Brooke Stepp, MS, CN, LMHCA
324 15th Ave. E, Suite 102 — Seattle, WA 98112
phone: 206.414.9365 — e-mail: [email protected]
www.haveheartwellness.com
DISCLOSURE STATEMENT
This disclosure statement and the Washington State Department of Health information titled,
“Counseling or Hypnotherapy Clients” provides you important information about my professional
psychotherapy services and office policies. Please ask questions about this information before signing
this disclosure statement. Please initial all sections to show your agreement to policies, and sign and
date the last page.
About your Therapist:
I am a licensed mental health counselor associate and certified nutritionist with a Masters degree in nutrition
and clinical health psychology from Bastyr University.
Philosophy, Experience and Style:
I offer a holistic approach to counseling and nutrition which is grounded in multicultural, somatic,
existential/humanist, mindfulness and health at every size approaches. My clinical experience has primarily
been focused on the intersections of trauma, body image and disordered eating. I have worked extensively
with LGBTQ+ populations. I am currently in the process of obtaining full licensure in the state of Washington.
My clinical supervisor is Cassie Salewske, MA, LMHC. I am also in the process of gaining competency in
the lineage of Somatic coaching. My supervisor is Nathan Shara, MSW.
Treatment Approach: Healing and transformation of all types is a collaborative effort between client and
therapist and my style reflects this. I have a strong commitment to offering individuals, relationships, and
groups professional clinical services designed to meet their specific needs. To that end, I use a variety of
techniques in therapy, tailoring what I do to what I think will work best for each client. Together we will
gather your strengths and resources and take the direct route to your stress and/or pain. Through our work
you will develop more skill and grace to meet yourself and others in what was once before met with fight,
flight or freeze responses. Many clients find that their emotional range will be increased. With a renewed
connection to your strengths, you will have more ability to listen to and work with these emotions that you
have had difficulty welcoming. We will discern the sensations you feel/don’t feel in your body due the
impacts of trauma and oppression. Using your emotions, mind, and body, what you once experienced as
anxiety and depression will have a different meaning and purpose. Although I cannot guarantee a particular
outcome, I can say that I give my full attention to working with you in a responsible, caring, thoughtful and
professional manner.
Because I work somatically, our work will go beyond the traditional talk therapy paradigm. In addition to
building the narrative of your experience so common in traditional talk therapy, we will also engage in
specific somatic practices meant to regenerate competencies, such as the ability to set boundaries that are
often lost due to the impacts of trauma and oppression.
Because I believe the body is a domain of dignity, learning and action, and that one of the most accessible
roads in to healing is through the body, some of our work may involve physical contact including somatic
bodywork. Somatic bodywork is meant to increase our sense of aliveness, our embodiment, and our choice
and agency. Consent is at utmost importance to me, and you are always at choice in the work we do
together.
Regardless of the length of your therapy, you are most likely to benefit with consistent attendance. At times
you may feel ambivalent about your therapy as the process can sometimes be uncomfortable. These
feelings are important to discuss in our sessions.
Psychotherapy can have benefits and risks. Since therapy often involves being with difficult aspects of your
life, you may experience uncomfortable feelings. While they may be initially uncomfortable, we will together
likely have a positive outcome and understanding of those feelings. Therapy often leads to better
relationships, solutions to problems, and significant reductions in feelings of distress. However, there are no
guarantees of what you will experience.
Confidentiality and Professional Records
Information disclosed within sessions, including that of minors, is kept strictly confidential except when
the following legal limitations apply:
1) Where there is a reasonable suspicion of child or elder abuse or neglect;
2) Where there is a reasonable suspicion that the client presents a danger of violence to others or
where the client is likely to harm themselves unless protective measures are taken;
3) Pursuant to legal proceeding;
4) In the course of my receiving regular professional consultation.
According to the standards of my profession, if you utilize insurance I will keep records of the mental
health services I provide you. If necessary, you may see, copy or correct that record. I do not disclose
any records to others without your written consent, or unless I am mandated to do so by law. If you are
interested in not having any records kept and you are not using insurance we can discuss that as an
option.
I welcome feedback from clients at any and all points of our work together. Please feel free to bring up
any concerns or questions. These conversations are often a very important part of the therapeutic
process. If you feel unsatisfied about our resolution or otherwise find it necessary to file a complaint, you
may do so with the Washington State Department of Health, at (360) 236-4901.
