Professional Disclosure Statement

Edith Tlaseca
I am currently a graduate student on the school-counseling track for Wake Forest University and will be
eligible to hold a valid North Carolina Teaching License as a Professional School Counselor after
graduation in May of 2016. During my time in practicum (165 hours at Sherwood Forest Elementary)
and internship (600 hours at Atkins High School), I have developed my guidance and counseling skills
from a solution-focused, person-centered, perspective under the supervision of licensed counselors. I will
be pursuing an LPC under the supervision of a licensed counselor in the state of North Carolina. My
approach to solution-focused brief therapy incorporates various techniques that include, but are not
limited to goal setting, coping strategies, scaling, and miracle questions. In addition, person-centered
therapy allows me to employ warm empathic techniques and active listening of my clients that encourage
personal-growth and focus on self-actualization. Other areas of competence include play therapy,
behavioral counseling, and rational-emotive behavioral therapy from a multicultural perspective.
I earned a Bachelor of Arts in Psychology in the spring of 2008 from the University of Texas at Austin
and have a background in early childhood education. I have been previously certified to teach at early
childhood education and development centers in Texas and North Carolina. My five years of experience
in the classroom have helped me develop skills in classroom management, lesson planning, leadership,
presentations, group management, and building strong working relationships with my colleagues. My
background in education has also afforded me with the ability to foster positive alliances between parents
and teachers for the benefit of students.
Counseling relationships are confidential in nature. I adhere to national and state confidentiality
standards and laws as well as the ACA Code of Ethics. Exceptions to confidentiality include situations
where disclosure is required to protect clients or identified others from serious and foreseeable harm or
when legal requirements (court order, not subpoena) demand that confidential information must be
revealed; I will seek supervision from my site and university supervisors if I should have any concerns or
doubts regarding my counseling practices. In some instances, I may keep counseling notes during my
session to use for diagnosis and treatment that will be added to the students counseling file. These notes
are for my use and this file is confidential, cannot be accessed by other counselors, and will not be part of
their student records. Clients and their families are encouraged to contact me if they have any concerns
regarding my performance as a counselor. Clients can also file a formal complaint with my supervisors,
professors, administration, and/or the school board, and ACA professional ethical boards if they deem my
services unsatisfactory, unethical, and/or unprofessional. Reference contact information for my
supervisors and lead instructors at Wake forest are included below.
Clients are primarily students and school personnel. No fee is charged to the clients. Length of sessions is
typically 30 minutes to an hour. All counseling relationships are professional and ethical in nature.
Students may be referred by others or refer themselves. The school psychologist is in charge of diagnosis
in the school setting. I may choose to refer cases to another counselor, psychologist, social worker, or
offer a list of approved referral locations for mental health services if issues presented by the client are
outside of my scope of competence or if they are deemed by the school counselor (myself) to need
specialized clinical treatment. Any diagnosis disclosed to me will be included in a secured file in the
counseling records that only the counselor can access and not with academic records. Students may be
uncomfortable at first, especially if it is their first time receiving professional counseling services. I will
create a safe environment for students to receive guidance in the areas of personal-social growth,
educational planning, and career/vocational development.

Contact information for my references:

Wake University Internship Lead Instructors:
Dr. Katherine Ziff
Email: ziffka@wfu.edu
Phone: 336-758-8629
Dr. Tammy Cashwell
Email: Cashweth@wfu.edu
Phone: 336-682-2567
Wake Forest University Internship and Practicum Supervisors:
Dr. Mark Eades
Email: eadesmp@wfu.edu
Dr. Holly Sopko
Email: sopkohk@wfu.edu
Internship Site Supervisors:
Ms. Kenya Rocker, Director of Guidance at Atkins High School
Mrs. Felicia Tubbs, Guidance Counselor
Candace Shaw, Career Development Counselor
Email: KTRocker@wsfcs.k12.nc.us
Phone: 336-703-6759
Mrs. Chrissy Sergiacomi, Director of Guidance at Sherwood Forest
Email: cmsergiacomi@wsfcs.k12.nc.us
Phone: 336-774-4646

Edith Tlaseca Updated March 6, 2016

We agree to these terms and will abide by its guidelines:
Clients Signature: ________________________________ Date: _____________________
Counselors Signature: _____________________________ Date: _____________________