LCMHCA Professional Disclosure Statement

Samantha Simon Lohorn, M.A.Ed., LCMHCA, NCC

(704) 991-5159
E-mail: samantha.lohorn@outlook.com
My Qualifications

I earned a Master's of Education in Clinical Mental Health Counseling from the University of North
Carolina at Pembroke in the Spring of 2017. I have over 2,000 clinical experience hours of counseling and
have worked in outpatient mental health, academic counseling, hospital, and university settings. I received
my Bachelor of Arts in Psychology from East Carolina University that was conferred in December of
2014. I am currently obtaining my PhD in Counseling and Counselor Education from NC State University
and plan to graduate by 2021.

Restricted Licensure

I am currently pursuing a licensure as a Licensed Clinical Mental Health Counseling Associate

(LCMHCA), license #A13168. Once I complete 3,000 clinical supervised hours, I will apply to be a
Licensed Clinical Mental Health Counselor (LCMHC). I am currently under the supervision of Monica Z.
Obsurn, PhD, LCMHC Supervisor.

Counseling Background

I have been working in the counseling field for over three years in different settings. During my graduate
career, I worked with two different agencies and clientele. During the Spring of 2016, I worked with
Scotland Family Counseling Center in which I worked with a range of clientele, mostly dealing with
PTSD, anxiety, and depression. My clinical supervisors were an EMDR specialist, Charles Wentz,
LCMHC Supervisor and Mary Thompson, LCMHC. In the Fall and Spring of 2017, I worked with the
Striving Toward Academic Recovery (STAR) program in which I counseled students who were referred
for academic probation, dealing with stress, study skills, time management, and adjustment issues. Also
during my time at STAR, I taught an introductory psychoeducation class and was a group leader for group
counseling sessions regarding anger, personal problems, and stress. My supervisor during this time was
Timothy Hunt, LCMHC Supervisor. My counseling experience includes work with PTSD, anxiety,
depression, and life transitions. I have worked with couples, college-aged students, children, adolescents,
families, and individuals. I promote advocacy for all clients and specifically work alongside the
LGBTQIAA+ population to promote equality for all in and outside of the counseling room. I have worked
with eye movement desensitization and reprocessing (EMDR), art therapy, play therapy, group therapy,
and individual counseling. I am currently a counselor for the NC State Counseling center providing
services to those on campus for the Fall/Spring semesters.

I am a person-centered, solution-focused counselor, showing empathy with the client, unconditional

positive regard, and congruence in session. I work alongside the client to develop measurable and
attainable goals and objectives that will aid the client’s wellbeing and sense of self. I use cognitive
behavioral therapy techniques that allow the client to see their negative cognitions and reframe them into
positive thoughts that will increase their mental health. I believe that every client has a unique story and
will work together with them to create a space that makes them feel appreciated, heard, and promotes
growth. I am open, and encourage, clients to express if there is a type of technique or therapy that does
not work for them or causes extreme distress. Working together, I believe we can create a plan towards
growth and mental betterment.

Session Fees and Length of Service

Sessions are going to be determined by the counselor and based off of client schedule. Sessions will last
one hour. Fees will be designated by NC State University protocol and client insurance, which will be
documented through such means. I accept cash, credit cards, and debit cards. If client insurance requires a
co-pay, this should be paid in full before sessions begin. If the client cannot pay for the co-pay the day of
the appointment, the client will be billed. All session lengths and terms of service will abide by NC State
University rules and are subject to change.

Use of Diagnosis

Some health insurance companies will reimburse clients for counseling services and some will not. In
addition, most will require that a diagnosis of a mental-health condition and indicate that you must have
an “illness” before they will agree to reimburse you. 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 in imminent danger to yourself or others (including child, elder, or disabled persons 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/aca-code-of-ethics.pdf​).

North Carolina Board of Licensed Clinical Mental Health Counselors

P.O. Box 77819
Greensboro, NC 27417
Phone: 844-622-3572 or 336-217-6007
Fax: 336-217-9450
E-mail: ​complaints@ncblcmhc.org
Acceptance of Terms

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

Client: ___________________________________________________ Date: ___________

Counselor: ________________________________________________ Date: _________