SUMMARY OF INTAKE DOCUMENTS
James Fitzgerald, MS, NCC, LCMHC
PURPOSE OF THIS PAGE
This online form should be considered electronic communication outlining the terms and conditions of therapy and the practitioner’s qualifications and credentials. The forms you need to sign will be available through the client account portal. All forms, documents, and assessments will be managed directly out of my electronic health records software, Therapy Portal, and Therapy Notes, LLC. Once you sign them, they are returned to me electronically and are part of your permanent electronic medical record.
The intake forms on this website are for informational purposes only and do not constitute a legally binding agreement. You will need to be registered and logged into the website as a therapy client to view the pages. The forms you receive from an encrypted software service and electronically sign are the legal client records documents. The intake forms you sign electronically are protected health information and are covered by HIPAA regulations and VT state rules.
The Purpose of Therapy
HOW I APPROACH THE WORK
Psychotherapy can be a rewarding, challenging, and, at times, uncomfortable process. In a safe, supportive space, I may ask you to stay in and experience the full range of your emotions, thoughts, and sensations, in order to build mindfulness, distress tolerance, and emotional regulation skills. Successful therapy usually means learning how to relate to our lives in ways that cultivate growth and health, while becoming aware of and reducing habitual patterns that cause suffering. This is a collaborative process where we work together. Together we will focus on feelings, thought processes, and physical sensations, in order to support positive relationships, emotional health, and increased awareness and empowerment. I will provide support, feedback, treatment ideas, diagnostic information, suggestions for reading/education, referrals as needed, and a space for you to explore all of the above. Please remember that psychotherapy is a process based on communication and a deepening level of trust, safety, and connection.
METHODS AND DURATION
My approach to treatment pulls from a combination of humanistic, existential, cognitive, and mind-body integration perspectives. The specific treatment methods I use and the duration of psychotherapy will depend on your history, current circumstances, the issues we explore, and our mutually-established goals for therapy. I believe counseling is a collaborative effort, which is successful with an individual’s energy, courage, and commitment to look deep within. In our first meeting we can discuss your goals for therapy, and explore the therapeutic path you are interested in. Together we will formulate a treatment plan (therapy action plan) that works the best for you.
I provide ongoing therapy for individuals who are interested in deepening their understanding of themselves, as well as their relationships, goals, and patterns. I offer guidance and support with relational issues, anxiety, depression, personal transitions, suppressed creativity and vitality, gender identity, sexual orientation, religious values, and body image and eating issues. I offer traditional talk therapy, as well as an additional option to work with mental health concerns by incorporating mindfulness practices, guided meditation, and integral life planning. I work collaboratively with other alternative approach professionals to provide continuity of care across all of life’s domains. These methods can complement talk therapy and allow for a fuller exploration of the root of symptoms. Regardless of the treatment methods used, the focus will be on empowering you to make the changes you wish to make in your life. Please feel free to ask me any questions you may have about my experience, training, methods used, collaborative partnerships, or duration of treatment.
IN BETWEEN SESSIONS
At some point during our work together, you might want to take what you are working on in therapy sessions and apply it in your everyday life. This can be especially challenging given the nature of our society and culture. Can you make a commitment to yourself, and treat yourself as important or even more important than anyone else, your career, your responsibilities, and your family? At some point I may ask you to read books, complete workbooks, watch videos, listen to podcasts, journal about your experiences, and practice skills in the real world. In other words, practical application of the skills you will learn in therapy. I will try not to call this “homework assignments.” Can you make the time to work on yourself?
Appointments and Cancellations
Sessions are typically 50 minutes long and may be scheduled once a week, every other week, or on an as-desired basis. Sometimes sessions will be more or less frequent. My cancellation policy is as follows: Once your appointment time is scheduled, that spot is reserved solely for you. I require a 24-hour notice of cancellation, with the exception of emergencies and sickness. If you do not provide a minimum of 24 hours, you will be charged a $30.00 missed appointment fee for your appointment. This is primarily due to the difficulty of filling the vacated spot in such a short amount of time. I often have a waiting list of individuals interested in scheduling an appointment, and with 24 hours’ notice, I am more likely to be able to fill the spot. Your understanding is greatly appreciated. Insurance companies will usually not cover this missed appointment fee, so it must be made out of pocket.
