1. Professional Disclosure Statement
and Consent for Mental Health Counseling Services
~ Tamela M. McGhee, LCPC ~
Licensed Clinical Professional Counselor in Illinois--License #0000
Please read this document carefully, before selecting me as your counselor. The Professional
Disclosure Statement is required by the Illinois Department of Financial and Professional
Regulations. Within it, you will find a description of my credentials, experience, my counseling
philosophy and approach, and fee information. You will also find important information
concerning confidentiality in keeping with Illinois state laws. All of this information is given to
you, so that you can make an informed decision concerning my services.
Training
B.S. in Psychology, Capella University - Summa Cum Laude - 2015
M.S. in Mental Health Counseling, Capella University - 2019
Internship at Logan County Women's Correctional Facility, Lincoln, IL - 2018
Clinically-supervised field work at Chestnut Health Care Systems, Bloomington, IL - 2020-2022
Experience
Addiction/Substance Abuse Co-dependency
Individual, Family, Group Counseling Psychodynamic Approach to Career Counseling
Dual Diagnosis & Co-occurring Disorders Bereavement Counseling
Depression & Anxiety Behavioral Intervention
Community Contributions
Facilitator and Chair person of Co-dependents Anonymous, Lincoln, IL - 2016 to present
Volunteer mentor with McLean County Youth-Build, Normal, IL - 2016 to present
Founder of Empowered Futures: a short-term psychodynamic approach to career counseling for
the underprivileged, Lincoln, IL - 2023 to present
Professional Memberships
American Counseling Association
Illinois Counseling Association
Association for Spiritual, Ethical, and Religious Values in Counseling

2. My Counseling Philosophy
I believe that counseling is a journey. This journey may require looking into the past, to identify
why you think and behave as you do. Often times these patterns stem from oppressed,
dysfunctional, and/or traumatic experiences. However, by becoming self-aware and taking
responsibility for current thinking and behavioral patterns, a transformation can begin. Though it
may seem frightening and even impossible at times, we will be taking this journey together.
Through our trustworthy and honorable relationship, you can experience empowerment in your
life. You can become all that I believe you were meant to be. We must work as a professional
and dedicated team. I need your proactive engagement for this empowering transformation to
occur. I will also need your honesty every step of the way. Without that, I cannot properly
identify your needs, or make adjustments where necessary. I am here to be your helper, but you
will always be the captain of your own counseling experience.
Counseling Approach
For your journey to begin, we will need to engage in a thorough assessment process. These
culturally-sensitive assessments will help me understand you and your environment, so that we
can form a treatment plan that will work best for you. I will utilize a wellness model assessment
approach, as this will give me insight into all integral aspects of you and your life. I may conduct
other assessments to form diagnoses or incorporate your own brand of spirituality into your
counseling experience if desired. We may discover that you need additional professional and
community services. Consultations will be arranged to help you with this. During this initial
phase, open communication will begin growing our counseling relationship, as we move forward
into the work which lies ahead of us.
I take a psychoanalytic and cognitive behavioral approach to counseling. While my professional
goal is to help you revise your thinking and behavioral patterns, I also believe it is necessary to
understand why and how these patterns formed to begin with. By doing this, more complete
healing and transformation can be experienced. There will be times when I will give you
assignments to do at home, such as worksheets and behavior logs. I may encourage creative
approaches such as journaling, coloring, or breathing and meditation techniques. Always
remember that you are the captain. These are only suggestions, but I ask you to have an open
mind. The more you put into your counseling, the more you will receive from it to carry forward
into a happy and fulfilling life.
Each individual is unique in their needs, and the length of time it will take to address them. I
want you to leave feeling equipped and empowered to manage your life once again. Your
trusting cooperation will assure you of progress in a more timely manner. Together, we will re-
assess your progress and treatment plan, to make sure goals are being addressed and improving.
We may or may not, need to make adjustments. Most importantly, I want our professional
relationship to be built on trust, honor, integrity, and thorough communication.
I will assure you of ethical services, however if you wish to terminate at any time, this will be
honored and a referral made if desired. Any additional concerns or complaints, can be filed with
the following:

3. Professional Counselor Licensing and Disciplinary Board
320 W. Washington Street, 3rd Floor
Springfield, IL 62786
217/785-0800
217/524-6735 (TDD)
217/782-7645 (fax)
Confidentiality
As your counselor, I will honor all confidentiality and regulations as set forth by Illinois HIPPA
laws, the Illinois General Assembly, and the American Psychological Association's Code of
Ethics. Your written consent will always be required before counseling procedures or release of
information is conducted. However, there will be state-mandated exceptions required by the
Illinois General Assembly's Professional Counselor and Clinical Professional Counselor
Licensing and Practice Act (225 ILCS 107/75) including, but not limited to:
1. When a communication reveals an intended act to harm others, or jeopardize public safety.
2. In the course of formally conferring with superiors, colleagues, or consultants who share
professional responsibility.
3. In legalities pertaining to adoption, child abuse and/or child neglect.
4. Legal exemptions pertaining to minors.
Complete confidentiality information and copies of all confidentiality forms will be given for
you to review and sign, before counseling will take place. You will be given copies for your
personal records as well. Further questions can be directed to:
Illinois General Assembly
705 Stratton Building
Springfield, IL 62706
217-782-3944 or 217-782-2050 (TTY)
Fees and Payments
Counseling sessions are approximately 50 minutes long, with each session costing $100.00. I
require a minimum of 24 hour notice for cancellations and re-scheduling. Same-day
cancellations and no-shows will be charged in full. I accept cash, personal check, and credit/debit
cards. A $35.00 fee will be applied for returned-checks. I work with most major insurance
companies, as well as some out-of-network companies. Insurance companies require a diagnosis
to process claims. However, a diagnosis will permanently remain on your insurance record.
Insurance forms will be given to you, and your written consent required before put into motion. I
additionally offer services on a sliding scale, based on show of low income, if necessary.

4. Emergency Contacts
In the event of an emergency and I am not in my office, please leave me a message, then contact
your primary care physician, or call 911.
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Client Signature Date
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Therapist Signature Date