PROFESSIONAL DISCLOSURE STATEMENT
Vermont State OPR Board of Allied Mental Health Professionals regulations for non-licensed psychotherapists. Each client must review this online document, and verify with me that they have reviewed the contents of this disclosure, no later than the third counseling session. I will submit a link to an electronic copy for you to sign electronically via email. There will be a space for your signature on the document. Thank you for choosing me to accompany you on this journey.
College of St. Joseph, Rutland, Vermont
Bachelor of Arts Degree (Psychology)
Confirmed: December 2017, Provider Scholarship Fund Recipient
University of Vermont, Burlington, Vermont
Master of Science Degree (Clinical Mental Health Counseling)
Confirmed: August 2020, CACREP Accredited Program
2020 – 2022 (Present): James Fitzgerald Therapy, PLLC
(Private Practice) VT Roster Pre-license Psychotherapist
Apprentice Addiction Professional
2020 – 2021: Baymark Health Services
(BAART Programs) MAT Counselor
Apprentice Addiction Professional
2017 – 2020: University of Vermont Medical Center
(Inpatient Psychiatry) Mental Health Technician
CPR/AED Certification, MOAB & ProAct Certified
2019 – 2020: Central Vermont Substance Abuse Services
(Internship) Intensive Outpatient Program Clinician
Adult Outpatient Program, CBT, MET, MI
2014 – 2017: Rutland Mental Health Services
(Residential/Crisis Intervention) Peer Support Specialist, Crisis Support Specialist, Residential Recovery Specialist,
Site Safety Coordinator, Group Facilitator
2013 – 2016: Vermont Psychiatric Survivors
(Community Outreach Program) Peer Support Specialist, Recovery Coach,
Wellness Recovery Action Plan Facilitator, Intentional Peer Support Certified
Telehealth for Mental Health Professionals (PESI)
Instructor: Joni Gilbertson, MA, NCC, LCPC, LMHC, BCTMH, CTMH
CEU: 12.5 Hours (Online); Test Completed 04/08/2020 – 10:46 AM CST; Original Program Date 02/20/2020
Cognitive Behavior Therapy Techniques for Everyday Practice (PESI)
Instructor: John Ludgate, Ph.D., Licensed Psychologist Psychotherapist
CEU: 6.25 Hours (Online); Test Completed 07/19/2020 01:26 AM CST; Original Program Date 07/26/2016
Advanced Practical Clinical Skills for the Trauma-Informed Therapist (PESI)
CEU: 6.25 Hours (Online); Test Completed 07/12/2020 10:43 PM CST; Original Program Date 03/21/2017
Wellness Recovery Action Plan Group Facilitator (Vermont Recovery Network)
Copeland Center for Wellness & Recovery
Instructors: Karen Lorentzon, Jane Winterling
Turning Point Center, Rutland, VT, September 2013
Professional Credentials & Affiliations
VT Secretary of State Board of Allied Mental Health Professionals
Non-Licensed & Non-Certified Psychotherapist (License # 097.0134612)
VT Secretary of State Office of Professional Regulation
Apprentice Addiction Professional (License # 149.0133944)
American Counseling Association (Member # 6526860)
National Board of Certified Counselors (National Certified Counselor)
Office of Professional Regulation Notice
The Office of Professional Regulation provides Vermont licenses, certifications, and registrations for over 56,000 practitioners and businesses. Forty-six professions and occupations are supported and managed by this office. A list of professions regulated is found below.
Each profession or occupation is governed by laws defining professional conduct. Consumers who have inquiries or wish to obtain a form to register a complaint may do so by calling (802) 828-1505, or by writing to the Director of the Office, Secretary of State’s Office, 89 Main Street, 3rd Floor, Montpelier, VT 05620-3402.
Upon receipt of a complaint, an administrative review determines if the issues raised are covered by the applicable professional conduct statute. If so, a committee is assigned to investigate, collect information, and recommend action or closure to the appropriate governing body.
All complaint investigations are confidential. Should the investigation conclude with a decision for disciplinary action against a professional’s license and ability to practice, the name of the license holder will then be made public.
Complaint investigations focus on licensure and fitness of the licensee to practice. Disciplinary action, when warranted, ranges from warning to revocation of license, based on the circumstances. You should not expect a return of fees paid or additional unpaid services as part of the results of this process. If you seek restitution of this nature, consider consulting with the Consumer Protection Division of the Office of the Attorney General, retaining an attorney, or filing a case in Small Claims Court.