Fees and Payments
Please feel free to discuss payment questions or problems with me if you anticipate any difficulties. I accept VT State Medicaid, Cigna, MVP, and Blue Cross/Blue Shield. Sometimes other insurance companies that I currently do not contract with will also reimburse; you can ask me if you are unsure about out of network benefits. If I am out of network on your insurance, I can provide you with a superbill to submit for reimbursement.
Additionally, I offer a sliding scale for my psychotherapy services. If your insurance plan changes, please notify me of that change. There will be a $30 fee for all returned checks. In addition to weekly appointments, it is my practice to charge the set amount on a prorated basis for other professional services you may require such as report writing, telephone conversations over 15 minutes, attendance at meetings or consultations with other professionals which you have authorized, preparation of records or treatment summaries, or the time required to perform any other professional services you request. If you become involved in a litigation which may require my participation, you will be expected to pay for the time required.
Confidentiality
Information disclosed in psychotherapy is confidential. If you and I decide together that it would be wise to enhance your treatment with another practitioner, we will sign an Authorization to Release Information that would allow me to disclose necessary information to the individual(s).
The limits to confidentiality are the following:
1) If you are using health insurance, many insurance companies require treatment plans and diagnostic information before payment will be made. Your name and a certain amount of identifying information will need to be given. You will need to sign an authorization for me to file claims with your insurance company. Occasionally, insurance companies will conduct chart reviews and/or audits, and may request records from me.
2) If, in my clinical judgment, I determine that you are in imminent danger of hurting yourself or another person, and no safety plan can be established, I am required to alert emergency and/or crisis services.
3) I am legally required to report situations which involve abuse or neglect of children, adults who are incompetent, or adults who are physically or mentally disabled. This includes providing alcohol and/or drugs to minors, using drugs in front of minors, or using drugs while pregnant.
4) I am legally and ethically required to report threats made toward others to the person being threatened and the proper authorities.
5) I am legally and ethically required to report property damage or threats of property damage.
6) I am legally required to submit records requested by a court of law, signed by a judge.
Contacting Me / Emergencies
I am not available for after-hour emergencies. For adults experiencing a mental health emergency, please call Howard Center Mobile Crisis at (802) 488-6400. For minors experiencing a mental health emergency, please call First Call at (802) 864-7777. I am often not immediately available by telephone. I do have voice mail and email that I check frequently. You may also send me an SMS text message or chat message through my client engagement app ‘Quenza’. I will return calls, texts, messages, and emails within 48 hours, with the exception of weekends and holidays. If you are difficult to reach, please leave me times you will be available.
If I am unable to continue with my private practice as a therapist, due to unforeseen circumstances, such as death, terminal illness, or accident, you will be provided a list of therapists you can contact to continue services from my designated agent Caryn Connolly, who has signed a HIPAA compliant business associate agreement. You will also be provided a list of directory services to search for a temporary or permanent therapist. You may also reach out to either of my clinical licensure supervisors, Caroline O’Connor, LCMHC, or Callia Zimmerman, LICSW, LADC.
Electronic Communication
This online form can be considered electronic communication. A more secure version of this document will be included in the Consent for Services via the Client Therapy Portal system Therapy Notes LLC. I need your written permission to send and receive encrypted and unencrypted emails to you from my business email accounts. I need your permission to send and receive SMS texts over cellular phone networks, and to send messages through a chat feature on the therapist’s client engagement app and client portals. I need your permission to offer you access to my private members only client engagement area of my website. You are providing your implied consent to electronic communication via the public website and blog by visiting and interacting with the public pages and forum. If you interact within the public areas of the website, confidentiality and privacy are not guaranteed.
Occasionally, it is convenient to communicate with clients via email and text. It is convenient for me to send links, articles, documents, and therapy worksheets electronically as well as email reminders and text reminders for upcoming appointments. It is also convenient to allow for electronic payments of account balances over Jituzu, Square, Pay Pal and Venmo. I regularly send out payment requests over the Venmo app, and invoices through Jituzu and Square client account management websites. I also will encourage new clients to register on this website and the client portal through Jituzu and MyClientsPlus. You may receive an invitation to the portal and/or invoice reminders from Caroline O’Connor, Inner Resources, and/or James Fitzgerald Therapy, PLLC.
To communicate with you and transmit data to you over electronic platforms, email programs, and text, you must provide your consent, recognizing that electronic communication is not a secure form of communication. There is some risk that any protected health information that may be contained in an email/text message may be disclosed to, or intercepted by, unauthorized third parties. I will use the minimum necessary amount of protected health information to respond to your query.
