Credentials

Professional Disclosure Statement

Barbara Hubbard, MCOUN, MA, NCC, Professional Counselor Associate

Supervisor: Kacy Mullen, PsyD

Ad Lucem Integrative Therapy & EMDR, LLC

                                                         1611 E Barnett Rd, Medford OR 97504

(541) 216-4003

www.adlucemtherapy.com

Philosophy and Approach to Counseling: My treatment philosophy is rooted in cognitive behavioral therapy and solution-focused therapy. While a look into the past may at times be warranted to understand trauma and its far-reaching implications, I aim to focus on the here and now as well as on building a better future based on a holistic approach to mental health, mindfulness, healthy self-esteem, solid boundaries, and thriving relationships. I work with teens and adults on a range of mental health concerns. I provide individual therapy both in person and online. I have a special interest in depressive disorders, bipolar and related disorders, anxiety disorders, and trauma recovery. I believe that my job as a counselor is to help you use your innate capacity to learn and grow. I can help facilitate the healing of your emotional wounds, guide you toward developing healthier coping mechanisms, and support you on your journey to a happier, more grounded, and fulfilled you.

Education and Experience: I hold a master’s degree in clinical mental health counseling from Oregon State University. I graduated with honors in Summer of 2023. My coursework included individual, family, and group counseling, human development, counseling theories and techniques, crisis and grief counseling, appraisal, career counseling, psychopathology, psychodiagnosis and psychopharmacology, addiction counseling, cross-cultural counseling, and 600 hours of direct client contact across six terms of Practicum and Internship. I hold additional certification in trauma therapy and specialize in Eye Movement Desensitization and Reprocessing therapy (EMDR). I am also a nationally certified counselor and on track to become a licensed professional counselor in the state of Oregon. As a Registered Associate with the Oregon Board of Licensed Professional Counselors and Therapists (OBLPCT), I abide by its Code of Ethics. I am supervised by Kacy Mullen, a licensed psychologist and highly experienced mental health provider.

Fees: I accept Jackson Care insurance. The out-of-pocket fee is $180 per hour.

Confidentiality and Informed Consent: The success of a therapeutic relationship requires trust, openness, and implied confidentiality between client and therapist. Information about clients, including case notes and records are confidential and protected by the law. Your clinical records can only be released to third parties with your prior, written consent for release of that information.

In accordance with my professional code of ethics as well as that of the American Counseling Association, in some rare situations, I may be legally and ethically obligated to disclose some confidential information to a third party. These exceptions that limit the confidentiality of our therapeutic alliance are as follows:

1.  You provide consent to release your records or to share information regarding your treatment;

2.  I believe that you may be at risk of imminent serious harm to yourself or others;

3.  I believe that a child, elderly person, or disabled person is being abused and/or neglected.

4.  I receive a court order to disclose information (e.g. child custody or mental competency cases);

5.  You file a complaint with a licensing board or in cases of a malpractice suit in which case records will be released to the Board and/or legal counsel.

These situations are rare but possible. I will make every effort to fully discuss it with you before releasing any information to a third party. Relevant portions or summaries of the state laws and/or the American Counseling Association code of ethics regarding these issues are available for your review if needed.

Professional Boundaries

If we meet outside my counseling office, I will not acknowledge our counseling relationship unless you choose to initiate communication. This is done to protect the confidentiality of our therapeutic relationship. To maintain a healthy and productive counseling relationship, I purposefully avoid social and business interactions with my clients. Such outside relationships have been known to cloud judgment and be detrimental to the long-term success of our therapeutic work and are best avoided.

Sessions

My sessions are typically 53-57 minutes long and are scheduled on a weekly or biweekly basis according to your preference or need and our mutual availability. The initial sessions allow me to get to know you, connect, and evaluate your needs. Once the evaluation phase is completed, we will discuss potential treatment goals and create a treatment plan. The hope is that as we work together toward your specified treatment goals, you will start to experience improvement in functioning across multiple life settings including your relationships and interactions with others.

 After Hours Crisis Line

In the event that you experience a mental health emergency/crisis occurring after my scheduled business hours, please call 1.800.SUICIDE (1.800.784.2433) and/or 1.800.273.Talk (1.800.273.8255). You may also call 911 or go immediately to your nearest hospital emergency room.

If you are deemed an imminent danger to yourself or others, your therapist has a professional duty to contact proper authorities. Medical and/or law enforcement officials may be notified with or without your consent. By signing below, you are stating that you have read and understood the rules of confidentiality.

Signature of Client (or Guardian) ______________________________________________

Date ___________________________

Consent to Treatment

I have read the above and accept the foregoing policies. I certify that I am over eighteen years of age and consent to the above conditions for therapy. I voluntarily agree to receive counseling assessment and counseling services and authorize Barbara Hubbard to provide such counseling assessment, treatment, or services. I have read and understand the information described in this “Professional Disclosure Statement”. I have had the opportunity to ask questions and seek clarification of anything unclear to you. I understand that just as I have the right to initiate and continue treatment, I have the right to withdraw my consent and discontinue treatment at any time. By signing below, I acknowledge that I have read and understand this document and agree with the conditions outlined. This agreement will remain in effect for the duration of the services.

Printed Name of Client: ______________________________________________

Signature of Client:_________________________________________________

Date: _____________________________________

Client’s Bill of Rights [OAR 833-060-0001(4)(h)]

As a client of services offered by a Professional Counselor Associate in the state of Oregon, you have the following rights:

1.      To expect that your counselor has met the minimal qualifications of training and experience required by state law;

2.       To examine public records maintained by the Board and to have the Board confirm credentials of your counselor;

3.      To obtain a copy of the Code of Ethics (Oregon Administrative Rules 833- 100);

4.      To report complaints to the Board.

5.      To be informed of the cost of professional services before receiving services.

6.      To be assured of privacy and confidentiality while receiving services as defined by rule and law, including the following exceptions:

 a. Reporting suspected child abuse.

 b. Reporting imminent danger to client or others.

 c. Reporting information required in court proceedings or by client’s insurance company, or other relevant agencies.

 d. Providing information concerning intern case consultation or supervision.

 e. Defending claims brought by client against the counselor.

7. To be free from discrimination because of age, color, culture, disability, ethnicity, national origin, gender, race, religion, sexual orientation, marital status, or socioeconomic status.

For additional information about this counselor, consult the Board’s website. If you do not feel as though your concerns are being addressed appropriately, please feel free to contact the Oregon Board of Licensed Professional Counselors and Therapists at:

3218 Pringle Rd SE, #120, Salem, OR 97302-6312

Telephone: (503) 378-5499, Email: lpct.board@mhra.oregon.gov, Website: www.oregon.gov/OBLPCT