Ewa Lichnowska, M.S., LMHC
INFORMED CONSENT FORM
Washington State law and professional ethics mandates that each client be provided with the following disclosure information at the commencement of any program of treatment by a licensed psychologist and licensed mental health counselor. You are free to ask questions and to discuss concerns regarding this form with me. Your feedback is welcome.
As a Mental Health Counselor practicing for a fee, I am licensed with the Department of Health for the protection of the public health and safety. Licensure indicates that a practitioner has met basic education, competency, and supervision standards. If more information is needed, contact the Department of Health, PO Box 47890, Olympia, Washington 98504-7890, (360) 236-4030. My registration with the Department does not include recognition of any practice standards, nor necessarily implies the effectiveness of a treatment. My license number is: LH60334006.
I have earned a Master of Science Degree in Psychology with specialties in clinical and health psychology from the University of Lodz, Poland, 2003 (regionally accredited in the US).
Since 2005 I have worked as a psychotherapist in the Washington state and have met national standards set for licensed mental health counselors which include passing a national examination and years of practice under a licensed clinical supervisor. My clinical experience includes providing psychotherapy and crisis intervention for individuals and families (including one’s with at risk youth and children), assisting parents in improving their parenting skills and parent-child bond, both in individual and group setting, and coordinating care for children and families affected by mental illness and disability as a wraparound facilitator. The scope of my practice includes: sex therapy and sexuality issues, depression, anxiety, trauma, relationship issues and couples’ counseling, family counseling / parenting support, self-improvement / wellness, stress management, conflict resolution / communication, grief counseling (including child and pregnancy loss) and working with adult children of alcoholics. I have also a special interest in maternity/paternity issues including family planning and labor preparation, infertility, prenatal/postpartum issues, infant attachment and adjustment to parenthood.
Psychotherapy is a dynamic purposeful relationship between a therapist and a client aimed at identifying and working in collaboration towards meeting clients’ needs. I strive to provide an environment of emotional safety, respect, empathetic understanding, self-worth and trust where I will encourage you to be actively involved in developing a treatment plan that will address your needs, specify goals and provide solutions and new strategies that will hopefully lead towards desired changes. It will also serve as a point of reference when assessing your satisfaction from the therapeutic process, progress towards your goals and modifications that might need to be applied. Psychotherapy, unlike visiting a medical doctor is a mutual process in which the outcomes are greatest when clients are motivated, honest and willing to work towards self-awareness and personal growth even when one might feel uncomfortable. As such an important part of the therapeutic process is practicing new skills that we will identify during the sessions. I will ask you to practice outside our meetings and we will work on setting homework assignments that you are ready to commit to work on.
As a practitioner I use eclectic approach to therapy and I draw from many models including but not limited to: Rational Emotive Behavioral, Mindfulness Based Cognitive, Attachment Theory, Motivational Interviewing, Systematic Desensitization, Structural and Functional Family, Solution Focused, John Gottman’s theory and Marshal Rosenberg’s Nonviolent Communication. I specially value developing mindfulness (awareness of one’s emotions, thoughts and habitual reactions), and use of Rational Emotive Behavioral approach to therapy which means that I will likely assist you in identifying unhelpful beliefs and thoughts and discover how they affect your wellbeing, feelings, relationships and the level of life satisfaction. It is often very beneficial to work on gaining understanding of your past experiences, relationships, traumas, or “unfinished business”, however if we discuss it in our sessions, it will be in order to help you understand how it affects you now and, more importantly, how to change what you do now to be more satisfied and fulfilled. Change will sometimes be easy and quick but more often it will be slow and frustrating as I cannot promise instant, painless cures. However I will encourage you to set realistic expectations of yourself, continue your efforts and offer support, feedback and empathetic understanding.
I strive to enter a therapeutic relationship only with clients that I believe I can be of assistance to and I will not commit to being your therapist in case I believe I cannot help you. Similarly if after working with you for some time I come to believe that my abilities to help you have been exhausted, I will encourage you to work with another professional; or if I believe that involvement of another professional (for example psychiatrist, psychologist, medical doctor) might be necessary to supplement therapy, I will encourage you to get involved with such a provider. In either case, I shall provide you with referrals to other professionals whose services might be more appropriate for you. Perceived effectiveness of the therapy either by client or therapist will not affect the financial agreement between the client and the therapist.
I understand the importance of culture, privilege, racism, heterosexism, oppression, classism, ageism, etc. These contextual elements play an important role in our lives and are considered when determining goals and strengths. None of my clients will be denied services on the basis of race, color, religion, creed, national origin, sex, age, marital status, sexual orientation, disabled veteran status, Vietnam Era Veteran status, or disability (including having AIDS or being HIV positive). Denial or continuity of providing services may be based only on its effectiveness and client’s satisfaction. My services may be discontinued if my ability to help you has been exhausted.