LPCA Professional Disclosure Statement

Ashley Elsaesser MS. Ed, LPCA

Phone: (315) 525-6994
Office: (704) 814-9772
E-mail: Ashley@aeprofessionalcounselingservices.com
Ashley.elsaesser@ucps.k12.nc.us

My Qualifications

I received a Master of Education degree in School Counseling in 2009 from the University at Buffalo in
Buffalo, NY. I am a certified North Carolina School Counselor. I am also a Licensed Professional
Counselor Associate (#A10977). I completed a yearlong graduate internship at Colonial Village
Elementary School in Niagara Falls, NY from August 2008-June 2009. I then worked as a interim
School Counselor at Oriskany Central School District from September-October 2009. I then completed
another interim position at Colonial Village Elementary School from November 2009-February 2010. I
then worked in the Elmira City School District at Hendy Avenue Elementary School from March of
2010-June 2011. I worked for Billingsville Elementary School in Charlotte, NC from August 2011 to
March 2014. I am currently a School Counselor at Weddington Middle School in Matthews, NC. I have
been a School Counselor for five years.

In June of 2014, I began a private counseling practice under the name, Ashley Elsaesser Ms.Ed, LPCA,
PLLC.

To further my education, I am currently enrolled in the Graduate Certificate in Play Therapy Program at
the University of North Carolina at Charlotte.

Licensure

As a Licensed Professional Counselor Associate I receive supervision from a Licensed Professional
Counselor Supervisor. I am currently under the supervision of Lori Fox, LCSW. If you need to contact
Ms. Fox please call 704-776-8728.


Counseling Background

I currently service Children and Adolescents ages 4-18 years of age. I also service families around an identified
child or adolescent client. I utilize individual, group and family therapy to provide the most beneficial therapeutic
relationship with the child/adolescent. My therapeutic basis is from the Person Centered approach. I believe that
all children and adolescents have the innate ability to overcome obstacles and challenges presented in their lives.
Using this guiding belief, I use many Person Centered techniques, Solution Focused Interventions and
Psychoeducational approaches as necessary. I use these approaches through Child Centered Play Therapy, Filial
Play Therapy as well as directive Cognitive Behavioral Therapy.

I believe that by establishing goals with the client and their family, and through the use of specific counseling
interventions, clients gain an increase in self-awareness, self-regulation and self-worth.


Session Fees and Length of Service

Initial sessions will be for 90 minutes. We will assess concerns, and determine the most appropriate services for
your child. Each session following will be 50 minutes. The cost of the initial session will be determined upon
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receiving my licensure. All payments will be in the form of check or cash. Please be aware that I do not accept
health insurance, or file any health insurance claims at this time. The cost of the initial session is $100. The
following sessions are priced at $85. A sliding scale fee may be used and the amount determined by the counselor
based on the clients employment, situation, etc. will be determined and discussed with the client prior to services.

It is expected that your session will begin at the agreed upon time. Any session that begins after the agreed upon
time cannot be extended after the scheduled finish time. A 24 hour advanced cancellation or rescheduling of the
appointment is required. If the requirements are not met, a $30.00 fee will be assessed.

Use of Diagnosis

Diagnosis is established using the DSM-IV-TR (Diagnostic and Statistical Manual) to inform treatment; however
when working in the capacity of School Counselor I will not be diagnosing students, I will refer students to the
appropriate source for an evaluation.

Although I am not currently accepting insurance at this time, in the future, a qualifying diagnosis may be required
for the insurance company to cover the cost of treatment. Some conditions for which people seek counseling do
not qualify for reimbursement. If a qualifying diagnosis is appropriate in your case, I will inform you of the
diagnosis before we submit the diagnosis to the health insurance company. Any diagnosis made will become part
of your permanent insurance records.


Confidentiality

All of our communication becomes part of the clinical record, which is accessible to you upon request. I will
keep confidential anything you say as part of our counseling relationship, with the following exceptions: (a) you
direct me in writing to disclose information to someone else, (b) it is determined you are a danger to yourself or
others (including child or elder abuse), or (c) I am ordered by a court to disclose information.

Complaints

Although clients are encouraged to discuss any concerns with me, you may file a complaint against me with the
organization below should you feel I am in violation of any of these codes of ethics. I abide by the ACA Code of
Ethics (http://www.counseling.org/Resources/CodeOfEthics/TP/Home/CT2.aspx).


North Carolina Board of Licensed Professional Counselors
PO Box 1369
Garner, NC 27529
Phone: 919.661.0820
Fax: 919.779.5642
E-mail: ncblpc@mgmt4u.com


Acceptance of Terms

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


Client: ___________________________________________________ Date: ___________

Counselor: ________________________________________________ Date: ___________
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