EMOTIONAL FREEDOM TECHNIQUES (EFT) COACHING DISCLOSURE STATEMENT AND AGREEMENT

Welcome! This document contains important information about my professional services and business policies. It is rather long because it covers a wide range of possible situations, many of which will not apply to you. Still, it provides a framework for understanding the services you are considering. Please read it carefully and note any questions you might have. We can discuss them at our next appointment. If you decide to use my services and sign this document, it will represent an agreement between us.

WHAT IS EFT COACHING?

The non-profit International Coach Federation (http://www.coachfederation.org), defines coaching as “partnering with clients in a thought-provoking and creative process that inspires them to maximize their personal and professional potential.” My approach to “EFT coaching” draws from a field called “Energy Psychology”. The roots of Energy Psychology trace back to Eastern healing practices that work with the acupuncture points, the chakras, and the body’s energy systems. The method usually involves having you tap with your fingers on specific areas of the skin while bringing to mind a personal response or pattern you would like to change. This is believed to shift the brain’s chemistry in ways that support that change. Other verbalizations and physical movements may also be used. Energy Psychology is still considered an “experimental approach,” although research has been promising. I can provide you with links to the most current research upon request. I have received professional training in the use of Emotional Freedom Techniques as well as other energy psychology techniques and will be happy to discuss them with you.

WHAT ARE THE LIMITATIONS OF EFT COACHING?

EFT coaching is not psychotherapy, nor is it a substitute for the diagnosis and/or treatment of mental health conditions by a psychologist, psychiatrist, or other licensed mental health professional. Although I am a licensed mental health professional, I do not function as one in this role, and I may refer you out for evaluation or services elsewhere. If you have a diagnosed mental disorder and are receiving services by a licensed mental health professional, my services should be used only in conjunction with your obtaining that care. I do not diagnose mental health disorders in my current role. EFT coaching attempts to help you optimize your overall vitality and mental well-being through the coaching relationship.

The following nine differences between psychotherapy and EFT coaching are important for you to understand prior to engaging my services:

1. Psychotherapists provide a diagnosis based on the DSM (the American Psychiatric Association’s Diagnostic and Statistical Manual). A primary focus of psychotherapy is the identification and diagnosis of mental disorders. Coaching does not diagnose.

2. Psychotherapy can provide diagnosis independent of the client's self-assessment. This function is recognized by third parties such as the courts and insurance carriers, which often call up on psychotherapists to make diagnoses independent of the

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client's self-assessment. Coaching, by way of contrast, relies on the client's self-

assessment.

  1. Psychotherapy can use its diagnoses to treat clinical disorders. Coaching makes no

    claims of efficacy in treating clinical disorders.

  2. Psychotherapy is often reimbursable by health insurance since diagnosis and

    treatment is recognized as being part of health care. Coaching is not usually

    reimbursable since it does not involve diagnosis or treatment.

  3. Goals in psychotherapy may be set by the therapist after diagnosis. Goals in

    coaching are typically self-identified by the client.

  4. Psychotherapy goals typically involve treatment of a mental disorder by the

    therapist. Coaching goals typically focus on quality of life.

  5. Psychotherapy typically involves recognized power differentials between client and

    therapist. This vulnerability of clients gives psychotherapists legal and ethical responsibilities. Coaching is in the nature of a supportive peer-to-peer relationship, with the results evaluated by the client.

  6. Psychotherapy may be provided by primary caregivers such as hospitals and may be considered an aspect of primary care. Coaching is not associated with primary care.

  7. Coaches are required to refer clients to psychotherapists or psychiatrists if the client's problem is outside their scope of practice.

 

MY BACKGROUND AND TRAINING

I have been working in the field of mental health since 1994. I began this work as an undergraduate student at Miami University in Ohio working at a community crisis center. I ended up graduating with a B.A. in both Psychology and Social Work and went on to spend a year working in a psychiatric hospital in Atlanta, Georgia before returning to graduate school to pursue a masters degree in social work. I earned my M.S.W. from Loyola University in Chicago and went on to become a Licensed Clinical Social Worker in 2000. Since that time, I have spent many years providing mental health treatment to individuals, families and groups, primarily working with clients who were involved with the child welfare system. I gained expertise in the field of trauma treatment during that time and have worked with many individuals with extensive trauma histories.