Communication technologies must never replace the crucial interpersonal contacts that are the very basis of the client-psychotherapist relationship.
Client-psychotherapist electronic mail can be defined as computer-based communication between therapists and clients within a professional relationship, in which the therapist has taken on an explicit measure of responsibility for the client’s care. These guidelines do not address communication between professionals and potential clients in which no ongoing professional relationship exists.
Communication Guidelines
- I will return emails/text messages as soon as possible within 24 hours of receipt during business hours. If I am on vacation, emails/text messages may or may not be returned until I return.
- All email/text communication will be retained in electronic copies for the term applicable to paper records. I will back-up all communication weekly.
- Therapeutic communication (sensitive subject matters) should be kept at a minimum. Please call to set up an appointment for therapeutic matters.
- E-mail/text correspondence will not be used to establish a patient-psychologist relationship. E-mail/text messages should supplement other, more personal encounters. Without the benefit of face-to-face interaction, email/text messages can be misinterpreted in tone and meaning.
- Email/text communication to schedule, cancel, or change an appointment is acceptable. I cannot guarantee I will reply before the scheduled appointment time if you cancel an appointment.
- Please put in subject line the nature of the communication (e.g., appointment, advice, billing question), and please make sure your name and/or identifying information about the client is in the body of the message.
- Please be concise in your email/text message. If the matter cannot be written in a concise fashion, please call to schedule an appointment.
- You will be reminded if you do not adhere to these guidelines.
- Encrypted messages are the most protected form of communication. I use an encrypted email service. Venmo transactions should have privacy settings and not shared publicly. Square is secure and private for payment services but is not encrypted. My computers are password protected.
- Your email/text message will not be forwarded to a third party without your expressed permission, unless you have already signed a release for me to communicate with a professional.
- I am the only one with access to my email address and/or mobile number. I will double-check all “To” fields prior to sending messages.
A. General electronic communication risks include but are not limited to the following:
- Email/text messages can be immediately broadcasted worldwide and received by many intended and unintended recipients.
- Recipients can forward email/text messages to other recipients without the original sender’s permission or knowledge.
- Users can easily send an email/text message to the incorrect address.
- Emails/text messages are easier to falsify than handwritten or signed documents.
- Backup copies of email/text messages may exist even after the sender or the recipient has deleted his or her copy.
- Public setting Venmo transactions are discouraged; you may inadvertently breach your own protected health information privacy.
B. Specific electronic communication risks include but are not limited to the following:
- Email/text messages containing information pertaining to a patient’s diagnosis and/or treatment must be included in the patient’s medical records. Thus, all individuals who have access to the medical record will have access to the email/text messages.
- If you are sending email from your employer’s computer, your employer does have access to it.
- While it is against the law to discriminate and Vermont subscribes to a “no cause” termination policy, an employer who has access to your email can use the information to discriminate against the employee. Additionally, the employee could suffer social stigma from a workplace disclosure.
- Although practitioners will endeavor to read and respond to email/text correspondence promptly, they cannot guarantee that any particular email/text message will be read and responded to within any particular time frame.
- C. Conditions for use of electronic communication: All email/text messages sent or received that concern your diagnosis or treatment or that are part of your medical record will be treated as part of your PHI. Reasonable means will be used to protect the security and confidentiality of the email/ text messages. Because the security and confidentiality of email/text messages cannot be guaranteed and involve the risks outlined above, your consent to email/text correspondence includes your understanding of the following conditions:
- Your email/text message will not be forwarded outside my office without your consent or as required by law.
- Though all efforts will be made to respond promptly, this may not be the case. Because the response cannot be guaranteed, please do not use email/text messaging in a medical emergency.
- You are responsible for following up with me by phone if you have not received a response.
- Medical information is sensitive and unauthorized disclosure can be damaging. You should not use email/text messaging for communications concerning diagnosis or treatment of AIDS/HIV infection, other sexually transmitted diseases, mental health, and developmental disability or substance abuse issues.
- Since employers do not observe an employee’s right to privacy in their email system, you should not use your employer’s email system to transmit or receive confidential email.
Informed Consent to Electronic Communication
- If you consent to the use of email/text messaging, you are responsible for informing me of any type of information that you do not want sent to you by email/text message other than the information detailed in Section B.
- You are responsible for protecting your passwords and access to your email account/mobile phone and any email/text message you send, or you receive from James Fitzgerald, MS to ensure your confidentiality. Your therapist cannot be held liable if there is a breach of confidentiality caused by a breach in your account’s security.
