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Supervision Professional Disclosure Statement: James W. Pruett, Ph.D.; D.Min.

Bridgepath Inc.

  Corporate Office
104 N Daniel Morgan Ave Suite 103
Spartanburg, SC 29301
Direct Phone: 980-399-5118
 jameslmfts@gmail.com
Qualifications

I am glad that you have selected me as your pastoral psychotherapist.  In considering our professional relationship, I have designed this document to describe my background and my clinical approach.

 

I hold the Doctor of Ministry degree from the Southern Baptist Theological Seminary (1981) and the Doctor of Philosophy form Louisiana Baptist University (1997) with a specialization in pastoral therapy and supervision.  I also have completed the Master of Theology (1969), Master of Religious Education (1970), and the Specialist in Education (1971) from the New Orleans Baptist Theological Seminary with majors in theology and pastoral counseling and psychotherapy and the Bachelor of Arts degree in psychology and religion from Carson-Newman College (now University, 1967).

 

Since 1967 I have been practicing pastoral counseling and psychotherapy.  I am licensed by the state of North Carolina as a Licensed Clinical Mental Health Counselor Supervisor and a Licensed Marriage and Family Therapist (# 619).  I also am a North Carolina Certified Fee-Based Practicing Pastoral Counselor (# 41).  I also hold comparable licenses in South Carolina (SC LPC #14, LMFT #15, LPCS # 881, LMFTS #909) and Tennessee (LPC-MHSP #842, LMFT #258, and LCPT # 2).   My professional certifications include:

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  • Diplomate, American Association of Pastoral Counselors (AAPC)

  • Certified, Spiritually Integrated Psychotherapist and Faculty Member of the Spiritually Integrated Psychotherapy Program, Association for Clinical Pastoral Education (ACPE)

  • Diplomate (Dual Supervisor) & Board Certified-Clinical Chaplain, and Pastoral Psychotherapist, College of Pastoral Supervision and Psychotherapy (CPSP)         

  • Clinical Professional and Approved Supervisor, American Association for Marriage and Family Therapy (AAMFT)

  • Board-Certified-Certified Clinical Mental Health Counselor (BC-CCMHC) and Board Certified-National Certified Counselor BC-NCC), National Board for Certified Counselors (NBCC)

  • Board Certified-TeleMental Health Provider (BC-TMH) and Approved Clinical Supervisor (ACS), Center for Credentialing and Education, Inc. (CCE)

 

I am a supervisor of therapists seeking multiple licenses and certifications as well as a supervisor of supervisors in training. I am experienced in providing depth psychotherapy for psychotherapists and their families as well as formation supervision for seasoned psychotherapists.

Counseling and Psychotherapy Services offered:  Theoretical Approaches

As a pastoral counselor and psychotherapist, I am an ordained and endorsed minister of the Cooperative Baptist Fellowship.  I bring specialized training, experiences, and interest in how psychology (“the study of the soul”), theology, spirituality, the sacred scriptures, and philosophy can facilitate personal and relational change.  Respecting the uniqueness of each person and his/her faith journey, my responsibility is to facilitate and empower your use of your thoughts, feelings, intuition, and behavior to achieve healing and wholeness in your life season. I use a bio-psycho-social-cultural-spiritual approach to respond sensitively and compassionately to you given the fullness of your history, story and its meaning. 

 

Since there are no instant, painless or passive cures, nor “magic pills,” you and I will work together with respect and mutuality.  While some changes can be easy and rapid, most change is slow and deliberate and requires proactive commitment to one’s formation.  Reading, dream work, journaling, written and behavioral assignments, and sensitivity to one’s selfhood and relationships may assist our work together.

 

My clinical perspective is an integration of Jungian, Bowenian, cognitive-behavioral, and experiential perspectives although I am informed by virtually all of the theories and approaches current in use. As such, my purpose is to encourage one’s individuation through learning to differentiate and form in relationships.  Using the measures such as the Myers-Briggs Type Indicator, signature strengths, and resiliencies, I work with persons to determine how temperament, learning style, communication style, and one’s life situation – both conscious and unconscious – can be utilized to foster individuation and spirituality in bonded relationships.

