(323) 508-3231

Professional Disclosure Statement

Big Picture Therapy
Chauney Peck, LMFT #103576

Welcome

Thank you for considering Big Picture Therapy for your mental health needs. This Professional Disclosure Statement provides important information about my qualifications, approach to therapy, practice policies, and your rights as a client. Please review this information carefully, and feel free to ask questions about anything that is unclear.

Therapist Qualifications and Credentials

Professional License

Name: Chauney Peck
License: Licensed Marriage and Family Therapist (LMFT)
License Number: 103576
Licensing Board: California Board of Behavioral Sciences (BBS)
License Status: Active and in good standing

You can verify my license status at: www.bbs.ca.gov

Education and Training

  • Master Marriage and Family Therapy and Clinical Art Therapy, Loyola Marymount University, Los Angeles, CA, 2015
  • Bachelor of Arts in Cultural Studies and Studio Arts, Evergreen State College, Olympia, WA, 2002

Specialized Training:

[Insert relevant specialized training, certifications, or continuing education]

  • Hakomi Institute, Protector Parts and Judgement States Workshop, 2025
  • Hakomi Institute, Level II Training in Somatic Psychotherapy, 2024
  • NICABM, Trauma and the Limbic System Workshop, 2023
  • CIBHS, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), 2017

Professional Memberships

  • California Association of Marriage and Family Therapists (CAMFT)
  • American Art Therapy Association (AATA)

Business Structure

Big Picture Therapy operates as an S-Corporation in the State of California. The sole owner and provider is Chauney Peck, LMFT.

Business Address:

3401 Glendale Blvd. #B
Los Angeles, CA 90039

Contact Information:

Phone: (323) 508-3231

Email: chauney@bigpicturetherapy.org

Scope of Practice

What I Do

As a Licensed Marriage and Family Therapist in California, I am qualified to provide psychotherapy services for:

  • Individuals (adults, adolescents, children)
  • Couples
  • Families
  • Groups

Areas of Focus:

  • Anxiety and depression
  • Relationship Issues and Codependency
  • Emotional and Nervous System Regulation
  • Neurodivergent Affirming Care
  • Trauma and PTSD
  • Life transitions and adjustment
  • Grief and loss
  • Self-esteem and identity issues
  • Stress management
  • Work-life balance

What I Don’t Do

I do not:

  • Prescribe medication (only psychiatrists and medical doctors can prescribe)
  • Provide forensic evaluations or court-ordered assessments
  • Conduct psychological testing or formal assessments
  • Provide 24/7 crisis intervention services
  • Guarantee specific treatment outcomes

If you need services outside my scope of practice, I will provide appropriate referrals.

Therapeutic Approach and Philosophy

My Approach to Therapy

At Big Picture Therapy, I believe in taking a holistic, collaborative approach to mental health treatment. My therapeutic style integrates several evidence-based approaches tailored to each client’s unique needs:

Primary Theoretical Orientations:

  • Systems Theory: Understanding how relationships and family dynamics influence individual well-being
  • Somatic Therapy: Use of body-based interventions, such as applied mindfulness and awareness focusing, to access bottom-up processing
  • Attachment Theory: Exploring how early relationships shape current patterns
  • Humanistic/Person-Centered: Creating a safe, non-judgmental space for growth and self-discovery
  • Mindfulness-Based Approaches: Building awareness and acceptance through slowing down automatic thought patterns and habits

What to Expect in Therapy

Initial Sessions:

  • The first 1-3 sessions focus on assessment, history-taking, and understanding your concerns
  • We’ll collaborate to identify your goals for therapy
  • We’ll develop a treatment plan tailored to your needs

Ongoing Therapy:

  • Sessions are typically 50-55 minutes, scheduled weekly or bi-weekly
  • Between sessions, you may be given exercises, readings, or practices to support your progress
  • We’ll regularly review your progress and adjust our approach as needed

My Role:

  • Provide a safe, confidential, and non-judgmental space
  • Listen actively and empathetically
  • Help you gain insight into patterns and behaviors
  • Teach coping skills and strategies
  • Support you in making positive changes

Your Role:

  • Attend sessions regularly and arrive on time
  • Be open and honest about your thoughts, feelings, and experiences
  • Actively participate in the therapeutic process
  • Complete between-session assignments when appropriate
  • Communicate concerns about therapy or our relationship

Client Rights and Responsibilities

Your Rights as a Client

You have the right to:

  1. Informed Consent: Receive clear information about treatment before it begins
  2. Confidentiality: Have your information kept private within legal and ethical limits
  3. Ask Questions: Request clarification about any aspect of therapy
  4. Participate in Treatment: Be actively involved in developing your treatment plan
  5. Refuse Treatment: Decline or discontinue treatment at any time
  6. Access Records: Request to review your clinical records (with some limitations)
  7. File Complaints: Report concerns about my professional conduct
  8. Respectful Treatment: Be treated with dignity, respect, and cultural sensitivity
  9. Qualified Care: Receive services from a licensed, competent professional
  10. Second Opinions: Seek consultation with other mental health professionals

Your Responsibilities as a Client

To get the most from therapy, clients are expected to:

  • Attend scheduled sessions or provide adequate notice of cancellation
  • Arrive on time for appointments
  • Pay fees as agreed upon
  • Be honest and forthcoming in therapy
  • Inform me of any medications or other treatments you’re receiving
  • Let me know if you have concerns about our work together
  • Notify me if you’re experiencing suicidal thoughts or plans to harm yourself or others
  • Respect professional boundaries
  • Refrain from contact with me outside of scheduled sessions except for scheduling purposes

Confidentiality

Commitment to Privacy

Everything discussed in therapy is confidential and will not be shared without your written permission, except in specific circumstances required or permitted by law.

Legal Exceptions to Confidentiality

I am required by law to break confidentiality in the following situations:

  1. Danger to Self: If I believe you are at serious risk of harming yourself
  2. Danger to Others: If I believe you pose a serious threat of violence to another person
  3. Child Abuse or Neglect: If I have reasonable suspicion of abuse or neglect of a child under 18
  4. Elder or Dependent Adult Abuse: If I have reasonable suspicion of abuse or neglect of adults 65+ or dependent adults
  5. Court Orders: If a judge orders the release of information
  6. Legal Proceedings: If your mental health is at issue in a legal proceeding you have initiated

Other Situations Involving Your Information

With your authorization, I may share information with:

  • Other healthcare providers involved in your care
  • Insurance companies for billing purposes
  • Family members you designate

Consultation and Supervision: I may consult with other mental health professionals about cases for clinical purposes. In such consultations, your identity is kept confidential unless you have provided authorization.

Limitations of Confidentiality in Certain Settings

  • Couples/Family Therapy: In couples or family therapy, I do not keep secrets. Information shared in individual sessions may be relevant to joint sessions.
  • Group Therapy: While I require all group members to maintain confidentiality, I cannot guarantee that other group members will do so.
  • Minors: Parents/guardians generally have the right to access their minor child’s records. However, California law grants certain confidentiality rights to minors 12 and older for specific mental health services.

Risks and Benefits of Therapy

Benefits of Therapy

Therapy can provide numerous benefits, including:

  • Reduced symptoms of anxiety, depression, or other mental health concerns
  • Improved relationships and communication skills
  • Better understanding of yourself and your patterns
  • Enhanced coping strategies
  • Increased self-esteem and confidence
  • Greater life satisfaction
  • Personal growth and development

Risks of Therapy

Therapy also involves potential risks and challenges:

  • Experiencing uncomfortable emotions (sadness, anger, anxiety, guilt) as you explore difficult issues
  • Changes in relationships as you grow and change
  • Temporary increase in symptoms before improvement
  • Difficult memories or experiences may surface
  • Therapy requires time, effort, and financial investment
  • No guarantee of specific outcomes or “cure”

Making changes in your life can be challenging. I will work with you to minimize risks and maximize benefits, but therapy requires your active participation and commitment.