- Any email/text message that you send that discusses your diagnosis or treatment constitutes informed consent to the information being transmitted. If you wish to discontinue email/text correspondence, you must submit written consent informing me that you are withdrawing consent to email/text correspondence.
Telehealth/Telemedicine Service
Telemedicine describes the use of audio and video technology to conduct counseling or other medicine at a distance. This will allow us to meet when it is not possible for us to meet in person in my office. While conducting telemedicine counseling, I use a secure connection and an online platform that complies with federal health privacy laws. I will give you a link to access this platform via email and this form. You will be able to access our telemedicine appointment with a smartphone, tablet, or computer. Our connection will be most successful if you are connected with reliable high speed internet. Telemedicine allows us to maintain a connection when it would otherwise be impossible. There are also risks to this kind of counseling, including technical difficulties such as connection interruption or unauthorized access. There is the possibility that our internet connection could be too weak to proceed with our session, resulting in an inability to communicate. In this case, either one of us may choose to end the session. There is always the possibility that our connection confidentiality could be breached, though this is very rare. All laws and regulations that apply to in person counseling also apply to telemedicine. An additional regulation in Vermont is that it is illegal to record or tape our sessions without consent, either by client or counselor. If you plan on using your insurance to pay for counseling, it is your responsibility to be sure that it will cover telemedicine. You are responsible for payment in the event that your insurance does not cover telemedicine, or if your coverage changes over time.
Telehealth/Telemedicine Instructions
I use multiple platforms for telemedicine sessions. Zoom professional is the primary platform, because of its security features, stability, and reliability. I will send you a link to the meeting each week before the session. I also use the videoconference applications “Sessions” from Psychology Today and “Jituzu” videoconference from My Clients Plus. I recommend rehearsing getting into the platforms before the time of our first appointment. Closing other programs on your device and turning off the internet on other devices may increase your connection speed. I recommend finding a quiet space, free from distraction for our appointment. It is best if no one else has access to this space for the duration of our appointment; a room with a door is requested. Headphones can also be helpful. If our connection is disrupted or distorted, we can try again by exiting the platform and entering again. If we try a number of times and are unable to connect appropriately, we can try an audio only call for the remainder of the session.
Public Disclosure
The State of Vermont’s Office of Professional Regulation and Board of Allied Mental Health Practitioners requires that all clinical mental health counselors provide their clients with information regarding what constitutes unprofessional conduct and who to contact in the instance that they wish to file a complaint. Professional Licensed Counselors are also required to give information about their professional qualifications and experience. My information is listed here. Each client must review this information and verify with me that they have reviewed the contents of this disclosure, no later than the third counseling session.
Education
College of St. Joseph, Rutland, Vermont
Undergraduate
June 2017: Bachelor of Art in Psychology. (Cum Laude)
Courses of Study
Spring Semester 2013: Health Science; Philosophy; English; Business & Consumer Mathematics
Fall Semester 2013: Introduction to Statistics; Introduction to Psychology; Introduction to Sociology; Literature
Spring Semester 2014: Public Speaking; Seminar in Effective Living; Effective Writing; Research Methods; Principles of Learning; Human Development
Fall 2014: Writing for the Web; Website Development; Trauma & Grief; Forensic Science
Spring 2015: PTSD Survey; Foundations of Alcohol & Drug Abuse Counseling; Drugs and Society; Art Appreciation; Abnormal Psychology
Summer 2015: Ethics in Psychology; Statistics & Probabilities; Physical Fitness Training
Fall 2015: Theories of Counseling; Moral Issues; Cosmic Horror (Arts & Entertainment); Field Experience (Rutland Mental Health Services); Neuroscience
Spring 2016: Religion and Society; Crime in the Media; Introduction to Human Services; Health Psychology
Fall 2016: Research Methods; Organizational Psychology; Introduction to Criminal Justice; Culture and Community; History of Psychology
Provider Scholarship
As a scholarship fund recipient I was required to complete community service hours to give back to my community. I helped with events such as: the annual Easter Egg Hunt; the annual trick or treating Halloween event; fundraising for Dismas House; Bingo with residents at the Bardwell House; and I organized a public screening of “The Anonymous People.”
University of Vermont, College of Social Services & Education. Burlington, VT
Graduate
August 2020: Master of Science in Clinical Mental Health Counseling. (CACREP Accredited Program)
Courses of Study
Fall 2018: Human Development; Ethics; Counseling Theory; Lab Experience
Spring 2019: Diagnosis in Counseling; Practice of Mental Health Counseling; Counseling Practicum; Diversity Issues; Group Counseling
Summer 2019: Psychopharmacology; Research Methods
Fall 2019: Child & Adolescent Counseling; Family & Couples Counseling; Advanced Group Counseling; Internship (Central VT Substance Abuse Services)
Spring 2020: Assessment in Counseling; Addictions Counseling; Career Counseling; Internship (Central VT Substance Abuse Services)
Summer 2020: Trauma Informed CBT for Veterans; Postpartum/Perinatal Mental Health; Internship (Central VT Substance Abuse Services)
VT State Licensing Examinations
May 2021: Passed the National Counselors Examination (NCE). National Certified Counselor (NCC)
October 2022: Passed the National Mental Health Counselors Examination (NCMHCE)
National Board of Certified Counselors (NBCC). Center for Credentialing & Education (CCE)
October 2020: Passed the Alcohol & Drug Counselors Examination (ADC). Apprentice Addiction Professional (AAP)
2023 (TBD): Take the Advanced Alcohol & Drug Counselors Examination. Advanced Alcohol & Drug Counselor (AADC)
International Certification & Reciprocity Consortium (ICRC).
Work Experience
James Fitzgerald Therapy, PLLC (Private Practice)
May 2023 – present:
Master’s of Science, National Certified Counselor, Addiction Subspecialty, Licensed Clinical Mental Health Counselor
James Fitzgerald Therapy, PLLC (Private Practice)
July 2021 – May 2023:
(Pre-Licensed) Master’s Level, National Certified Counselor, Apprentice Addiction Professional, VT Roster of Psychotherapists
Baymark Health Services (BAART Programs)
August 2020 – June 2021
(BAART Programs) Master’s Level, MAT Counselor, Apprentice Addiction Professional
University of Vermont Medical Center
September 2017 – December 2020
(Inpatient Psychiatry) Master’s Level, Mental Health Technician, CPR/AED Certification, MOAB & ProAct Certified
Central Vermont Substance Abuse Services
August 2019 – August 2020:
(One Year Internship) Bachelor’s Level, Intensive Outpatient Program – Group Clinician, Adult Outpatient Program Clinician
Rutland Mental Health Services (Community Care Network Family Assistance Grant) ARIS Administrator
June – September 2017
Life Skills Support Worker for an Adult on the Autism Spectrum
Rutland Mental Health Services
(Maplewod Residential Program) (Crisis Stabilization Inpatient Diversion Program)
September 2015 – June 2017
Crisis Support Specialist, Residential Recovery Specialist, Site Safety Coordinator, Group Facilitator
Rutland Mental Health Services
(Maplewod Residential Program) (Crisis Stabilization Inpatient Diversion Program)
September 2014 – September 2015
Peer Support Services & Community Programs Coordinator
Vermont Psychiatric Survivors – Outreach Program
June 2013 – March 2015
Peer Support Specialist, Recovery Coach, Wellness Recovery Action Plan Facilitator, Intentional Peer Support Certified
Turning Point Center for Rutland County – Volunteer
September 2012 – June 2013
Support Staff, Group Facilitator, Meeting Chairperson, Front Desk Staf
.
Training: Certificates
February 2023: Sleep: An Overview (Online Course) (CE4Less)
Instructor: Jassin M. Jouria, MD
NBCC ACEP Number 6991. CEU: 1 Clock Hours (Online); Test Completed: 2/4/2023; Score 100%; Program Created: 2017 (Course Completed)
February 2023: Self Study Course | Counseling Theories – Addiction and Clinical Mental Health Counseling
(Certificate) (Online Course) (All CEUs – Counselor’s Toolbox Podcast)
Instructor: Dr. Dawn Elise-Snipes, PhD. LPC-MHSP.
CEU: 2 Hours (Online); Test Passed 2/4/2023; Certificate Course Completed
January 2023: Self Study Course | Health Coaching – Comprehensive Case Management
(Certificate) (Online Course) (All CEUs – Case Manager’s Toolbox Podcast)
Instructor: Dr. Dawn Elise-Snipes, PhD. LPC-MHSP.
CEU: 2 Hours (Online); Test Passed 1/30/2023; Certificate Course Completed
January 2023: Self Study Course | 3-Day Dialectical Behavior Therapy Certification Training
(Certificate) (Online Course) (PESI) (Evergreen Certification Pending)
Instructor: Lane Pederson, PsyD, LP, DBTC
CEU: 20 Hours (Online); Test Passed 1/13/2023; Original Program Date (11/15/2022) Completed
January 2023: Self Study Course | A Clinician’s Guide to Teaching Mindfulness
(Certificate) (Online Course) (All CEUs – Counselor’s Toolbox)
Instructor: Dr. Dawn Elise-Snipes, PhD. LPC-MHSP. Based on: A Clinician’s Guide to Mindfulness by Christiane Wolf, MD and J. Greg Serpa, PhD
CEU: 12 Hours (Online); Test Passed 1/15/2023; Course Completed (Book still being used as a reference in practice)
January 2023: Self Study Course | IFS and Polyvagal Theory: Healing through Compassionate Connection
(Certificate) (Digital Seminar) (PESI)
Instructor: Alexia (Lexi) D. Rothman, Ph.D.
CEU: 2 Hours (Online); Test Passed 1/17/2023; Original Program Date (February 2, 2022); Completed
January 2023: Self Study Course | Mindfulness Based Stress Reduction | Mindfulness Based Cognitive Therapy
(Certificate) (Online Course) (Udemy)
Instructor: Stan Cerulus
Accredited Program: 17.5 Hours (Online Videos/Webinar/Classroom); Course Completed 1/23/2023
January 2023: Self Study Course | Professional Life Coach Certification
(Certificate) (Online Course) (Udemy)
Instructors: Joeel & Natalie Rivera, Transformation Academy Services
Accredited Program: 13 Hours (Online Videos/Webinar/Classroom); Course Completed 1/23/2023
May 2021: Internal Family Systems Step by Step: IFS for Deep Healing with Richard Schwartz (Online Course) (PESI)
Instructor: Richard Schwartz, PhD, The Center for Self Leadership
CEU: 7.5 Hours (Online); Test Completed: 05/11/2021; Original Program Date: 7/12/2016 (Course Completed)
November 2022: Human Sexuality: Across the Lifespan (Online Course) (CE4Less)
Instructor: Jessie Simmons, LCSW
NBCC ACEP Number 6991. CEU: 3 Clock Hours (Online); Test Completed: 11/23/2022; Score 100%; Original Program Date: 2022 (Course Completed)
November 2022: Clinical Applications of Internal Family Systems (IFS) 2 Day Advanced Workshop (Online Course) (PESI)
Instructor: Frank Anderson, MD
CEU: 11.75 Clock Hours (Online); Test Completed: 11/23/2022; Original Program Date: 03/12/2020 (Course Completed)
July 2020: Cognitive Behavior Therapy Techniques for Everyday Practice (PESI)
Instructor: John Ludgate, Ph.D., Licensed Psychologist Psychotherapist
CEU: 6.25 Hours (Online); Test Completed 07/19/2020 01:26 AM CST; Original Program Date 07/26/2016
July 2020: Advanced Practical Clinical Skills for the Trauma-Informed Therapist (PESI)
CEU: 6.25 Hours (Online); Test Completed 07/12/2020 10:43 PM CST; Original Program Date 03/21/2017
April 2020: Telehealth for Mental Health Professionals (PESI)
Instructor: Joni Gilbertson, MA, NCC, LCPC, LMHC, BCTMH, CTMH
CEU: 12.5 Hours (Online); Test Completed 04/08/2020 – 10:46 AM CST; Original Program Date 02/20/2020
September 2013: Wellness Recovery Action Plan Group Facilitator (Vermont Recovery Network)
Copeland Center for Wellness & Recovery
Instructors: Karen Lorentzon, Jane Winterling
Turning Point Center, Rutland, VT, September 2013
June 2013: Intentional Peer Support (Vermont Psychiatric Survivors)
Shery Meade
Instructor: Chris Hanson
Capitol Hotel, Montpelier, VT, June 2013
Professional Credentials & Association Memberships
VT Secretary of State, Office of Professional Regulation, Board of Allied Mental Health Professionals
Licensed Clinical Mental Health Counselor (License # 068.0135266)
American Counseling Association (Member # 6526860)
National Board of Certified Counselors (National Certified Counselor)
Office of Professional Regulation
The Office of Professional Regulation provides Vermont licenses, certifications, and registrations for over 56,000 practitioners and businesses. Forty-six professions and occupations are supported and managed by this office. A list of professions regulated is found below.
