Professional Disclosure Statement

Anisha Cooper, M.Ed., LAPC, NCC

Office: 912.478.5541
Fax: 912.478.0834
Credentials
I received my Masters degree in Community Counseling from Georgia Southern University
in July, 2014. I am Nationally Certified Counselor (NCC) seeking full licensure at the
Georgia Southern Counseling Center, under the supervision of Dr. Mark Perez-Lopez,
Licensed Psychologist. I have been trained in multiculturalism, trauma therapy, animal
assisted therapy, and group counseling. My personal references include Dr. Jodi Caldwell,
Director of the Counseling Center, a Licensed Psychologist, and American Psychology
Association (APA) member. She can be contacted at 912-478-5541 and
jodic@georgiasouthern.edu. Another reference is Dr. Beth Durodoye, Chairmen of the
Leadership, Technology and Human Development and American Counseling Association
member .She can be contacted at 912-478-5307 and bdurodoye@georgiasouthern.edu.
Lastly, Ms. Lisa Whitaker, Human Resource Specialist at Georgia State University. She can
be contacted at 404-413-2712 and lwhitaker5@gsu.edu.
Theoretical Orientation
I primarily utilize psychodynamic techniques and cognitive behavioral techniques with an
interpersonal approach. This means that you and I will work collaboratively to improve your
current thoughts/emotions/mentality related to themes and patterns youve experienced
throughout your life. You may often be encouraged to complete tasks outside the therapy
room to advance your progress. I only have the honor of working with you for a short amount
of time, and to use this time efficiently, you may be challenged to apply these concepts to
your daily activities. Throughout therapy, I tend to implement reflective questions, and
silence because they provoke critical thinking. At any time, we may reevaluate the treatment
plan to successfully meet your goals. Ill be happy to answer any questions you have about
the techniques we use.
Counseling Philosophy
Counseling is often sought out in an effort to reduce, improve, maintain, or change something in a clients life. I believe it is a collaborative process that will involve your time, energy,
and finances. Though we strive for positive change, this process can also be painful. There
may be times where you are challenged. You are responsible for completing recommended
tasks; however, you have the right to refuse and/or terminate treatment at any time, for any
reason. I have the right and ethical responsibility to keep your confidence, which is described
in the following section. I also have the right to refer you if I or my agency cannot adequately
treat you under ethical and legal standards. It is my responsibility to protect and uphold our
counseling relationship. I vow to treat it with the upmost respect. Please inform me of any
mental or medical health history in order to better serve you.
Confidentiality
The communication we engage in is a part of the clinical record, which is accessible to you
upon request. In order to file for insurance, some of your information must be provided to
your insurance company. I will only disclose the necessary information to collect my fee(s).
It is my ethical responsibility to keep your information confidential as part of our counseling
relationship, with the following exceptions:
(a) you direct me in writing to disclose information to someone else, (e.g., filing for insurance)
(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.

Counseling Background
I serve clients with diverse presenting concerns, including trauma clients (i.e., sexual assault,
domestic violence, & suicide survivors). I have had experience with groups and couples. Im also
experienced with multicultural populations. These are my areas of expertise. Here a few techniques I
may implement:
(a) Role Playing using the therapist and the client to act as another person to process potential circumstances.
(b) Counterstatement Journaling using visuals to understand thinking, emotions, and behaviors.
(c) Reflective questions (i.e., clarifying, summarizing, reflections, projections)- phrasing questions to
elicit understanding.
(d) Silence use of silence to allow processing and reflection.

Ethical Statement & Values Disclosure

As a member of the American Counseling Association, I agree to uphold the ethical standards
of this organization. I respect the counselor-client relationship. It is my responsibility to uphold
your confidence while protecting your safety. I respect you and appreciate your mental health
investment.
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 American Counseling Association (ACA) Code of Ethics (http://
www.counseling.org/Resources/CodeOfEthics/TP/Home/CT2.aspx). You may also write a letter to the ACA. This address is available upon request.

May 14, 2015

Anisha Cooper

Anisha Cooper, M.Ed., LAPC, NCC