Conflict Resolution Institute (CRI), 2026 Austin Dr., Novi, MI 48377
Terence B’Nu, MAC, LPC, NCC, Lead Counselor
Office:  248-385-3498, Fax:  810-213-0555
Contact@ConflictResolutionInstitute.com

Disclosure & Informed Consent Statement




[X] Qualifications

[X] Counseling Experience

I have experience diagnosing, assessing and treating a wide range of mental health disorders and their effects with individuals, couples, families and groups, including those related to Anxiety, Depression, Trauma, Psychosis, Compulsions, Impulsivity, Conduct, Attention, Substance Abuse and Addictions of many types.

[X] Counseling Practice

My practice is eclectic, rooted in the Evidence-Based, Third-Wave, Transdiagnostic, Process-Based and Mindfulness-Based therapy of the Contextual Behavioral Science tradition, Acceptance and Commitment Therapy, whose targets are the components of the Psychological Flexibility Model.

[X] Diagnosis: If the client seeks Health Insurance reimbursement, a mental-health disorder diagnosis will be necessary. Diagnoses become part of the client’s permanent insurance records.

[X] Confidentiality: Communications are confidential with the following exceptions:
 
  • The client directs the counselor in writing to disclose information to someone else
  • The counselor thinks the client poses a danger to self or others
  • The counselor detects child, spouse or elder abuse
  • The client informs the counselor of positive HIV status or
  • The counselor is ordered by a court to disclose information.
  • The counselor reviews cases with a team of LPCs
[X] Voluntary Treatment: The client has the right to terminate treatment without cause. CRI has the right to refer client(s) to a more suitable counselor when deemed necessary.

[X] Complaints: A client may file a complaint with the Michigan Department of Licensing and Regulatory Affairs, Bureau of Professional Licensing, Investigations & Inspections Division, P.O. Box 30670, Lansing, MI 48909, (517)241-0205.

[X] Results & Risks: The client recognizes the change process involves changing one’s self concept, perspective, behaviors and relationships. CRI does not force or recommend changes, rather talks to the client about options and uses evidence-based techniques to help. CRI does not guarantee results. The client does not hold CRI responsible for its efforts to assist the client with his/her problem.

Acceptance of Terms: We agree to these terms and will abide by these guidelines.

Client Signature

Reset Signature


Date of Consent
 
 


Guardian Signature

Reset Signature