As the years went on, I began developing an interest in mind/body interventions to mental health. I saw dramatic improvements in the results with my clients through the uses of these, so I pursued further trainings in these techniques. I began teaching more classes and workshops on these approaches as well, to share them with as many people as possible. The approaches I have been trained in include: mindfulness, mediation, Dialectical Behavior Therapy, Eden Energy Psychology and Emotional Freedom Techniques. Currently, I incorporate aspects from all of these techniques into my coaching work, with EFT being the primary modality due to its effectiveness, ease of use and portability (as clients can use it on their own very quickly after learning it).

MEETINGS VIA WEB-BASED TELE-THERAPY

I generally schedule one appointment of 60 minutes’ duration per week, at a time we agree upon. Sessions may also, by prior agreement, be longer, shorter, more frequent, or less frequent. All meetings take place via the internet in a practice known as tele-therapy. Using a service called DoxyMe, clients need only to click the link on my website for us to see each other at the scheduled session time. This is a secure video portal that protects clients’ confidentiality and there is no need to download anything or create an account for clients. You will however need access to a webcam to use the service or use a smart phone or iPad. Sessions can also be conducted via the telephone if need be.

PROFESSIONAL RECORDS

I keep brief records on each session, primarily noting the date of the session, the topics discussed, the interventions used, and progress or obstacles observed as they relate to your goals in working with me. You are welcome to request, in writing, that I make available to other health care providers a copy of your file. I maintain your records in a secure location that cannot be accessed by anyone else. I will maintain your records for at least five years after our last contact, after which time I may securely dispose of them.

CONFIDENTIALITY

With the exception of special situations described below, you have the absolute right to the confidentiality of your sessions. I cannot and will not tell anyone else what you have told me, or even that you are in coaching with me without your prior written permission. Under the provisions of the Health Care Information Act of 1992, I may under certain circumstances legally speak to another health care provider or a member of your family about you without your prior consent, but I will not do so unless the situation is an emergency. I will always act so as to protect your privacy to the best of my ability. You may direct me to share information with whomever you chose, and you can change your mind and revoke that permission at any time.

You are also protected under the provisions of the Federal Health Insurance Portability and Accountability Act (HIPAA). This law insures the confidentiality of all electronic transmission of information about you. Whenever I transmit information about you electronically, it will be done with special safeguards such as a secure server to insure confidentiality. If you elect to communicate with me by email at some point in our work together, please be aware that email is not completely confidential. All emails are retained in the logs of your or my Internet service provider. While under normal circumstances no one looks at these logs, they are, in theory, available to be read by the system administrators of the Internet service provider. Following are five exceptions to your right to confidentiality:

  1. There are some situations in which I am legally obligated to take action to protect others from harm, even if I have to reveal some information about a client’s treatment. For example, if I believe that a child, an elderly person, or a disabled person is being abused, I must file a report with the appropriate state or local agency.

  2. If I believe that a client is threatening serious bodily harm to another, I am required to take protective actions. These actions may include notifying the potential victim, contacting the police, or seeking hospitalization for the client.

  3. If I believe that you are in imminent danger of harming yourself, I may legally break confidentiality and contact the police, a local crisis team, or a family member or other intimates.

  4. If you tell me of the behavior of another named health or mental health care provider which suggests that this person has either (1) engaged in sexual contact with a patient, including yourself, or (2) is impaired from practice in some manner due to cognitive, emotional, behavioral, or health problems, then the law requires me to report this to the practitioner’s state licensing board. I would inform you before taking this step. If you are my client and also a health care provider, however, your confidentiality remains protected under the law from this kind of reporting.