___I use electronic means to communicate with clients including email. I also check my email on my
mobile device. While I have a security app for my mobile device, I cannot guarantee your confidentiality.
Your initials here indicate that you understand the risk and accept this risk when you contact me by
electronic means.
If you do not accept this risk, please only contact me by phone 206.414.9365
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Financial Policy Agreement
Professional services will be provided to you at a fee of 120.00 for a 45-minute session, or 180.00 for 75
minute sessions, or as negotiated. Payment for each session is expected at the time of services
rendered, unless other arrangements are made in advance. I accept cash or check.
___ I understand the fees for service.
___ I understand that provider does not bill secondary insurance, and that I am responsible for the copay at time of service.
Other fees are as follows: Report writing: $60.00 an hour. Court appearance: $200.00 an hour billed
from time of leaving my office to the time of return.
*Rates subject to change
Office Hours and Availability
___ Office hours are by appointment only. Please provide at least 24 hours notice if you need to
cancel or reschedule your appointment. Except in an emergency, clients will be charged the full
fee of the session if less than 24 hour notice is given. I do not work Fridays. If you have an
appointment on Monday, you must cancel no later than Thursday.
If you wish to communicate with me by normal email or normal text message, please read and complete
the Consent for Non-Secure Communications form included with these office policies.
___ Electronic communication such as email and texting is limited to scheduling appointments unless
otherwise agreed upon in writing. If there is a clinical question or concern please contact me by calling
my telephone at 206.414.9365. If there is no written consent between client & counselor, the counselor
will respond to any non-emergent client concerns in session.
Please refrain from making contact with me using social media such as Facebook, Instagram, Twitter,
etc. These methods have very poor security and I am not prepared to watch them closely for important
messages from clients. Furthermore, if you contact me via these means, you are violating your own
confidentiality. I do not “friend, follow, etc.” clients on social media. There are no exceptions to this rule.
My voicemail is confidential and only heard by me. I check my email every 24 hours. If you have an
emergency please respond to my telephone number. Leave me a message if I do not answer (see
Emergency Procedure below).
Emergency Procedure
I check my telephone messages and email every business day (Monday-Thursday). If you need to
speak with me, please call and leave detailed information of where and when I can reach you. I will call
you back as soon as possible. In case of an emergency, please call the crisis line at (206) 461-3222, go
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to the nearest emergency room, or call 911. When stabilized, please call my office number and leave
me a message and contact number. I will contact you as soon as I am able. I do not carry a beeper and
do not provide 24-hour emergency call coverage. I will provide follow-up help as soon as possible.
Please be sure to discuss with me any questions or concerns you have about this emergency policy.
Please note that SMS (normal phone text messages) are not designed for emergency contact. SMS text
messages occasionally get delayed and on rare occasions may be lost. So, please refrain from using
SMS as your sole method of communicating with me in emergencies. Be aware that there may be times
when I am unable to receive or respond to messages, such as when out of cellular range or out of town.
Termination of Therapy
Therapy is a joint effort between therapist and client. In order for the therapy to work, it is vital to keep
the lines of communication open. Please come and talk to me about any concerns you have at any time
during our work together. At any point in treatment you have the right to terminate therapy and receive a
referral to another therapist. Please be aware that a therapist also has the right to terminate therapy: 1)
If a therapist feels that it is in the client’s best interest to be treated by another professional who has
specialized expertise in the area needed by the client; 2) If a therapist feels threatened by a client or they
are being treated abusively by a client; 3) If a client repeatedly attempts to violate the boundaries of the
therapeutic relationship; 4) If the therapist should lose objectivity; and lastly; 5) If a therapist is not being
paid for services.
Washington State Law requires that the following paragraphs appear on this disclosure statement:
“Counselors practicing counseling for a fee must be registered or Certified with the Department
of Health for the protection of Public health and safety. Registration of an individual with the
Department does not include a recognition of any practice standards, nor necessarily implies
the effectiveness of treatment”
“The purpose of the Counseling Credentialing Act (chapter 18, 19 RCW) is (A) to provide
protection for public health and safety; And (B) To empower the citizens of the State of
Washington by providing a complaint process against those counselors who would commit acts
of unprofessional conduct.”
I affirm that I am a certified nutritionist and licensed mental health counselor associate in the state of
Washington in good standing since 2015. My license numbers are: NU60571006 and MC60569464
Signature_______________________
Name___________________________
Date__________________
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