 

During our first session I shall listen to your story and history to learn the specific initial therapy goals that are emerging. We shall evaluate and fine-tune these goals together as the process unfolds.  At the beginning of any session each of us may evaluate how our process is developing and where goal revision is indicated.  Closure is the most important part of therapy.  A person is ready to stop when s/he is able to provide for oneself the container, self-confrontation, and self-support that can be developed through pastoral therapy.  At all times we agree to have at least one termination session for closure and assess how you will move from this relationship. The actual length of termination may depend upon both the nature of your journey as well as the length of our work together. 

 

Pastoral counseling and psychotherapy can be both a joyous and painful experience.  Coming to know oneself more in-depth and in relationships can be awe inspiring; however, it also can be painful when one experiences sadness, guilt, anxiety, anger, frustration, and difficulty in facing the forbidden.  Some changes may lead to what initially seems to be worsening circumstances or even losses.  Not all relationships – even marriages – will remain intact.  I pledge to support you with integrity until your work is complete.


I elect to work with persons whom I respect, who seem to be in process, who are committed to this process with me, and who seem to be able to benefit from who I am and what I have to offer.  My work generally is more productive with mutual respect.  In order to maintain privacy and the sanctity of our time together, I ask that cell phones and beepers be turned off before entering the session.

Confidentiality

For our relationship to be respectful, confidentiality is a must.  Neither of us is to discuss the content of our work together outside sessions in order to keep the energy in the therapeutic container.  State law and the ethical principles of my professional organizations mandate confidentiality except under these two circumstances:  (1) when I believe you intend to harm yourself or another person, or (2) when I believe a child or elderly person has been or could be abused or neglected.  In rare circumstances, pastoral counselors and psychotherapists can be ordered by a judge to release information.  Otherwise, I will not disclose anything about your therapy process, diagnosis, history or even acknowledge our professional relationship to anyone without your full knowledge and a signed Authorization of Release Form.  Such a form must be signed even to release information to your insurance carrier.

Explanation of Dual Relationships

Ethical and legal standards mandate that even though our relationship might be very intimate psychologically, it must remain professional rather than social.  You will be best served if our relationship remains strictly professional and if our sessions concentrate exclusively on your concerns.  Since ours is a professional relationship, I may not be invited to social gatherings, receive gifts, or relate to you in any way other than in the professional context of your sessions.

Length of Sessions

I assure you that my services will be rendered in a professional manner consistent with accepted ethical standards and the policies and procedures of Bridgepath Inc.  Sessions will last forty-five (45) minutes and are scheduled by mutual agreement.  Often persons respond favorably if they project a standing appointment time.  These arrangements assist them in preparing to attend sessions that are reserved just for them.  A twenty-four (24) hour notice (by Friday at 12:00 noon for Monday appointments) is required for cancellations unless there is a sickness or an emergency.  Payment for missed sessions without these exceptions is required.  This policy permits persons with emergency situations to be seen responsibly and helps to under gird the financial solvency of Bridgepath Inc. Every effort is made to start and stop sessions on time.  Each of us has the responsibility of being prompt. Many chose to arrive early for sessions in order to prepare themselves for our time together: to be fully present.

Fee and Methods of Payment

The fee for the initial evaluation is $160.  Thereafter, the fee for pastoral counseling and psychotherapy is $150 per session. Payments may be made by personal check made to “Bridgepath, Inc.,” credit card (VISA or MasterCard), or in exact cash at the beginning of the appointment.  Bridgepath policy is to keep your confidential credit card information on file and use it to secure your account for any unpaid balances owed by you. Our office will provide you with a super bill for your records or for you to submit to your insurance carrier in the case of out of network benefits.

 

Some insurance companies reimburse persons for pastoral counseling and psychotherapy services with me.  Others will not.  Those who do reimburse usually require that a standard amount be paid by you before reimbursement is allowed, and then frequently only a percentage of my fee is reimbursable.  Bridgepath Inc. asks that you contact your insurance company representative before therapy begins to determine whether your insurance company will reimburse you and, if so, about what the schedule of reimbursement will be.  Bridgepath Inc. requires you to declare at the FIRST session if you wish to use your health insurance.  The Center will not file in network insurance if such decision is made at a later time.  Please remember that you and not your insurance company are responsible for paying in full the fees agreed upon.