  5. In certain legal proceedings, particularly those involving child custody or those in which your emotional condition or treatment is an important issue, a judge may order my testimony. Confidentiality is not protected when a judge makes such an order or in certain other legal procedures. Consult with an attorney if you are involved in a legal situation where such confidentialities may be at issue.

 

PROFESSIONAL FEES

My fee for a 60-minute session is $150, unless otherwise determined by a special or package. If we decide to meet for a longer session or a shorter session, I will bill you prorated on this hourly fee. In addition to scheduled appointments, I also pro-rate the hourly fee for other professional services you may request. Other services might include emergency telephone conversations lasting longer than 10 minutes, reading and responding to e-mails other than for routine business, attendance at meetings with other professionals you have authorized, and the preparation of requested records or treatment summaries. If you become involved in legal proceedings that require my participation, you will be expected to pay for my professional time even if I am called to testify by another party. Because of the difficulty of legal involvement, I charge $200 per hour for preparation and attendance at any legal proceeding.

 

BILLING AND PAYMENTS

You will be expected to pay for each session at the time it is held unless we agree otherwise. Payment schedules for other professional services will be agreed to when they are requested. Once an appointment is scheduled, you will be expected to pay for it unless you provide 24- hours’ advance notice of cancellation. If you miss a session without canceling, or cancel with less than twenty-four hours' notice, you must pay for that session by the time of our next meeting unless we both agree that you were unable to attend due to circumstances beyond your control. In circumstances of unusual financial hardship, I may be willing to negotiate a payment installment plan.

If that is done and your account has not been paid for more than 60 days and arrangements for payment have not been agreed upon, I have the option of using legal means to secure the payment. This may involve hiring a collection agency or going through small claims court. If such legal action is necessary, its costs will be included in the claim. In most collection situations, the only information released is the client’s name, contact information, dates and type of services provided, and the amount due.

 

CONTACTING ME

I am often not immediately available by telephone. When I am unavailable, you will reach my voice mail. I monitor it frequently and will make every effort to return your call before the end of the next business day. If it will be difficult to reach you, please inform me of some times when you will be available. If you are unable to reach me and feel that you can’t wait for me to return your call, contact your family physician or, if you are experiencing a medical emergency, call 911 or go to the emergency room of a nearby hospital.

 

OTHER ASPECTS OF OUR RELATIONSHIP

I Welcome Your Questions. You have the right to ask me questions about anything that happens in our work together. I'm always willing to discuss how and why I've decided to do what I'm doing, and to look at alternatives that might work better. You can request that I refer you to someone else if you decide I'm not the right practitioner for you. You are free to terminate our work together at any time.

  • Contacts Outside Our Work Together. I generally avoid social and business relationships with my clients, and I, of course, never engage in sexual intimacies with clients.. Our work together will be most effective when kept free from possible outside entanglements. However, it is possible we may run into each other in the community in a public or social setting. I will not acknowledge you first. You are free to acknowledge me in which case I will reciprocate but please be aware that although I will not reveal to anyone, with whom I may be with that at the time that you are my client, they may draw certain conclusions based on knowing my profession. So therefore, you may chose not to acknowledge that you know me at all, which I will honor in turn.

  • Legal Proceedings. If you are involved in legal proceedings based on your having been traumatized, please understand that the goals of our work together may involve healing the physical and emotional aftermath of the trauma, and this could adversely affect your ability to provide legal testimony that carries the same impact as it would prior to treatment.

  • Terminating Services. You normally will be the one who decides when our work together will end, but there are three exceptions to this. If I determine that I am unable, for any reason, to provide you with the services you are requesting at a high professional standard, I will inform you of this decision and refer you to another practitioner who may better meet your needs. Second, if you verbally or physically threaten or harass me, my office, or my family, I reserve the right to terminate you from treatment immediately and unilaterally. Third, I reserve the right to refuse or terminate a session if you are suspected of being under the influence of a mood-altering substance. You will be responsible and charged for full payment of the normal fee.

 

Please let me know if you have any questions or matters of concern with me.  

847/957/4700

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