Nob Hill Wellness Center Telephone Consent

Consent for Life Coaching
Telephone Session

Energy Psychology
As part of my Life Coaching practice, I incorporate methodologies that appear to have promising mental health benefits but have yet to be fully researched by the academic community. This informed consent will provide you with some basic information about one of those methods called Energy Psychology, and how it is an option in our work together. We can discuss any aspect of this consent, and you are under no obligation to agree to these methods. The prevailing premise of Energy Psychology is that the flow and balance of the body’s electromagnetic and more subtle energies are important for physical and emotional health, and there are energy-based methods that help in fostering that well-being.

There appears to be an interactive effect among the following: emotions, thoughts, beliefs, images, biochemistry, behaviors, electromagnetic and subtle energies, and bodily sensations. These influence each other and each may promote health and well-being. The relationship you have to others, your community, the environment, and spirituality may also impact your health and well-being. Your coaching sessions may focus on any combination of these in order to most effectively help you obtain your goals.

What is Subtle Energy?
The relevance and interactive effect among all these aspects has been researched from the Western scientific perspective, except for the role of subtle energy. You may have heard of subtle energy through such terms as life force, chi, meridians, chakras, biofields, or auras. These energies are called “subtle” because they are not easily detectable and scientists have not been able to develop instruments to reliably measure them. However, many people for centuries and across cultures have described seeing or feeling subtle energies to varying degrees.

Subtle energy is one of the forms of energy still being explored. It can be considered part of the ever-present energy from which all matter is derived, in the sense of Einstein’s E=mc², i.e., matter is a form of energy. In many healing traditions, the “life force” that distinguishes life from death is understood as involving the presences of subtle energies. Energy Psychology suggests that by promoting balance and flow in these fields of subtle energy, the health of the body is enhanced.

Role of Subtle Energies in Life Coaching
Energy Psychology is based on the premise that by affecting electromagnetic and more subtle energies there can be a shift in emotions, thoughts, and behaviors. There are a variety of methods that appear to have an impact on subtle energies. The most common method is based on the ancient principles of acupuncture. It is a simple procedure that gently balances the energies without the discomfort of needles. Clients recall a troublesome thought or feeling and are taught which traditional acupuncture points on their body to stimulate through tapping, rubbing, or holding (rather than using needles). The stimulation of such points, sometimes referred to as acupressure, has been observed to reduce psychological symptoms. This is the method (specifically, EFT) I would most commonly use.

There are numerous other methods all designed to balance the flow of energies. For a review of these energy systems and the methods used to enhance them, see Eden’s book, Energy Medicine (1998), Gerber’s book, Vibrational Medicine (2001), and the web site for the Association for Comprehensive Energy Psychology (www.energypsych.org).

In summary, you understand there are promising reports from psychotherapists about the effectiveness of Energy Psychology, but that it is considered an experimental procedure with limited published research. Therefore, it has not been proven to be effective from a Western scientific standpoint. You understand that as a Life Coach, I will be using conventional methods in our work, and you also have the option of using those methods exclusively. If you feel we are not a good match, you are free to discontinue at any time, and I am very willing to provide you with names of other providers.

As with all forms of emotional healing work, it is possible to experience some emotional distress and physical sensations related to prior life experiences. The clinical reports from Energy Psychology show no additional side-effects when used appropriately. Emotions may continue to arise after a session, and you are encouraged to discuss such emotions with me.

If you agree to proceed with applying Energy Psychology methods toward reaching your goals, please read the following section covering general Life Coaching practice and then sign and date below. Your consent is given freely, without any obligation and with complete understanding of the above information.

Life Coaching
Prior to entering in a Life Coaching relationship, please carefully read the following and indicate your understanding and agreement by signing below:

I understand that Life Coaching is a relationship I have with a Life Coach (Performance Coach, Personal Coach, Executive Coach) that is designed to facilitate the establishment of long-range goals and the achievement of those goals.

I understand that Life Coaching is designed to be a long-term relationship where the Life Coach is assisting me to improve the quality of my life.

I understand that life coaching is comprehensive in that it deals with almost all areas of my life, including work, finances, education, health, relationships, and entertainment. I acknowledge that deciding on how to handle these issues and implementing my decisions remains my exclusive responsibility.

I understand that Life Coaching is for people who are already basically successful, well-adjusted, and emotionally healthy.

I understand that confidentiality in the Life Coaching relationship is limited. Confidentiality may not apply to certain crimes that have been committed or certain crimes that are being planned e.g., in the case of a clear and present danger to self or others, and suspected child/sexual abuse. It is also possible that certain topics could be reviewed with other helping professionals for training and development purposes.

I understand that Life Coaching does not treat mental disorders as defined specifically in the book titled Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association. If I have anything in my past indicating that I have an unresolved and serious emotional or physical problem, or a mental disorder, then I certify that I am not using Life Coaching as a substitute for assistance from a mental health professional and/or a medical doctor.

I will not use Life Coaching as a substitute for counseling, psychotherapy, psychoanalysis, mental health care or substance abuse treatment. I realize that this Life Coaching is not done by a licensed mental health professional.

I promise that if I am currently in therapy or under the care of a mental health professional, that I have consulted with that person regarding the advisability of my working with a Life Coach.

I will not use Life Coaching in lieu of professional medical advice, legal counsel, accounting assistance, business consultation, or spiritual guidance, and for each of these areas, I should consult the appropriate professionals. I acknowledge that I will not use Life Coaching as a substitute for such professional guidance. I further acknowledge that all decisions dealing with these issues lies exclusively with me.

By electronically completing this form, I agree that if I need to cancel our phone session, I will do so at least 24 hours in advance. If I fail to do that, I may be required to make payment before our next scheduled appointment to be used towards payment of that appointment. I will make all cancellations by phone rather than e-mail. I understand that it is my responsibility to place the phone call to 505.463.8628 on the agreed upon date and time.

My consent is given freely, without any obligation and with complete understanding and agreement with the above information. This consent may be revoked verbally by me at any time.

*Please follow-up any verbal request to revoke consent in writing so we are both very clear. We can discuss any aspect of this Consent before signing.

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Copyright KL Roush - 2008