 

Health insurance companies require that I diagnose a person’s mental health and determine that the insured has an “illness” before they will reimburse.  Should a diagnosis apply in your situation, I shall inform you as to the meaning of your diagnosis.  Any diagnosis submitted to your insurance carrier will become a part of your permanent insurance records. You must decide whether or not to use insurance under these circumstances.  Please note that insurance carriers typically do not pay for couple or family therapy where only a relational code applies. They do not insure marriages. 

 

There are distinct advantages to out of pocket psychotherapy. First, aside from the legal limits of reporting, the scope of care is private and confidential without any exchange of clinical information to an insurance carrier.  Second, there is no responsibility to report a diagnosis to an insurance carrier that may effect life insurance or short and long term disability coverage. Third, you and the psychotherapist together are freer to select the best practice path for you including the focus of care, its duration, and both the frequency and length of sessions.

 

Phone calls may need to occur as a part of our process together even though the context and energy for our work will be during our sessions. There will be no charge for the first ten minutes; however, the rate afterwards will be $2.00 per minute. We shall not communicate through texts and email messages in order to protect privacy and to promote the clearest and most direct communication.  If you leave me a voicemail, please be brief and share both times and numbers when you can be reached and check to be sure that your voicemail box is set up and not filled.

Complaint Procedures

If you have difficulty with any aspect of our work, please inform me immediately so that we can discuss how we might work more effectively and efficiently.  This discussion is an important aspect of our continuous evaluation of our process together. Should you feel treated unfairly or unethically by me or another therapist, you may make a formal complaint to the following licensure and certification boards:

                                                                                                                

North Carolina Board of Licensed Clinical Mental Health Counselors (NCBLCMHC)

P.O. Box 77819

Greensboro, North Carolina 274403

844-662-3572

 

North Carolina Board 

P.O. Box 10912

Raleigh, North Carolina 27605

919-654-6914

 

North Carolina Board of Examiners of Fee-Based Practicing Pastoral Counselors

P.O. Box 447 

Kernersville, North Carolina 27285-9447

336-794-3470


 

Board of Counselors, Marriage and Family Therapists, Addiction Counselors and Psycho-Educational Specialists

110 Centerview Drive 

Columbia. South Carolina 29210

803-896-4658                                                                                            

 

                                                T

Tennessee Board of Licensed Professional Counselors, Licensed Family Therapists, Licensed Marital and Family Therapists, Licensed Certified Pastoral Therapists

710 James Robertson Parkway

Nashville, Tennessee 37243

615-532-5088


By signing this Professional Disclosure Statement, I signify that I have read, understand, have had the opportunity to ask questions and (1) agree to the conditions outlined herein as well as to those specified in the Bridgepath HIPPA compliance statement a copy of which I may receive, and (2) hereby authorize Bridgepath, Inc. to bill my credit card on file for any unpaid balance owed by me.

Counseling Background

My education, training, continuing education, clinical/supervisory, cognate group (national, regional and state) cognate group leadership, professional writing, and program development experience are such that I can supervise persons seeking multiple licenses and cognate group certifications in these general areas of competence and clientele in mental health: mental health centers, mental hospitals and treatment centers, prisons, parish, home-based therapy, private practice, faith-based centers, EAP’s, HMO’s, distance therapy, schools and colleges, and wilderness programs, TeleMental Health Provider programs. 

 

I offer individual, couple, family and group psychotherapy; individual, triadic and group supervision; consultation for psychotherapists, clinical practices, congregations and businesses. I have been a court expert witness, supervised psychotherapists who had contracted with their respective Board to be in supervision with me as a part of their licensure reinstatement process and also provided psychotherapy for psychotherapists as well as a numerous clergy and their families.