Barbers & Cosmetologists
Clinical Mental Health Counselors
Drug and Alcohol Counselor
Hearing Aid Dispensers
Marriage & Family Therapists
Motor Vehicle Racing
Nursing Home Administrators
Osteopathic Physicians and Surgeons
Private Investigative & Security Services
Real Estate Appraisers
Social Workers, Clinical
Chapter 78: Roster of Psychotherapists Who Are Non-licensed
§ 4090. Disclosure of Information
The board shall adopt rules requiring persons entered on the roster to disclose to each client the psychotherapist’s professional qualifications and experience, those actions that constitute unprofessional conduct, and the method for filing a complaint or making a consumer inquiry, and provisions relating to the manner in which the information shall be displayed and signed by both the rostered psychotherapist and the client. The rules may include provisions for applying or modifying these requirements in cases involving institutionalized clients, minors and adults under the supervision of a guardian.
The Vermont Statutes Online
Title 3: Executive
Chapter 5: SECRETARY OF STATE
Sub-Chapter 3: Professional Regulation
3 V.S.A. § 129a. Unprofessional Conduct
(a) In addition to any other provision of law, the following conduct by a licensee constitutes unprofessional conduct. When that conduct is by an applicant or person who later becomes an applicant, it may constitute grounds for denial of a license or other disciplinary action. Any one of the following items or any combination of items, whether the conduct at issue was committed within or outside the State, shall constitute unprofessional conduct:
(1) Fraudulent or deceptive procurement or use of a license.
(2) Advertising that is intended or has a tendency to deceive.
(3) Failing to comply with provisions of federal or State statutes or rules governing the practice of the profession.
(4) Failing to comply with an order of the board or violating any term or condition of a license restricted by the board.
(5) Practicing the profession when medically or psychologically unfit to do so.
(6) Delegating professional responsibilities to a person whom the licensed professional knows, or has reason to know, is not qualified by training, experience, education, or licensing credentials to perform them, or knowingly providing professional supervision or serving as a preceptor to a person who has not been licensed or registered as required by the laws of that person’s profession.
(7) Willfully making or filing false reports or records in the practice of the profession, willfully impeding or obstructing the proper making or filing of reports or records, or willfully failing to file the proper reports or records.
(8) Failing to make available promptly to a person using professional health care services, that person’s representative, or succeeding health care professionals or institutions, upon written request and direction of the person using professional health care services, copies of that person’s records in the possession or under the control of the licensed practitioner, or failing to notify patients or clients how to obtain their records when a practice closes.
(9) Failing to retain client records for a period of seven years, unless laws specific to the profession allow for a shorter retention period. When other laws or agency rules require retention for a longer period of time, the longer retention period shall apply.
(10) Conviction of a crime related to the practice of the profession or conviction of a felony, whether or not related to the practice of the profession.
(11) Failing to report to the Office a conviction of any felony or misdemeanor offense in a Vermont District Court, a Vermont Superior Court, a federal court, or a court outside Vermont within 30 days.
(12) Exercising undue influence on or taking improper advantage of a person using professional services, or promoting the sale of services or goods in a manner that exploits a person for the financial gain of the practitioner or a third party.
(13) Performing treatments or providing services that the licensee is not qualified to perform or that are beyond the scope of the licensee’s education, training, capabilities, experience, or scope of practice.
(14) Failing to report to the Office within 30 days a change of name, e-mail, or mailing address.
(15) Failing to exercise independent professional judgment in the performance of licensed activities when that judgment is necessary to avoid action repugnant to the obligations of the profession.
(A) Impeding an investigation under this chapter or unreasonably failing to reply, cooperate, or produce lawfully requested records in relation to such investigation.
(B) The patient privilege set forth in 12 V.S.A. § 1612 shall not bar the licensee’s obligations under this subsection
(a) and a confidentiality agreement entered into in concluding a settlement of a civil claim shall not exempt the licensee from fulfilling his or her obligations under this subdivision (16).
(17) Advertising, promoting, or recommending a therapy or treatment in a manner tending to deceive the public or to suggest a degree of reliability or efficacy unsupported by competent evidence and professional judgment.
