Broadway, Suite 1340, Denver, Colorado 80202, (303) 894-7766.

At your request, you have the right to receive information from me about the methods of therapy and techniques used, the duration of your therapy (if it can be determined), and the fee structure. You may seek a second opinion from another therapist or terminate treatment at any time. In a professional psychotherapeutic relationship, dual relationships or sexual intimacy between client and therapist is never appropriate and should be reported to the State Grievance Board.

Generally speaking, the information provided by and to the client is legally confidential and the therapist cannot be forced to disclose this information without your consent. There are exceptions to this rule, however, and are listed in the Colorado Statutes (Section 12-43-218, C.R.S.). These exceptions will be discussed at any time, and will be identified to you if such situations arise during the course of therapy. You should be aware that, except in the case of information given to a licensed psychologist, legal confidentially does not apply in a criminal or delinquency hearing.

Aspects of my caseload will be discussed with other professionals during peer supervision however, names will be omitted protecting the identity of my clients.

Information provided during the course of therapy is confidential except for situations described above.

If you have any questions or would like additional information, please feel free to ask. For a more in depth description of my policies and clinical approach please read the Office Policies and General information Agreement for Psychotherapy Services form.

I have read the preceding information and understand my rights as a client/patient.