Each profession or occupation is governed by laws defining professional conduct. Consumers who have inquiries or wish to obtain a form to register a complaint may do so by calling (802) 828-1505, or by writing to the Director of the Office, Secretary of State’s Office, 89 Main Street, 3rd Floor, Montpelier, VT 05620-3402.
Upon receipt of a complaint, an administrative review determines if the issues raised are covered by the applicable professional conduct statute. If so, a committee is assigned to investigate, collect information, and recommend action or closure to the appropriate governing body.
All complaint investigations are confidential. Should the investigation conclude with a decision for disciplinary action against a professional’s license and ability to practice, the name of the license holder will then be made public.
Complaint investigations focus on licensure and fitness of the licensee to practice. Disciplinary action, when warranted, ranges from warning to revocation of license, based on the circumstances. You should not expect a return of fees paid or additional unpaid services as part of the results of this process. If you seek restitution of this nature, consider consulting with the Consumer Protection Division of the Office of the Attorney General, retaining an attorney, or filing a case in Small Claims Court.
Accountancy
Acupuncture
Architects
Athletic Trainers
Auctioneers
Audiologists
Barbers & Cosmetologists
Boxing Control
Chiropractic
Clinical Mental Health Counselors
Dental Examiners
Drug and Alcohol Counselor
Electrolysis
Engineering
Funeral Service
Hearing Aid Dispensers
Land Surveyors
Landscape Architects
Marriage & Family Therapists
Midwives, Licensed
Motor Vehicle Racing
Naturopaths
Nursing
Nursing Home Administrators
Occupational Therapists
Opticians
Optometry
Osteopathic Physicians and Surgeons
Pharmacy
Physical Therapists
Private Investigative & Security Services
Property Inspectors
Psychoanalyst
Psychology
Professional Engineering
Psychotherapist, Non-licensed
Radiologic Technology
Real Estate Appraisers
Real Estate
Respiratory Care
Social Workers, Clinical
Tattooists
Veterinary
Chapter 78: Roster of Psychotherapists Who Are Non-licensed
§ 4090. Disclosure of Information
The board shall adopt rules requiring persons entered on the roster to disclose to each client the psychotherapist’s professional qualifications and experience, those actions that constitute unprofessional conduct, and the method for filing a complaint or making a consumer inquiry, and provisions relating to the manner in which the information shall be displayed and signed by both the rostered psychotherapist and the client. The rules may include provisions for applying or modifying these requirements in cases involving institutionalized clients, minors and adults under the supervision of a guardian.
The Vermont Statutes Online
Title 3: Executive
Chapter 5: SECRETARY OF STATE
Sub-Chapter 3: Professional Regulation
3 V.S.A. § 129a. Unprofessional Conduct
(a) In addition to any other provision of law, the following conduct by a licensee constitutes unprofessional conduct. When that conduct is by an applicant or person who later becomes an applicant, it may constitute grounds for denial of a license or other disciplinary action. Any one of the following items or any combination of items, whether the conduct at issue was committed within or outside the State, shall constitute unprofessional conduct:
(1) Fraudulent or deceptive procurement or use of a license.
(2) Advertising that is intended or has a tendency to deceive.
(3) Failing to comply with provisions of federal or State statutes or rules governing the practice of the profession.
(4) Failing to comply with an order of the board or violating any term or condition of a license restricted by the board.
(5) Practicing the profession when medically or psychologically unfit to do so.
(6) Delegating professional responsibilities to a person whom the licensed professional knows, or has reason to know, is not qualified by training, experience, education, or licensing credentials to perform them, or knowingly providing professional supervision or serving as a preceptor to a person who has not been licensed or registered as required by the laws of that person’s profession.
(7) Willfully making or filing false reports or records in the practice of the profession, willfully impeding or obstructing the proper making or filing of reports or records, or willfully failing to file the proper reports or records.
(8) Failing to make available promptly to a person using professional health care services, that person’s representative, or succeeding health care professionals or institutions, upon written request and direction of the person using professional health care services, copies of that person’s records in the possession or under the control of the licensed practitioner, or failing to notify patients or clients how to obtain their records when a practice closes.
(9) Failing to retain client records for a period of seven years, unless laws specific to the profession allow for a shorter retention period. When other laws or agency rules require retention for a longer period of time, the longer retention period shall apply.
(10) Conviction of a crime related to the practice of the profession or conviction of a felony, whether or not related to the practice of the profession.
