Workshop Informed Consent

Kristin Minto-Snowden, MA, LMFT, CDWF

Certified Life Coach

lifecoachkms@gmail.com

Introduction

 

This Agreement is intended to provide the client listed above (Herein “Client”) with important information regarding the practices, policies, and procedures of Kristin Minto Snowden (herein “Coach”), and to clarify the terms of the professional relationship between Coach and Client.

 

Any questions and concerns regarding the contents of this Agreement should be discussed with Coach prior to signing it. 

Important Group/Workshop Rules

1. Confidentiality

Safety, vulnerability, and confidentiality are paramount to a supportive, cohesive group. Therefore, it’s important to emphasize that anything said between any two or more group members at any time is part of the group and is confidential. The client understands that everything said in the group is confidential. The client agrees to keep secret the names of other members of the group and what is said in the group. The client agrees to keep secret anything that occurs between or among group members. The client understands that there is an exception to this confidentiality which applies to the group leader. If the group leader believes that someone is in danger, the leader has a professional obligation to take direct action in order to keep everyone safe. The client agrees not to keep secrets from the group anything which occurs within the group. Anything which occurs between or among any members as part of the group is kept secret from everyone outside of the group but is not kept secret from the group participants or group leader.

 

2. Privacy

No group member is ever required to answer any question, participate in any activity/exercise, or tell anything. If the client is asked questions or asked to participate in an activity that makes them feel uncomfortable, the client understands that s/he has the right to refuse. The client agrees to never pressure other group members to participate in any discussion or activity after the member has passed or refused. The client understands that the group leader is obliged to protect this right. The client also understands that s/he will benefit more from the group the more s/he is able to take risks in sharing and participating.

 

3. Dignity

No group member is ever humiliated, hazed, or abused in any way. The client agrees to avoid this destructive behavior. The client also agrees to avoid any advice-giving or opinions on other clients’ choices or circumstances.

 

4. Additional Therapeutic Services

These workshops and groups are not a substitute for therapy or professional therapeutic interventions. Workshops and group work are meant to complement and supplement the therapeutic healing process. The client understands it is strongly recommended that all group participants also engage a mental health professional for individual/family/couple support.

 

5. Removal From Group

The client understands that if s/he violates group confidentiality or any of the rules explained in the first three sections of the rules, s/he could be removed from the group.

 

Coach Background and Qualifications

 

Coach is a Certified Life Coach and has been working with individuals, couples, and families since 2013.

 

Coach has mainly worked with clients who have been struggling with addiction, intimacy, and relationship issues.

 

Coach has worked in drug treatment centers, private practice, hospitals, and private practice settings.

 

Coach has received specialty training in process addictions, love/intimacy issues, relationship patterns, and LGBTQ+ affirmative therapy.

 

What is Coaching?

 

“Coaching" is a form of consultation where the Coach aids the client in setting and reaching goals, producing better results, acting more effectively with greater agility, and accomplishing more than was possible without the aid of a Coach…

 

The Coach assists the client in attaining lasting excellence, while at the same time attaining fulfillment and balance.” (The Therapist, Nov/Dec 2007).

 

Coaching is not psychotherapy.

 

Coaching does not involve assessment, diagnosis or treatment.

 

Coaching is not marriage and family therapy.

 

Risks and Benefits of Coaching

 

Coaching is a process in which the Coach and Client discuss a myriad of issues, events, and experiences for the purpose of creating positive change so the Client can experience his/her life more fully.

 

There are a number of benefits from participating in coaching sessions. Coach can provide support, problem-solving skills, and enhanced coping strategies for presenting issues and goals.

 

Simply put: It is often helpful to have someone on the "outside" looking in. Coaching can provide a fresh perspective on a difficult problem or goal or point you in the direction of a solution. The benefits you obtain from coaching depend on how well you use the process and put into practice what you learn.

 

Participating in coaching may also involve some discomfort, including remembering and discussing unpleasant events, feelings, and experiences. The process may evoke strong feelings of sadness, anger, fear, etc.

 

There may be times in which Coach will challenge the Client’s perceptions and assumptions, and offer different perspectives. The issues presented by the Client may result in unintended outcomes, including changes in personal relationships.

 

The client should be aware that any decision on the status of his/her personal relationships is the responsibility of the Client.

