DISCLOSURE STATEMENT

1. Business Information:

Carolyn Aibel, Ph.D.

2027 11 St. Boulder, CO 80302

Phone: 303-579-3010

Email: carolyn@carolynaibel.com/ aibel@colorado.edu 

2. Degrees and Credentials

As a consumer of services, you are entitled to information regarding my credentials and educational background, which include the following:

• Licensed Psychologist in the state of Colorado, #2882
• SUNY Upstate Medical University in Syracuse, Completion of pre - doctoral clinical internship, 2002
• University of Colorado at Boulder, Ph.D. in Clinical Psychology, 200 3
• University of Colorado at Boulder, Masters in Clinical Psychology, 1998
• Wesleyan University in Connecticut, Bachelor of Arts in Psychology, 1995

3. Regulation of the Professions

The practice of licensed or registered persons in the field of psychotherapy is regulated by the Mental Health Licensing Section of the Division of Registrations. The Board of Psychologist Examiners can be reached at 1560 Broadway, Suite 1350, Denver, Colorado 80202, (303) 894 7800. As to the regulatory requirements applicable to mental health professionals: a Licensed Clinical Social Worker, a Licensed Marriage and Family Therapist, and a Licensed Professional Counselor must hold a masters degree in their profession and have two years of post-masters supervision. A Licensed Psychologist must hold a doctorate degree in psychology and have one year of post-doctoral supervision. A Licensed Social Worker must hold a master’s degree in social work. A Psychologist Candidate, a Marriage and Family Therapist Candidate, and a Licensed Professional Counselor Candidate must hold the necessary licensing degree and be in the process of completing the required supervision for licensure. A Certified Addiction Counselor I (CAC I) must be a high school graduate, and complete required training hours and 1,000 hours of supervised experience. A CAC II must complete additional required training hours and 2,000 hours of supervised experience. A CAC III must have a bachelor’s degree in behavioral health, and complete additional required training hours and 2,000 hours of supervised experience. A Licensed Addiction Counselor must have a clinical master’s degree and meet the CAC III requirements. A registered psychotherapist is a psychotherapist listed in the State's database and is authorized by law to practice psychotherapy in Colorado but is not licensed by the state and is not required to satisfy any standardized educational or testing requirements to obtain a registration from the state.

4. Methods of Therapy

You are entitled, to receive information from your therapist about the methods of therapy, the techniques used, the duration of your therapy, if known, and the fee structure. You can seek a second opinion from another therapist or terminate therapy at any time.

5. Sexual Intimacy

In a professional relationship, sexual intimacy is never appropriate and should be reported to the board that licenses, registers, or certifies the licensee, registrant or certificate holder.

6. Confidentiality

Generally speaking, the information provided by and to the client during therapy sessions is legally confidential and cannot be released without the client’s consent. There are exceptions to this confidentiality, some of which are listed in section 12-43-218 of the Colorado Revised Statutes, as well as other exceptions in Colorado and Federal law. For example, mental health professionals are required to report child abuse to authorities. If a legal exception arises during therapy, if feasible, you will be informed accordingly.

7. Maintenance of Client Records

Pursuant to law, I will maintain clinical records for a period of seven years commencing on the date of termination of services or on the date of my last contact with you, whichever is later. If client is a minor, I will retain records for a period of seven years commencing either upon the last day or treatment or when the child reaches eighteen years of age, whichever comes later, but in no event shall I keep records for more than twelve years. Any person who alleges that a mental health professional has violated the licensing laws related to the maintenance of records of a client eighteen years of age or older, must file a complaint or other notice with the licensing board within seven years after the person discovered or reasonably should have discovered this.

I have read the preceding information, and I understand my rights as a client or as the client’s responsible party.