Fees and Payment Policies

Session Fees

  • Initial Intake Session (60 minutes): $250
  • Individual Therapy Session (50-55 minutes): $250
  • Extended Session (80+ minutes): $375 per session or pro-rated

Other Fees

[Adjust as applicable to your practice]

  • Late Cancellation/No-Show: $250(or full session fee)
  • Phone Consultations: Free, per 15 minutes
  • Written Reports/Letters: $100 per hour
  • Legal/Court Services: $100 per hour (includes preparation, travel, testimony)
  • Records Review/Copying: $100 per page or as allowed by law

Payment

  • Payment is due at the time of service unless other arrangements have been made
  • Accepted payment methods: Cash, check, credit/debit card, HSA/FSA cards
  • Returned checks will incur a $50 fee
  • Outstanding balances may affect scheduling of future appointments

Insurance

I am an out-of-network provider and do not bill insurance directly. However, I can provide you with a “superbill” (detailed receipt) that you may submit to your insurance company for potential out-of-network reimbursement. Please check with your insurance company about your out-of-network mental health benefits.

Good Faith Estimate

Under the No Surprises Act, uninsured and self-pay clients have the right to receive a Good Faith Estimate of expected costs before beginning treatment. Please see our Good Faith Estimate document for detailed information.

Financial Hardship

If you are experiencing financial difficulty, please discuss this with me. I may offer a limited number of sliding scale fee slots based on financial need.

Appointment Policies

Scheduling

  • Sessions are typically 50-55 minutes
  • Sessions are usually scheduled weekly or bi-weekly at a regular day and time
  • If you need to reschedule, please contact me as soon as possible

Cancellation Policy

  • 24-Hour Notice Required: If you need to cancel or reschedule, please provide at least 24 hours advance notice
  • Late Cancellation Fee: Cancellations with less than 24 hours notice will be charged $250 (or the full session fee)
  • No-Show Fee: Failure to show for a scheduled appointment without notice will result in a full session fee charge
  • Insurance Note: Insurance does not cover missed appointment fees

Exceptions: Late cancellation fees may be waived in cases of genuine emergency, sudden illness, or circumstances beyond your control.

Late Arrivals

If you arrive late to a session, we will use the remaining scheduled time. You will be responsible for the full session fee. Sessions cannot be extended due to late arrival.

Therapist Cancellations

Occasionally, I may need to cancel or reschedule an appointment due to illness, emergency, or professional obligations. I will provide as much advance notice as possible and will not charge you for therapist-initiated cancellations.

Communication Between Sessions

General Guidelines

  • Email and Phone: You may contact me by phone or email for scheduling or brief administrative questions
  • Response Time: I typically respond within 1-2 business days
  • Not for Clinical Content: Email and voicemail are not appropriate for discussing clinical content or urgent matters
  • Security: Standard email is not secure or encrypted, so please do not share sensitive personal information via email

Emergencies and Crises

I do not provide 24/7 crisis services. If you are experiencing a mental health emergency:

  • Call 911 or go to your nearest emergency room
  • Call 988 – Suicide & Crisis Lifeline
  • Text “HELLO” to 741741 – Crisis Text Line
  • Los Angeles County Crisis Line: (800) 854-7771

Do not wait for a return call from me if you are in crisis. Seek immediate help using the resources above.

Professional Boundaries

Maintaining a Professional Relationship

To ensure effective therapy and protect both of us, I maintain professional boundaries:

  • No Dual Relationships: I do not accept friends, family members, or business associates as clients
  • No Social Contact: I do not connect with current or former clients on social media or engage in social relationships outside of therapy
  • Gifts: While I appreciate the sentiment, I generally cannot accept gifts from clients except token items of minimal value
  • Physical Contact: I maintain professional boundaries regarding physical contact. If you feel a hug or handshake would be helpful, please ask, and we can discuss it

Contact Outside Sessions

All communication should occur during scheduled sessions except for:

  • Scheduling or rescheduling appointments
  • Brief administrative questions
  • Notifying me of an emergency or hospitalization

I do not engage in social interactions or provide therapy via text message, social media, or casual encounters outside the office.

Termination of Therapy

How Therapy Ends

Therapy may end in several ways:

  • Goal Achievement: When you have met your therapy goals
  • Mutual Agreement: When we both agree you’re ready to conclude
  • Client Decision: You may terminate at any time for any reason
  • Referral: If I believe another provider would better meet your needs
  • Lack of Progress: If we are not making sufficient progress together

Planned Termination Process

When possible, I prefer to end therapy through a planned termination process that includes:

  • Reviewing progress and gains made
  • Discussing relapse prevention
  • Creating a plan for maintaining progress
  • Addressing feelings about ending therapy
  • Providing referrals if needed

Therapist-Initiated Termination

I may terminate therapy if:

  • You do not pay agreed-upon fees
  • You are frequently absent or cancel appointments
  • You are not benefiting from therapy or not engaging in the process
  • A conflict of interest or dual relationship develops
  • I am unable to provide services that meet your needs
  • You threaten or harass me or my staff

If I initiate termination, I will provide appropriate referrals and a reasonable transition period.

Records and Documentation

Clinical Records

I maintain clinical records for each client that include:

  • Intake information and assessments
  • Treatment plans and goals
  • Progress notes from each session
  • Any correspondence or collateral information
  • Billing records

Record Storage and Retention

  • Records are stored securely in HIPAA-compliant electronic health record systems and/or locked filing cabinets
  • Records are retained for 7 years after termination of services (or longer for minors as required by California law)
  • After the retention period, records are securely destroyed

Access to Your Records

You have the right to review your clinical records. If you wish to see your records:

  • Submit a written request
  • We will schedule a time to review records together
  • I may withhold certain information if I believe it could be harmful to you (rare)
  • You may request copies of your records (fees may apply as allowed by law)

Complaints and Grievances

How to File a Complaint

If you are dissatisfied with any aspect of your treatment or believe I have acted unethically:

Step 1 – Speak with Me Directly: I encourage you to discuss concerns with me directly. Many issues can be resolved through open communication.

Step 2 – File a Complaint with the Licensing Board: If you believe I have violated professional standards, you may file a complaint with:

California Board of Behavioral Sciences

1625 North Market Blvd., Suite S-200
Sacramento, CA 95834

Phone: (916) 574-7830

Website: www.bbs.ca.gov

Step 3 – Other Options:

  • Professional organizations (e.g., CAMFT, AAMFT)
  • Office of the Attorney General
  • Small claims court (for billing disputes)

You will not be retaliated against or penalized for filing a complaint.

Informed Consent

By beginning therapy with me, you acknowledge that:

  1. You have read and understood this Professional Disclosure Statement
  2. You have had the opportunity to ask questions and receive clarification
  3. You understand the nature of therapy, including potential risks and benefits
  4. You understand the limits of confidentiality
  5. You understand the fees and payment policies
  6. You understand your rights and responsibilities as a client
  7. You consent to participate in therapy

You will be asked to sign a formal Informed Consent document before treatment begins.

Questions?

Please ask questions about anything in this document that is unclear. I want you to feel fully informed about your therapy experience.

Contact Information:

Big Picture Therapy
Chauney Peck, LMFT #103576

3401 Glendale Blvd. #B
Los Angeles, CA 90039

Phone: (323) 508-3231

Email: chauney@bigpicturetherapy.org

I look forward to working with you.

© 2025 Big Picture Therapy. All rights reserved.

This Professional Disclosure Statement is provided to comply with California law and ethical standards for mental health professionals. It is intended to inform you about my qualifications, services, and policies.