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Informed Consent Brochure


Supervisee Information for:
Moore and Associates
A Licensed Psychological Practice
Agency

Welcome to Moore and Associates. The Clinic Director is Dr. David Moore, a Licensed
Psychologist in the State of Washington. Dr. Moore also retains specially-qualified
Psychological Residents who have graduate-school level education. His Senior Resident is
Steven Martel, M.A. The Office Manager is Nicole Moore; who is also a trained therapist and
has over ten years experience in behavioral health agencies as a Treatment Director or Managed
Care Director. With the office secretarial staff, she arranges therapy scheduling and insurance
billing. It is always the responsibility of the patient to identify insurance coverage.

Contact Information and Directions

The location of Moore and


Associates is: 402 S. 333rd
Suite 121; Federal Way WA
98003. Phone number is
253.929-1543. The FAX
number is 1-866-311-9279.

Counseling Psychology Practice


Psychologists in Washington State provide specific services and their quality
assurance is guided by professional and state agencies. A description of
Psychological Practices as outlined in Washington State is attached to this
brochure as the last pages.

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Supervised Post-Graduate Experience for Mental Health Counselor Associates

Dr. Moore is an approved supervisor, in accordance with WAC 246-809-234, for Licensed
Counselor Associates. He provides post-graduate supervisory experience using a combination of
Eriksonian and Existential strategies which is considered a psychodynamic supervisory
experience. While this supervisory experience will count towards an Associate’s required 100
hours of supervisory experience, Dr. Moore will not be considered responsible for clients being
seen by the Associate. That direct client supervision must occur separately, through an agency or
another approved supervisor.

The Core Responsibility of the Associate in Order to Receive Supervision


Your Responsibility: Each supervisee must obtain a valid license as a Mental Health Counselor
Associate from the Department of Health and understand all the requirements for becoming and
maintaining that licensure.
Requirements for, and description of, the Associate License1
The following must be completed in order to qualify for an associate license:
 Completed application with signature and date.
 The application and initial licensure fee.
 Completed out of state verification forms sent directly from each state (if applicable).
 Four (4) hours of HIV/AIDS education and training.
 Official transcripts sent directly from the college where the degree was obtained.
An associate is a pre-licensure candidate who has a graduate degree in mental health counseling
or a related field and is gaining the supervision experience necessary for licensure as a mental
health counselor. Associates may not independently provide mental health counseling for a fee,
monetary or otherwise.
If an associate is working under the supervision of an approved supervisor, it is not considered
independent practice.
Associate licenses are valid for one year and must be renewed every year on the date of issuance.
The associate license may be renewed no more than four times. This should allow licensed
associates enough time to complete their supervision requirements for full licensure.

Each supervisee is also responsible for knowing, and adhering to, the Ethical Standards from
the American Counseling Association; as well as for purchasing the following reference texts
which describe the basic overview of Moore & Associates’ supervision:
Wishnie, Howard A. Working in the Counter-transference: Necessary Entanglements.
Lanham, MD: Jason Aronson Publishing Co., 2005. ISBN 0765703696
Falender, Carol A. and Shafranske, Edward P. Clinical Supervision: A Competency-Based
Approach. Washington, DC: American Psychological Association (APA), 2004. ISBN
1591471192.
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[http://www.doh.wa.gov/hsqa/Counseling/AssocFAQs.htm#What%20is%20an%20assoc]

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Dr. Moore’s Core Responsibility for Your Supervision

Dr. Moore’s basic responsibility: Providing approved psychodynamic supervisory experience,


in a group setting, towards the necessary 100 hours of supervised post-graduate experience
[WAC 246-809-234].

Supervised Post Graduate Experience necessary to become licensed as a Mental Health


Counselor [246-809-230]:

Minimum of 36 months of full-time counseling or three thousand (3000) hours of postgraduate


mental health counseling under the supervision of an approved licensed mental health counselor
or equally qualified licensed mental health practitioner in an approved setting.

At least of 100 hours must be in immediate supervision with an approved licensed mental health
counselor or equally qualified licensed mental health practitioner.

At least 1200 hours must be direct counseling with individuals, couples, groups, or families.

Dr. Moore’s Counseling Theory, Therapeutic Approach and Supervisory Strategy

Dr. Moore and the clinicians at Moore & Associates primarily practice what is called an
Existential Eriksonian approach. Supervision is based on learning therapeutic skills from that
integrated counseling theory; as well as direct application of those strategies for insight into how
the clinician can work within their own counter-transference.

There are two important parts to an Existential approach that describe that counseling theory’s
application at our agency; as well as two Eriksonian principles that further explain our practice.