(11) Failing to report to the Office a conviction of any felony or misdemeanor offense in a Vermont District Court, a Vermont Superior Court, a federal court, or a court outside Vermont within 30 days.
(12) Exercising undue influence on or taking improper advantage of a person using professional services, or promoting the sale of services or goods in a manner that exploits a person for the financial gain of the practitioner or a third party.
(13) Performing treatments or providing services that the licensee is not qualified to perform or that are beyond the scope of the licensee’s education, training, capabilities, experience, or scope of practice.
(14) Failing to report to the Office within 30 days a change of name, e-mail, or mailing address.
(15) Failing to exercise independent professional judgment in the performance of licensed activities when that judgment is necessary to avoid action repugnant to the obligations of the profession.
(16)
(A) Impeding an investigation under this chapter or unreasonably failing to reply, cooperate, or produce lawfully requested records in relation to such investigation.
(B) The patient privilege set forth in 12 V.S.A. § 1612 shall not bar the licensee’s obligations under this subsection
(a) and a confidentiality agreement entered into in concluding a settlement of a civil claim shall not exempt the licensee from fulfilling his or her obligations under this subdivision (16).
(17) Advertising, promoting, or recommending a therapy or treatment in a manner tending to deceive the public or to suggest a degree of reliability or efficacy unsupported by competent evidence and professional judgment.
(18) Promotion by a treatment provider of the sale of drugs, devices, appliances, or goods provided for a patient or client in such a manner as to exploit the patient or client for the financial gain of the treatment provider, or selling, prescribing, giving away, or administering drugs for other than legal and legitimate therapeutic purposes.
(19) Willful misrepresentation in treatments or therapies.
(20) Offering, undertaking, or agreeing to cure or treat a disease or disorder by a secret method, procedure, treatment, or medicine.
(21) Permitting one’s name or license to be used by a person, group, or corporation when not actually in charge of or responsible for the professional services provided.
(22) Prescribing, selling, administering, distributing, ordering, or dispensing any drug legally classified as a controlled substance for the licensee’s own use or to an immediate family member as defined by rule.
(23) For any professional with prescribing authority, signing a blank or undated prescription form or negligently failing to secure electronic means of prescribing.
(24) For any mental health care provider, use of conversion therapy as defined in 18 V.S.A. § 8351 on a client younger than 18 years of age.
(25) For providers of clinical care to patients, failing to have in place a plan for responsible disposition of patient health records in the event the licensee should become incapacitated or unexpectedly discontinue practice.
(26) Sexually harassing or exploiting a patient, client, or consumer, or doing so to a coworker in a manner that threatens the health, safety, or welfare of patients, clients, or consumers; failing to maintain professional boundaries; or violating a patient, client, or consumer’s reasonable expectation of privacy.
(b) Failure to practice competently by reason of any cause on a single occasion or on multiple occasions may constitute unprofessional conduct, whether actual injury to a client, patient, or customer has occurred. Failure to practice competently includes:
(1) performance of unsafe or unacceptable patient or client care; or
(2) failure to conform to the essential standards of acceptable and prevailing practice.
(c) The burden of proof in a disciplinary action shall be on the State to show by a preponderance of the evidence that the person has engaged in unprofessional conduct.
(d)
(1) After hearing, and upon a finding of unprofessional conduct, a board or an administrative law officer may take disciplinary action against a licensee or applicant, including imposing an administrative penalty not to exceed $5,000.00 for each unprofessional conduct violation.
(2)
(A) Any money received under this subsection shall be deposited in the Professional Regulatory Fee Fund established in section 124 of this chapter for the purpose of providing education and training for board members and advisor appointees.
(B) The Director shall detail in the annual report receipts and expenses from money received under this subsection.
(e) In the case where a standard of unprofessional conduct as set forth in this section conflicts with a standard set forth in a specific board’s statute or rule, the standard that is most protective of the public shall govern. (Added 1997, No. 40, § 5; amended 2001, No. 151 (Adj. Sess.), § 2, eff. June 27, 2002; 2003, No. 60, § 2; 2005, No. 27, § 5; 2005, No. 148 (Adj. Sess.) ,
§ 4; 2009, No. 35, § 2; 2011, No. 66, § 3, eff. June 1, 2011; 2011, No. 116 (Adj. Sess.), § 5; 2017, No. 48, § 4; 2017, No. 144
(Adj. Sess.), § 6, eff. July 1, 2019; 2019, No. 30, § 4.)