 

As a Stage Four psychotherapist/supervisor it is typical for the therapist/supervisor and her/his theory of each to become almost one. My theory is Dr. Jim Pruett. I glean from my use of self in an integrated, eclectic way my ENFJ/ISTP life balance with my signature strengths (strategic, maximize, arranger, self-assurance and relator) and resiliencies: morality, insight, independency, relationships, initiative, creativity and humor. My core orientation is person-centered, Jungian, psychodynamic, narrative and systemic and gets operationalized using a mirroring energetic, temperament, learning style, strengths, and resiliency perspective. The most common techniques I use include CBT, DBT, bibliotherapy, dream diaries, active imagination, sand tray, art therapy, play therapy, anxiety and depression scales, the Myers-Briggs Type Indicator, StrengthsFinder 2.0, Damaged Model Inventory, Resiliency Mandala, creative handouts of numerous themes to facilitate communication, empty chair work with reversal, genograms, life lines, Inner Healing (Brugh Joy, MD), mindfulness, possibility sphere, spiritual and faith metaphors, projective object work, Awareness Continuum, I Message, life scripts and write a new narrative, relaxation exercises, catastrophic fantasy, putting the client in the driver’s seat, and body image work etc. These interventions and techniques are chosen artfully and intuitively in a way that is congruent with the person’s needs and based upon an assessment his/her/the system’s readiness to claim and utilize her/his “inner therapist” and in one’s life season. During the Intake I teach the person(s) both how I work and how best to utilize our professional relationship with its limits and boundaries in order to achieve mutually agreed upon written goals through (1) seeking best practices standards and (2) setting our intent together.

Confidentiality

The issues you discuss in supervision will be confidential with the following exceptions:

 

• Your performance and conduct in this clinical experience will be described in general terms when I submit quarterly reports and verification of supervision forms to the NC Board of Licensed Professional Counselors and other credentialing boards or when consultation with another professional is necessary.

• If I am asked to provide information about your clinical experience in the form of a recommendation for a job, licensure, or certification.

• Disclosures made in triadic or group supervision cannot be absolutely guaranteed as confidential.

Although I will take every measure to encourage confidentiality and act appropriately if confidentiality is not upheld.

Session Fees and Length of Service

Psychotherapy intakes are $160.00 for the on hour session for individuals, couples and families and are due at the start of the session. Thereafter, sessions are $150.00 per session. Group sessions are $50.00 per participant for the one and one-half hour session.

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If the person seeks to utilize insurance for a company for which I am a panel member I want to make it clear that such filings become a part of one’s health history and can influence other health and life insurance coverage. If a person elects to file one’s own insurance for a company for which I am not a provider then a form containing the CPT code, diagnosis, and my licenses will be provided to the person. Psychotherapy session times are reserved just for the person(s) for which the hour is expressly reserved. Less than a 24-hour cancellation or a failure to keep the appointment will mean that the person is billed full fee for the missed session. Please note that Monday appointments must be canceled by 12:00 Noon on Fridays to avoid this charge. In the case of an actual emergency we shall discuss whether or not this charge will apply. Sessions are reserved just for the persons who have scheduled the session and when a reasonable cancellation notice is given such times may be offered to others who need to be seen. If a person wants to use insurance the Bridgepath policy is that this intension be declared at the first session. No changes can be made thereafter. Please remember that you and not your insurance company are responsible for paying in full the fees agreed upon.

​

There are distinct advantages to out of pocket psychotherapy. First, aside from the legal limits of reporting, the scope of care is private and confidential without any exchange of clinical information to an insurance carrier. Second, there is no responsibility to report a diagnosis to an insurance carrier that may affect life insurance or short or long term disability coverage. Third, you and your psychotherapist together are freer to select the best practice path for you including the focus of care, its duration, and both the frequency and length of sessions.

​

Phone calls may need to occur in our process together whether it is for psychotherapy or supervision even though the context and energy of our work together will be during our sessions. There will be no charge for the first ten (10) minutes; however, the rate afterwards will be $2.25 per minute. We shall not communicate through texts and email messages in order to protect privacy and to promote the clearest and more direct communication. If you leave me a voicemail, please be brief and share both times and numbers when you can be reached and check to be sure that your voicemail box is set up and not filled.

 

Supervision fees are $110.00 per hour for individual supervision. Triadic supervision must be for a minimum of two hours with each person presenting. The total cost for triadic supervision is $220.00 divided equally by the two participants and calculates to $110.00 per person. These sessions also have the 24-hour cancellation policy noted above. In triadic supervision each person must pay so that the person who attends is not penalized by the other person’s absence. Group supervision lasts a minimum of three hours ($330.00) and so the hourly rate of $110.00 is multiplied time the length of the group divided by the number of participants. If a supervisee does not keep the group supervision session s/he still must pay one’s pro rata fee so others are not

encumbered. My experience has taught me that group supervision generally should be limited to six participants in order to have adequate presentation time with video tapes, air time for each participant and to keep up with the allied issues or cases that previous have been presented as well as those related to emergency and ethical issues.

