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Professional Disclosure Statement

James Michael Harold Germany, Licensed Professional Counselor Associate

Office: (601) 214-5994





  • M.A. in Counseling, Wake Forest University, May 2022




  • As a prospective LPC Associate, I will be practicing under a supervisor once my license is conferred. Clients may contact my supervisor with appropriate concerns.

  • Supervisor Name: *****; Phone:*****; Email: *****


Counseling Background:


As a counselor, I work with individuals of all ages, couples, and families. I have a history of working with children and adolescents with autism spectrum disorder using behavioral therapy. I operate using both goal-oriented and insight-focused approaches to therapy, working with my clients through a lens of compassion and offering direction as needed. Techniques used include acceptance and commitment therapy, cognitive-behavioral therapy, and narrative therapy. Using mindfulness, behavioral approaches, and thought-based approaches, we will work to clarify your therapeutic goals and develop a plan for achieving these goals.


Process and Limitations:


We will determine the length of treatment together according to your needs. Over the course of treatment, we will establish what your goals are for therapy, developing and following a treatment plan to achieve these goals. While the effectiveness of psychotherapy has been demonstrated in numerous studies, it is not guaranteed to be the best fit for everyone. If this is the case, we will develop a referral plan to best suit your needs.


Risks and Benefits:


Psychotherapy and counseling are avenues for change. With these changes you may develop new modes of thinking, new strategies for coping with and understanding emotions, and new ways of viewing and engaging in relationships. These changes yield their own risks and benefits. Risks may include difficult subjects coming up in therapy and changes in how you feel about certain relationships or activities. Benefits may include symptom reduction and increased wellbeing, among others.


Session Fees and Length of Service:


Sessions will last for 50 minutes unless a specific exception is made. Services are provided on a sliding scale ($50-$100) based on clients’ financial circumstances. Payment by cash, check, debit, and credit are acceptable.



Use of Diagnosis:


As an LPC Associate, I do not currently use DSM-5 diagnoses for insurance purposes. I do, however, use DSM-5 diagnoses for documentation purposes and to inform elements of treatment. This diagnosis will be entered on your client file, which is available to you upon request.




Our communication will be submitted to your secure clinical record and is accessible to you by request.  I will keep confidential anything you communicate as part of our counseling relationship, with the following exceptions: (a) you direct me in writing to disclose information to someone else, (b) it is determined you are a danger to yourself or others, (c) I am ordered by a court to disclose information, or (d) it is determined that elder or minor abuse has occurred. In the event of suspected abuse, I am bound by law to report said suspicions to the Department of Family and Protective Services. In the event that you are determined to be a danger to yourself or others, the law permits me to contact the appropriate medical and/or law enforcement authorities.


Distance Counseling:

During the COVID-19 pandemic, we have moved sessions to a HIPAA-compliant telehealth platform for the safety of our clients and counselors. We will continue to assess the risks associated with in-person sessions during this time and reestablish this option as when public health is not at risk.

Social Media:

In order to maintain client confidentiality and bolster my own professional conduct, I will neither follow nor interact with clients on any social media platform.




Although clients are encouraged to discuss any concerns with me, you may file a complaint against me with the organization below should you feel I am in violation of any of these codes of ethics. I abide by the ACA Code of Ethics ( You may also file a complaint or address concerns with one of my supervisors listed above.


Texas State Board of Examiners of Professional Counselors

333 Guadalupe St, Tower 3, Room 900

Austin, Texas 78701
(512) 305-7700
800-821-3205 (24-hour, toll-free complaint system)



Acceptance of Terms:



We agree to these terms and will abide by these guidelines.



Client:  ___________________________________________________   Date: ___________


Counselor:  ________________________________________________   Date: ___________

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