Jennifer Holladay, MA
Licensed Marriage and Family Therapist, North Carolina license 1851 

This document is designed to inform you about my background, ensure you understand our professional relationship, and document your understanding and consent to treatment. 

QUALIFICATIONS/EXPERIENCE 

I am licensed as a Marriage and Family Therapist in the state of North Carolina. I hold a Masters in Marriage and Family Therapy, issued in 2015 by the Pfeiffer University in Charlotte, NC.  I am certified as a therapist in Emotionally Focused Couples Therapy. My experience as a therapist began in 2013. I have worked with children and families under a bachelor’s degree in Social Work since 1995. My experience includes working with individuals, couples, and families in a variety of capacities including adolescence, parenting struggles, adoption transition, infidelity, couple distress, and family preservation. 

DESCRIPTION OF SERVICES/THEORETICAL APPROACHES 

I envision our therapeutic relationship to be a collaborative effort. I will be invested in your personal growth and within the scope of my training I will provide guidance to our times together. Likewise, I expect you to be invested in your personal growth during and between sessions. In addition to talk therapy, you may be invited to engage in homework assignments, exercises, writing and other projects. Therapy has no guarantees; however, I will seek to provide you with support as you pursue your goals and work towards them. In order to best serve and protect you, our relationship will be professional rather than social in nature. 

I use an integrative approach, practicing primarily from a family-systems attachment perspective, utilizing Emotionally Focused Therapy. I will draw from other approaches when deemed appropriate. If your needs as a client exceed the scope of my therapist training, appropriate referrals will be provided. At your request we can discuss and incorporate dynamics of spiritual life and faith into our work together. 

SCHEDULING SESSIONS & CANCELLATION POLICY 

The fee for our initial 105-minute session is $265. Individual sessions last 50 minutes and are $145. When possible, I prefer couple and family sessions to be 80 minutes. These 80-minute session are $230. If deemed necessary, time overage will be prorated. It will be your responsibility to pay at the time of the service rendered. If you would like to submit a claim to insurance I will provide you with a billing statement that you can submit for reimbursement. Since benefits vary, I recommend you review your insurance policy for coverage, checking for limitations and exclusions. Any diagnostic code communicated to an insurance company may become a part of your permanent record. Please note that a $25 fee is charged for each declined credit/debit card or returned check. 

If you need to contact me between sessions, please leave a voicemail or email and I will respond within 48 hours. If contact is made over the weekend I will respond on the next business day. In the event of a life-threatening emergency (considered danger to self or others, or catastrophic loss), contact 911 immediately and then contact me. I will let you know when there are times where I am unable to provide therapeutic services (e.g. vacations), and will provide you with the name and number of another trusted therapist that you may contact during my absence if needed. 

Your session is reserved exclusively for you; therefore, a full 48 hours advance notice is required for any cancellation or to re-schedule. Without 48 hours’ notice the full fee will be charged unless the cancellation involves a life-threatening emergency. If there is potentially dangerous weather you can expect communication directly from me, either through email or by telephone. 

TELEHEALTH

Virtual sessions utilize a HIPAA compliant TeleHealth technology as part of delivering therapeutic services and I understand that I have the right to use or refuse this service.  The privacy laws that apply to protecting confidentiality and exceptions to confidentiality are the same as in-office therapeutic services.  There shall be no recording of sessions by either party.  I also understand that we may encounter technical difficulties resulting in service interruptions.  If this occurs and we are unable to reconnect within ten minutes, we will connect via phone and discuss whether to continue the session or re-schedule.  TeleHealth services can also be used in the event of inclement weather.   

OTHER PROFESSIONAL SERVICES 

These are provided at my standard hourly rate and are prorated in 10-minute intervals. Such services may include, but are not limited to: non-legal report writing, preparation of records or summaries, attendance at meetings you have authorized with other professionals (e.g. your physician) and phone conversations unrelated to scheduling an appointment. Please know that in the unusual event of legal proceedings, I will only participate if ordered by the court and you will be expected to pay for my professional services, even if I am called to testify by another party. Legal proceedings are challenging and complex. As such, my fee is $325 per hour for preparation and attendance at any legal proceeding. I will always assume (if applicable) both partners love their children and want the best for them. For that reason, please know, I will not testify on behalf or against either party. 

CONFIDENTIALITY 

I regard the information that you share with me with the greatest respect. It is important that you know that I am ethically and legally required to maintain your privacy. I utilize both individual and group supervision in order to best serve you. The supervision team is also bound by confidentiality laws and ethical mandates. The primary reasons for limitations to client confidentiality are: (1) where there is a reasonable suspicion that you present danger to yourself or others; (2) where there is suspicion of child or elder abuse; and (3) court order. Otherwise, the only way I would share information about your treatment, history or even that you are a client with me would be with your clear permission accompanied by a signed release of information form. If you choose to communicate with me via email, please be aware that email is not a secure medium and that confidentiality cannot be guaranteed. 

Confidentiality with couples:  I have a no secrets policy, meaning that I cannot hold a secret from your partner.  Trust is important and secrets undermine our work together.  If you have something that is difficult to share, I will help you process, and we can share together within one to two weeks.  It is important that all communication is open and transparent.

Confidentiality with children:  Chile/teen confidentiality is limited to parental consent; however, trust is essential in working with children and teens.  I ask that you allow my sessions with them to be confidential unless I become aware that they are in danger.  I will do my best to help facilitate conversations between parent and child/teen to build and strengthen your relationship.    

COMPLAINT PROCEDURES 

If you have any concerns regarding our work together I invite you to discuss them with me. If you have addressed concerns directly with me but do not believe they have been resolved, you may contact the North Carolina Marriage and Family Therapy Licensure Board at 201 Shannon Oaks Circle, Suite 200, Cary, NC 27511, Tel: (919) 654-6914. 

By your signature on the First Appointment Form, you are indicating that you have read and understood this statement and/or that any questions that you have about this statement have been answered to your satisfaction.