Stephanie Munizza, MA, LMFT, CDP

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Stephanie Munizza, MA, LMFT, CDP Washington State law requires that I provide you with the following information, and that you indicate you have been informed by signing a copy of this form. The purpose of this disclosure statement is to give information about me, information about your rights and responsibilities, and information about what you can reasonably expect from our therapy work together, so please read all the information carefully. The foundation of successful therapy is a solid working relationship between client and therapist. If our work together is not meeting your needs, please feel free to discuss your concerns so we can make appropriate changes. I will assist you in finding another therapist if I am not able to address your concerns. You have a right to take a break, discontinue, or refuse treatment at any time. I welcome questions and feedback about our work together at any point throughout our process. Credentials: I am licensed in the State of Washington as a Marriage and Family Therapist (LMFT) and Chemical Dependency Professional (CDP). My credential numbers are LF60521654 and CP60312423. I received a Master of Arts Degree in Counseling Psychology from St. Martin's University in 2010 and a Bachelor of Science Degree in Psychology from St. Joseph's college in 2005. Theoretical Orientation and Practice: My training incorporates various counseling approaches: Family Systems, Cognitive-Behavioral Therapy (CBT), and Humanistic and Experimental theories. Because of my interest and belief in the connection of body, emotions, and cognition, my preferences of therapies are Eye Movement Desensitization and Reprocessing (EMDR) which is a psychotherapy that enables people to heal from symptoms and emotional distress that are the result of disturbing life experiences, and Sensorimotor Psychotherapy, a body-centered therapy that brings attention to the body with non-judgment and curiosity to help either develop inner resources in order to regulate affect or to help work out habitual fight, flight or freeze responses. With couples and families, I work from an attachment lens and lean greatly on Emotionally Focused Therapy. I have experience working with issues such as depression, anxiety, dependency (drugs, alcohol, food, shopping, sex etc..), trauma (big and small), grief and loss, as well as other aspects of the human condition in this modern era. Current Practice: I work with individuals, couples, and families. I believe that therapy is first about gaining awareness and understanding, and once that is accomplished, there is a choice to make a change or not. Making a change takes courage, energy, and risk on your part, and a strong therapeutic alliance is greatly needed…key really. Research shows that despite the therapeutic modality used in therapy, it is the relationship between therapist and client that is most important. That makes sense since therapy requires such intimacy. My job is to witness, and I feel immensely grateful to have the honor to do so. My belief is that you are the expert of your mind, emotions, body, and spirit. You do the work in session; my role involves navigating, challenging, mirroring, and supporting you on your path. My job is to hold…to be present…to be authentic…to create a safe, nourishing, comfortable space for you to explore, get to know yourself (body, mind, and spirit), and hopefully, create within you a greater sense of acceptance, empowerment, and agency. I fully welcome diversity and am a LGBT ally. Confidentiality: Information discussed in therapy is confidential. I will not release any information without your written permission, apart from the following exceptions as required by law: I may be authorized or required to disclose information you provide to me if I suspect there has been child or elder neglect and/or abuse or if you are a threat of harm to yourself or others. If you are on an insurance claim, information regarding your dates of service, diagnosis and treatment plans may be released to your insurance company. Your name and identifying characteristics will not be disclosed if at any time I consult with professional colleagues about general aspects of your case. Appointments: Making and keeping appointments is important to the therapeutic process. Appointments begin at our agreed upon time, not when you arrive. Your appointment is held exclusively for you. It is important to be on time because your appointment cannot be extended beyond the scheduled time since other people may have reserved that time. Emergency Calls: Please do not leave emergency messages on my personal voicemail, as I cannot assure I will retrieve messages after hours or on weekends. When you call the Rainier Associates main number (253-475-6021) an answering service takes all emergency calls outside of regular business hours. They will attempt to locate me in the event of an emergency or will contact the on-call therapist covering for me. Emergency numbers are the following: • Pierce County Crisis Line at (800) 576-7764 SuicidePreventionLifeling.org 1 (800) 273-TALK or 1(800) 273-8255 • 911 or go to the nearest emergency room. Billing and Payment: Please remember that fee payment is your responsibility. I request that you keep current with your portion of the bill (the part not covered by insurance) each session or at the end of the month. If you are unable to manage this, please work out a payment arrangement in advance with the billing office. Ultimately you are responsible for your account and are expected to pay your bill, whether insurance pays for a portion or not. A finance charge of 1% may be added to any balance not paid in 60 days after the charge is incurred. If 90 days passes without a payment, accounts may be sent to a collection agency. If you have questions about your account, you may speak to someone in the billing office at any time. Insurance: I am a contracted provider for many, but not all local insurance companies. You should be sure to check with your insurance company and our intake office to learn whether I am a provider for your plan. You should also inquire if your plan requires a preauthorization or a PCP referral, if you have a separate annual deductible for mental health and whether your mental health benefit has a maximum yearly number of sessions or a maximum yearly dollar amount. Our intake department can assist you with any of these questions. The billing department will submit claims to insurance companies that I am contracted with; in order for this to occur you need to provide a copy of your insurance card. Ending Psychotherapy: An expected goal of treatment is to end therapy. If you choose to end therapy prior to achieving your goals, I recommend you consider participating in a closure session which enables us to say goodbye. Changes to Office Policy: From time to time, the business policies described in this document may be changed. I will attempt to inform you of the relevant changes. Consent for Treatment: I have read Stephanie Munizza's Office Policy Statement and understand it. I consent to therapy under the terms described above and understand I have the right to terminate treatment at any time. My signature below indicates I have received a copy of this agreement.

* I acknowledge I have read the financial policy above and that I am responsible for all charges regardless of any insurance coverage I have. I understand that delinquent accounts may be assigned to a credit reporting collection agency and agree to pay for all legal costs and expenses including reasonable attorney fees. By signing this Acknowledgement, I agree that my electronic signature is the legally binding equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my electronic signature is not legally binding.

Please note: Rainier Behavioral Health does not provide disability evaluations or court related evaluations.

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