Existentialism is a type of client-centered practice where the therapist tries to view the current
life situation through the eyes of the client. In supervision, the Psychologist and peers apply that
same model. Though we will use standard definitions for issues like a diagnosis or community
norms, we try to de-mystify psychology and work with our clients to translate it into their terms.
The second important part of our Existential practice is finding and strengthening meaning in
each person’s life. We all experience suffering at times in life but, as an Existentialist perceives
it, suffering without meaning leads to despair, depression and anxiety. We subscribe to the
Frankl school of Existentialism. This also includes taking personal ownership for learning from
one’s history and owning the responsibility to chart a more effective future. In supervision, this
includes understanding the roots of our counter-transference and turning them into a
strengthened part of our self-monitoring during therapy. Our whole life becomes an opportunity
for personal growth. A perspective we model for our clients and peers. In supervisory groups, the
members work to help others understand their world accurately and the members work to apply
the same towards their peers. Instead of giving advice from “their expertise”, they learn the other
group member’s view and trying to find common ground in their lives where they have been

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successful in addressing a similar issue. People do not confront others in our groups; they receive
feedback, with their permission, guided by Supervising Psychologist.
Eriksonian therapy practices come from Erik Erikson, one of the original founders of modern
day Psychology [along with Freud, Adler, Anna Freud, Otto Rank and Carl Jung]. He came to
the United States, seasoned his beliefs among the Oglala Sioux tribe and ultimately refined his
therapeutic processes around “Identity Development” over the life stages. Today, the Eriksonian
Institute at Harvard University is the caretaker of his legacy and practices. The supervisory
contracts, as well as our client therapy plans, at Moore and Associates, focus on the different
parts of self-identity, where someone is in their life stage and the part[s] they wish to develop.
This is a social perspective, which also requires friends and peers to support and enjoy that part
of their world—Social-Family, Emotional, Intimacy, Recreational, Vocational, Spiritual, and
Intellectual-Educational. We find that, most often, the person is experiencing developmental
needs in one or more areas, and/or they have experienced problems and/or loss of a relationship
with an important person in one or more of those areas. Group supervisory work is ideal to
process goals and objectives relating to these issues. For Counselors, working in the counter-
transference, that includes skill-building in the area of vocational identity; as well as gaining
meaning from any suffering and struggles we have experienced in the other domains of identity.
Cognitive behavioral group processes. Dr. Moore’s paradigm is that Eriksonian Existentialism
is a comprehensive change strategy where the presenting developmental need becomes a way to
learn broad behavioral health strategies to use in the future. However, the agency realizes that
supervisees need to learn specific strategies, often called cognitive schemas, to deal with more
narrow and specific needs. In supervision, this includes the two texts; just as we recommend that
clients find workbooks that add to the therapy process, even if that is simply free-hand journaling
between sessions to synthesize specific learning. This style is in the domain of cognitive-
behavioral counseling theory due to its reliance on psycho education, changing perspectives, and
assisting the person to make more effective behavioral decisions. This process helps identify
strengths and discover patterns of behavior that can be made more effective.

The Supervision Process and Cost

Group Supervision: Dr. Moore provides supervision in groups of one-six Associates. The
sessions last 1.5 hours. There is a rotating focus of 30 minutes on two specific Associates; with
everyone benefiting from peer experiences. This allows for .5 hour of “Immediate Experience”
for each of the six supervisees. [WAC 246-08-210].
Quarterly Individual Supervisory Sessions: At the beginning of the supervision, and every 3
months thereafter, the Supervisee will meet with Dr. Moore to go over their Supervision Contract
and goals.
Time and Location: The group sessions will be on Tuesdays, late afternoon, from 4:30 PM to
6:00 PM. Due to Dr. Moore’s time demands in out-of-state research, he may, 3 weeks in
advance, cancel no more than one session in a month. The office will still be open and the
Associates are welcome to get together for their own peer discussion at the same time. The
individual introductory session and quarterly individual sessions are scheduled at a mutually
convenient time.

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Costs: Dr. Moore’s rates are those negotiated with managed care entities in his practice.
The cost for a 1.5 Hour Group Session is $75.00. The cost for a 60-Minute Individual Session is
$165.00; which also includes the written documentation for the supervisory contract. Payment is
arranged through the Office Manager and must be kept current. Missed sessions, unless agreed
to a week in advance, are 50% of cost.
Time Commitment: Supervision contracts are mutually agreed-to by Dr. Moore and the
supervisee. They are for 3-month periods of time. After the initial individual session, if an
agreement is collaboratively agreed on, the supervisee is expected to make a good faith effort to
honor the 3-month commitment.

• Items in a “Supervision Informed Consent


Contract” with Dr. Moore
 Supervisor professional disclosure
 Purpo se, go als, objectives
 Nature and context of supervision services
 Responsibilities of supervisor & supervisee
 Procedural considerations
 Evaluation procedures
 Ethica l a nd legal issues

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