(18) Promotion by a treatment provider of the sale of drugs, devices, appliances, or goods provided for a patient or client in such a manner as to exploit the patient or client for the financial gain of the treatment provider, or selling, prescribing, giving away, or administering drugs for other than legal and legitimate therapeutic purposes.
(19) Willful misrepresentation in treatments or therapies.
(20) Offering, undertaking, or agreeing to cure or treat a disease or disorder by a secret method, procedure, treatment, or medicine.
(21) Permitting one’s name or license to be used by a person, group, or corporation when not actually in charge of or responsible for the professional services provided.
(22) Prescribing, selling, administering, distributing, ordering, or dispensing any drug legally classified as a controlled substance for the licensee’s own use or to an immediate family member as defined by rule.
(23) For any professional with prescribing authority, signing a blank or undated prescription form or negligently failing to secure electronic means of prescribing.
(24) For any mental health care provider, use of conversion therapy as defined in 18 V.S.A. § 8351 on a client younger than 18 years of age.
(25) For providers of clinical care to patients, failing to have in place a plan for responsible disposition of patient health records in the event the licensee should become incapacitated or unexpectedly discontinue practice.
(26) Sexually harassing or exploiting a patient, client, or consumer, or doing so to a coworker in a manner that threatens the health, safety, or welfare of patients, clients, or consumers; failing to maintain professional boundaries; or violating a patient, client, or consumer’s reasonable expectation of privacy.
(b) Failure to practice competently by reason of any cause on a single occasion or on multiple occasions may constitute unprofessional conduct, whether actual injury to a client, patient, or customer has occurred. Failure to practice competently includes:
(1) performance of unsafe or unacceptable patient or client care; or
(2) failure to conform to the essential standards of acceptable and prevailing practice.
(c) The burden of proof in a disciplinary action shall be on the State to show by a preponderance of the evidence that the person has engaged in unprofessional conduct.
(1) After hearing, and upon a finding of unprofessional conduct, a board or an administrative law officer may take disciplinary action against a licensee or applicant, including imposing an administrative penalty not to exceed $5,000.00 for each unprofessional conduct violation.
(A) Any money received under this subsection shall be deposited in the Professional Regulatory Fee Fund established in section 124 of this chapter for the purpose of providing education and training for board members and advisor appointees.
(B) The Director shall detail in the annual report receipts and expenses from money received under this subsection.
(e) In the case where a standard of unprofessional conduct as set forth in this section conflicts with a standard set forth in a specific board’s statute or rule, the standard that is most protective of the public shall govern. (Added 1997, No. 40, § 5; amended 2001, No. 151 (Adj. Sess.), § 2, eff. June 27, 2002; 2003, No. 60, § 2; 2005, No. 27, § 5; 2005, No. 148 (Adj. Sess.) ,
§ 4; 2009, No. 35, § 2; 2011, No. 66, § 3, eff. June 1, 2011; 2011, No. 116 (Adj. Sess.), § 5; 2017, No. 48, § 4; 2017, No. 144
(Adj. Sess.), § 6, eff. July 1, 2019; 2019, No. 30, § 4.)
§ 4093. Unprofessional conduct
(a) Unprofessional conduct means the following conduct and conduct set forth in section 129a of Title 3:
(1) Providing fraudulent or deceptive information in an application for entry on the roster.
(2) Conviction of a crime that evinces an unfitness to practice psychotherapy.
(3) Unauthorized use of a protected title in professionalactivity.
(4) Conduct which evidences moral unfitness to practice psychotherapy.
(5) Engaging in any sexual conduct with a client, or with the immediate family member of a client, with whom the psychotherapist has had a professional relationship within the previous two years.
(6) Harassing, intimidating or abusing a client.
(7) Entering into an additional relationship with a client, supervisee, research participant or student that might impair the psychotherapist’s objectivity or otherwise interfere with his or her professional obligations.
(8) Practicing outside or beyond a psychotherapist’s area of training, experience or competence without appropriate supervision.
(b) After hearing, and upon a finding of unprofessional conduct, the board may take disciplinary action against a rostered psychotherapist or an applicant. (Added 1993, No. 222 (Adj. Sess.), § 17; amended 1997, No. 40, § 71; 1997, No. 145 (Adj. Sess.), § 61; 1999, No. 52, § 37.)