 

Methods of payment that are accepted for psychotherapy or supervision are cash, check, HSA card, and credit card (VISA and MasterCard for which there is an extra $2.00 charge) and a receipt will be given for your record. Bridgepath policy is that each person must keep a current credit card on file with the office to secure one’s account against any unpaid balance.

Supervisee’s Responsibilities in Supervision

  1. Prepare for and attend all sessions. Supervisees are to email confidential, encrypted supervision templates to the supervisor and if it is either triadic or group supervision to one’s peers by 8:00 PM the night before clinical supervision.

  2. Complete homework or assignments.

  3. Watch videotapes of counseling sessions and complete the video critique as noted under 1.

  4. Keep supervisor informed regarding all client issues and progress with the precedent template.

  5. Maintain liability insurance at all times (minimum $1M single incident/ $3M aggregate) providing the supervisor ongoing with a copy of the face sheet to assure one’s current coverage.

  6. Complete supervision record at each supervision session.

Supervisor's Responsibilities in Supervision

  1. Prepare for and attend all sessions

  2. Provide feedback each session and a formal evaluation at each quarter and at the end of the supervision contract

  3. Review client case notes and other materials for quality control purposes.

  4. Complete supervision record at each supervision session.

  5. Maintain state licensure and cognate credentials as a clinical supervisor for each state and each cognate group for which I supervise.

Emergency Contact

In case of emergency, you can reach me by phone (704) 577-5862.

Complaints

I abide by the NBCC, ACA, and NCBLPC Code of Ethics as well as the CCE’s Standards for the Ethical Practice of Clinical Supervision as well as the Code of Ethics for every state licensure and cognate group certification for which we contract for you to seek credentials. We mutually agree that we shall practice in accordance with the most stringent ethical code to which we are accountable. Although supervisees are encouraged to discuss any concerns with me first, you may file a complaint against me with any of these organizations should you feel I am in violation of any of the following codes of ethics.

North Carolina Board of Licensed Clinical Mental Health Counselors

 

7D Terrace Way

Greensboro, NC 27403

 

Phone: 844-622-3572 (Toll Free) or 336-217-6007

Email: LCMHCinfo@ncblcmhc.org

E-mail: Complaints@ncblcmhc.org

North Carolina State Board of Examiners of

Licensure Board Fee- Based Practicing Pastoral Counselors

201 Shannon Oaks Circle P.O. Box 447

Suite 200 Kernersville, NC 2785-0447

Cary, NC 27511 336-794-3470

North Carolina Marriage and Family Therapy North Carolina State Board of Examiners of Licensure Board Fee- Based Practicing Pastoral Counselors

201 Shannon Oaks Circle P.O. Box 447

Suite 200 Kernersville, NC 2785-0447

Cary, NC 27511 336-794-3470

919-654-6914

Tennessee Board of Licensed Professional

Therapists, Addiction Counselors and Psycho- Counselors, Licensed Marital and FamilymEducational Specialists Therapists, and Licensed Pastoral Therapists

P.O. Box 11329 710 James Robertson Parkway

Columbia, SC 29211 Nashville, TN 37243

803-896-4300 615-523-5088

Board of Counselors, Marriage and Family Tennessee Board of Licensed Professional  Therapists, Addiction Counselors and Psycho- Counselors, Licensed Marital and Family Educational Specialists Therapists, and Licensed Pastoral Therapists  P.O. Box 11329 710 James Robertson Parkway Columbia, SC 29211 Nashville, TN 37243 

803-896-4300  |  615-523-5088

Psychotherapy Arrangements

We will meet regularly for psychotherapy according to the above standards.

Acceptance of Terms

________________________________   Date: ___________

Signed

 

________________________________    Date: ___________

Signed

 

________________________________    Date: ___________

Psychotherapist

Supervision Arrangements

We will meet regularly for clinical supervision commensurate with our signed supervisory contract.

Acceptance of Terms

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

 

Supervisee:  _________________________ Date: ___________

 

Supervisor:  _________________________ Date: ___________

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