Agreement and Policy
This document contains important information about my professional services and business policies as of January 1st, 2021. It also contains your rights and responsibilities as a client. Please read it over carefully and feel free to ask any questions you may have. At the conclusion of this document is a place intended for your signature. Please be aware that upon signing this document, you are consenting to the conditions proposed wherein and it will represent an agreement between us.
Your rights as a Client:
I. You have the right to ask questions about anything that happens in coaching sessions. I am 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. Your input into the process of coaching, no matter how hard to put into words, is very important. You can ask me about my training or request that I refer you to someone else if you decide I’m not the right coach for you. You are free to leave the relationship at any time.
II. You have the right to confidential and safe treatment. What you say to me is confidential unless I am concerned about your safety or the safety of another person or otherwise required by law. (please see additional information on this under My Responsibilities to You as a Coach section I.)
Your responsibilities as a client:
I. You are responsible for coming to your sessions on time and at the time we have scheduled. If you are late, we will end on time and not run over into the next person’s session. If you miss a session without canceling, or cancel with less than twenty-four hours’ notice, you are still responsible for payment of the session
II. Your active participation is required. The success of our sessions depends on a number of variables, including, but not limited to the personalities of the coach and client and the particular issues presented. Unlike a visit to your medical doctor, your role in coaching is not a passive one. The process calls for a very active effort and involvement on your part and you may be asked to work on things we discuss both during our sessions and at home.
My Responsibilities to You as a Coach
I. Confidentiality: With the exception of certain specific instances 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 being coached with me without your prior written permission. I will always act so as to protect your privacy even if you do permit me in writing to share information about you. You may direct me to share information with whomever you chose, and you can change your mind and revoke that permission at any time. As well, you may request anyone you wish to attend a coaching session with you.
I consult with various experts in specific fields of mental health so that I can better serve my clients. I also participate in regular group consultation. If I consult on my work with you, I will not use your name or any information that can identify you.
The following are legal exceptions to your right to confidentiality.
(a) you direct me to tell someone else, and I agree to do so;
(b) I decide you are a danger to yourself or other
(c) I am ordered by a court to disclose information;
(d) you disclose abuse of a child, a disabled person, or an elderly person;
(e) you disclose that a previous therapist/coach sexually exploited you;
(f) other reasons as specified in laws of this state, such as criminal proceedings or
legitimate subpoenas in a civil proceeding;
(g) If you are a minor, your legal guardians will have the right to your records as well.
Even under the above circumstances, I will still restrict the sharing to those parts absolutely necessary in order to protect your interest in the best way I can.
II. Record-keeping: I normally keep very brief records, noting that you have been here, what we did in the session, and a few words describing the topics we have discussed. If you prefer that I keep no records, you must give me a written request to this effect for your file. And if you are in a group, I will maintain separate records for you and your group members.
III: Scheduled appointments. I will do my best to have a regularly scheduled appointment time for you. If I need to cancel for some unforeseen circumstance, I will do my best to get a hold of you as soon as possible and do my best to accommodate you. I will tell you well in advance of any planned absences.
My Qualifications and Style
I have a counseling psychology master degree from Palo Alto University and a Bachelor Degree in East Asian Studies from Harvard University.
I worked as a life coach for many years. Recently, I have finished master degree training in psychotherapy. I intend to practice and market myself as a coach, I will continue to pursue trainings in therapeutic and coaching strategies to benefit my coaching clients as well.
My clients have described me as warm, disarming and honest in our counseling relationships. Everyone who comes to seek coaching is brave in their self-care. I recognize and respect clients for their diverse family backgrounds and cultural values. I utilize each clients’ individual strength in forming a collaborative coaching process. I also keep abreast of the latest research so I can provide the most suitable treatment to you.
I am a member of the American Counseling Association.
Through understanding the client’s background and perspective, I act as an assistant in their journey to meet practical and emotional goals they have set out for themselves. I enjoy working with people in various stages of their lives, as long as they are open to making changes and taking a proactive stance with me in this process. I especially enjoy working with people in a transitional stage of their life, such as new marriage, new birth, career transitions, midlife transitions, couple relationship growth, etc.. It is in these moments in our lives that the greatest amount of stress as well as the biggest opportunity present themselves for our growth and awareness.
As always, each treatment is tailored to the needs and strength of each client. The first session will be 75 minutes for me to get to know you better and subsequent sessions 50 minutes. I will always be open to your feedback about the ways that I can be more helpful at any point during our relationship.
Because you are trusting me with private thoughts and feelings, it is important for me do everything possible to ensure that I provide the best service to you. In order to maintain my objectivity, it is important that we restrict our relationship to a professional nature, and doesn’t extend to a social context. Our contacts, other than accidentally running into each other, will be restricted to these counseling sessions. As a counselor and part of the ethical requirement of my job, I do not:
1. attend social gatherings;
2. accept any gifts;
3. connect with you any other way than in these treatment session.
Please understand that these rules are here to protect you. This ensures that I am not biased by any other relationships or emotional connections we might have, which can result in wrong coachinng approach. It will also protect you from undue influences from me outside of sessions.
Notice of Privacy Practices and Clients Rights
I have been given the HIPPA of Privacy Practice and Clients’ Rights. I understand that the information given below is my preferred contact information.
Consent for Treatment of Minors (if applicable)
In the case as a parent, I/we consent that my child __________________ may be treated as a client by the above referenced counselor.