Professional Disclosure Statement

Patricia Garrett Fearing

MCHMC
Counselor, The Retreat, Inc.
13 Goodfriend Drive
East Hampton, NY

Intentions: This document is to help inform you of my background and to explain what a
counselor - client relationship looks like.
Qualifications: I received a masters degree in Practical Theology for Pastoral Care and
Counseling from Columbia Seminary in 2013. I received a second masters degree in Clinical
Mental Health Counseling from Wake Forest University in December of 2016. Additionally, I
have been trained in play therapy, domestic violence counseling and trauma-informed
counseling. I am currently pursuing full licensure in marriage and family counseling (LMFT) and
clinical mental health counseling (LCMHC) in the state of New York, and counseling under
limited permits in both areas. My formal education has prepared me to counsel individual adults,
adolescents, children, groups, couples, parents, and families. Additionally, I have been trained in
play therapy, domestic violence counseling and trauma-informed counseling.
Experience: I completed my first counseling internship at Childrens Hospital of Atlanta in 2012.
I completed my second counseling practicum and internship at The Retreat, Inc. in 2016.
Professionally, I have served on the board of the New York Association of Play Therapy since
2016.
Supervision: In working under a limited permit, with the intentions of acquiring full licensure, I
am required under NY State Law to be under the supervision of a licensed counselor. I am
currently under the supervision of Regina Mysliborski, LCMHC. If at any time for any reason you
have questions about my training, or are dissatisfied with my services, please let me know. If I
am not able to resolve your concerns, you may report your complaints to my supervisor. Regina
may be reached at (631) 329-4398.
Nature of Counseling: My theoretical approach falls in the realm of person-centered
counseling, with specific practice, and continued study, in narrative therapy, play therapy and
existential therapy. My clients have majoritively been victims of trauma. I work with the
understanding that everyone has a story to tell, to learn from, and the ability to create the story
they desire for their future.
Permission to Participate and Confidentiality: All our counselor sessions are confidential.
This means that no information will be released to persons or agencies regarding the fact that
counseling has been received or the nature of the concerns without written consent. Danger to
self and/or others (i.e. suicide or homicide) may necessitate the breaking of confidentiality. In

addition, by law suspected child abuse and/or neglect and elder abuse and/or neglect
communicated by clients must be reported to appropriate agencies by counseling staff.
X _____ I have read the above statements and understand my rights regarding my participation
and confidentiality.
By your signature below, you are indicating that you read and understand this statement, that
any questions you had about this statement were answered to your satisfaction, and that you
were furnished a copy of this statement. By my signature, I verify the accuracy of this statement
and acknowledge my commitment to conform to its specifications.
______________________________________________________________________
Clients Signature
Date
______________________________________________________________________
Counselors Signature
Date