 

Personal growth and change may be easy at times but may also be slow and frustrating. The client is encouraged to address any concerns he/she has regarding his/her progress in coaching sessions with the Coach.

 

Confidentiality

 

Since California law does not recognize Coaching as a regulated profession and, thus, there are no limitations on or exceptions to confidentiality, to withholding, or divulging of information from the Coach/Client relationship is solely as defined and understood by the parties involved.

 

Therefore, this Coach agrees to maintain confidentiality with all information disclosed by the Client.

 

No information disclosed by the client will be shared with a third party without written authorization by the Client, except where required or permitted by law. Exceptions to confidentiality include, but are not limited to,

  • reporting child/elder/dependent adult abuse,

  • when the client is a serious threat of violence towards a reasonably identifiable victim,

  • or when a client is a danger to him/herself.

 

Should the client become involved in litigation, information revealed by the client could be discoverable, as there is no Coach/client privilege in California.

 

Coaching via Email/Telephone/Skype/FaceTime

 

Coach will sometimes conduct sessions via telephone and videoconference. This includes consultation, treatment, transfer of data, and education via interactive audio, video, or data communications. Such practices will be conducted with the same agreement of confidentiality as established in previous paragraphs (Confidentiality). These types of communication may not be as complete as face-to-face services but may still be beneficial to the client. The transmission could be disrupted or distorted due to technical failures or the transmission of information could be intercepted/interrupted/accessed by unauthorized persons. The client should discuss any concerns regarding the risks and benefits of telemedicine with the Coach.

 

Record-Keeping

 

Coach may take notes during the session and will produce other notes and records regarding the Client’s sessions. These notes constitute Coach’s business records and are the sole property of Coach.

 

Client Litigation

 

Coach will not voluntarily participate in any litigation, or custody dispute in which Client and another individual, or entity, are parties. Coach has a policy of not communicating with Client’s attorney and will generally not write or sign letters, reports, declarations, or affidavits to be used in Client’s legal matter. Coach will generally not provide records or testimony unless compelled to do so. Should Coach be subpoenaed, or ordered by a court of law, to appear as a witness in an action involving Client, Client agrees to reimburse Coach for any time spent for preparation, travel, or other time in which Coach has made herself available for such an appearance at Coach usual and customary hourly rate of $300 an hour.

 

Fee and Fee Arrangements

 

The usual and customary fee for service is $250 per 50-minute session via remote access, $180 per 50 minutes for office visits. Sessions longer than 50-minutes are charged additional time pro-rata.

 

Coach reserves the right to periodically adjust this fee and will notify the Client in advance. The agreed fee between Coach and Client is $250 per 50-minute hour.

 

Coach will provide an invoice prior to the appointment.

 

Payment is expected prior to the beginning of the session.

 

Coach accepts cash, checks, credit cards, and PayPal.

 

Cancellation Policy

 

Client is responsible for payment of the agreed-upon fee for any missed session(s).

 

Client is also responsible for payment of the agreed-upon fee for any session(s) for which

 

Client failed to give Coach at least 12 hours notice of cancellation.

 

Cancellation notice can be left on Coach’s voicemail or via email.

 

Coach’s Availability

 

Coach’s voicemail is confidential. Coach will make every effort to call Client back within one business day. Coach is unable to provide 24-hour crisis service. In the event the Client is feeling unsafe or requires immediate medical or psychiatric attention, he/she should call 911 or go to the nearest emergency room.

 

Termination of Relationship

 

Coach reserves the right to terminate the business relationship at her discretion. Reasons for termination include, but are not limited to,

  • untimely payment of fees,

  • failure to comply with homework and tasks,

  • and conflicts of interest.

 

The client has the right to terminate the business relationship at his/her discretion.

 

Coach will attempt to provide a smooth transition to another opportunity and provide necessary referrals to client.

 

Acknowledgment

 

By signing below, Client acknowledges that he/she has reviewed and fully understands the terms and conditions of this Agreement.

 

Client has discussed such terms and conditions with Coach and has had any questions with regard to the terms and conditions of the Agreement and consents to participate in coaching answered.

 

Client agrees to hold Coach free and harmless from any claims, demands, or suits for damages from any injury or complications whatsoever, save negligence, that may result from coaching.

 

I understand that I am financially responsible to Coach for all charges, including unpaid charges by my insurance company or any other third-party payor.

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