Informed Consent

Thank you for choosing to work with me. It is an honor and a privilege to work with you. This form provides you with background information about my training and approach, fees, confidentiality, and your rights as a client. Please feel free to ask any questions at any time.

MY APPROACH & TRAINING

My work is informed by many influences, some of these are:

  • Process-Oriented Psychology explores the ways our unconscious mind manifests in physical symptoms and hard-to-explain behavior.

  • Neurolinguistic Programming explores the ways our language shapes what we can think and feel.

  • Systemic Family Constellation Work explores how unresolved trauma and loss, difficult circumstances, and repeating patterns of behavior unfold across the generations and may shape our behavior today in unseen ways.

  • Social Construction explores how we co-create meaning together through our communication and actions, then live into the social worlds we make.

  • Attachment theory, a variety of trauma healing modalities, Interpersonal Neurobiology and Evolutionary Psychology explore how the evolved intelligence of our human bodies interacts with our modern industrial world.

These approaches allow me to take a long-term, broad view as well as noticing and unpacking in-the-moment signals that arise in our communication. I have several certifications including, Certified Clinical Hypnotherapist, Certified Behavioral Coach, Certified Master Practitioner of NLP, and INFOSYON Certified Master Trainer of Systemic Constellation Work. I hold a PhD in Human and Organizational Systems from Fielding Graduate University. I do not assess, diagnose or treat mental or physical health disorders.

FEES

A consulting session is 90 minutes. Fees are $250/individual, $285/couples. Executive coaching sessions are 1 hour at $500. I do not bill insurance; however, if desired, I will provide a receipt or letter describing services upon your request. I do provide a discounted rate for three or more sessions. The Institute accepts cash, checks, PayPal, and major credit cards. Payment is due at the beginning of the session. Multiple session discounts are available.

CANCELLATION POLICY

48 hours notice will be billed at the full rate for that session.

CONFIDENTIALITY & CONSULTATION

All information you disclose during sessions and the written notes related to our sessions are confidential and may not be revealed to anyone without your written consent, except where disclosure is required by law.  As part of my commitment to provide you the best service, I consult with other professionals regarding my clients’ situations; however, your identity will remain anonymous and protected. If I need to consult another professional you are working with on your behalf, I will ask you to authorize a release prior to my discussion with that practitioner. Should I be subpoenaed or ordered by a court to testify or be required to testify in court on my behalf, I may have to give information you have disclosed without your consent. In order to avoid this situation, I do not accept cases where there is a legal or custody dispute, or cases with domestic violence, diagnosed mental illness, or incarceration.

RISKS TO TREATMENT & CONTACTING ME BETWEEN SESSIONS

Exploring your issues is not without some risk. Long-standing, deeply held issues can stir up uncomfortable feelings, especially in the early stages of our work. As you change, others in your world may react to you differently. This can, of course, be a good thing. These are a normal part of making personal or professional changes. I encourage you to bring such experiences into our sessions I may offer between sessions learning activities to provide you opportunities to support you in implementing our work. You may also phone or email me at any time during our work together. My contact information is on the front of this form. With some exceptions, I will respond within 48 hours. Please know that my practice does not allow me to provide “on-call” services. I believe that you will find my approach is solution focused and effective. Your goals for yourself are my goals. I will regularly touch bases with you to monitor progress and determine that we are going in the right direction for your goals. 

YOUR RIGHTS AS A CLIENT

Your safety and well-being are my primary concern. I adhere to the ethical code of the American Counseling Association and the Association of Council of Hypnotist Examiners. If you ever feel uncomfortable in any way in our work together, please communicate that to me promptly. You have the right to stop any procedure at any time for any reason. You have the right to know beforehand what method is being employed. And, you have the right to ask questions at any time during our work together. I welcome your questions, suggestions and feedback on our work.

INFORMED CONSENT

By signing this agreement (please fill out the form fields below), you confirm that you understand and agree to the policies and terms outlined here.

Thank you! I look forward to working with you.

I understand and agree to the policies and terms outlined here: