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About the Sessions: Client Support Agreement, Statement of Intent, and Confidentiality Agreement

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Product Description

Maryanne holds a masters degree in somatic depth psychology and teaches a method of body-oriented self-inquiry. Her sessions often include

* helping you cultivate and or deepen your sense of your authentic self; how you long to move through the world.

* identifying unconscious and destructive patterns in your intimate relationships

* developing skills that lead to attracting and creating healthy, fulfilling, sustainable relationships

* learning about the wisdom that lies in your body and how learning to speak this language can set you on the course towards your heart's desires

* hands-on support for navigating the challenges of on line and real time dating. 

Please print out and sign the following agreements before you come to a session.

CLIENT SUPPORT AGREEMENT

Each new client is a welcome addition to my practice. We have had our introductory meeting and have determined that we are optimistic and enthusiastic about what we can accomplish together. To bring our “best selves” to the client support relationship, it is important that we share the same understanding about how we will work together.

BASIC SHARED AGREEMENTS: (please initial)

• I recommend weekly or bi-weekly Self-Inquiry Support Sessions (SISS) for a three-month period (if applicable). This time commitment ensures that you understand that it is hard work to change habits of thinking and acting, and that you are committed to making a concentrated effort and understand that takes time. _____

• Sessions will be paid in full after each session and payment needs to be received in order to maintain our support relationship. _____

• Each private session is 1 hour (at the rate of $225) to 1.5 (at the rate of $295) hours long and may take place either in my office, via phone or Skype. Couples sessions start at $265 per session for I hour and $325 for 1.5 hours. You can add time to any session in $65 increments.  _____

• I will bring myself to those support sessions free from distractions and respectfully request that you do the same. A support session with distractions and background noise is not optimal. _____

• We agree that we will each show up at the mutually scheduled time for our support session and if you have to reschedule you will do so with a minimum of 24 hours notice. I certainly understand that emergencies do arise and will accommodate those on a case-by-case basis. Canceled or missed appointments within the 24-hour period will be charged at a full session rate. _____

• If you need an “emergency call,” I can usually accommodate within the same week and I do not bill for calls that are 10 minutes or fewer. _____

• I welcome your input and questions along the way. Our relationship is a collaborative one, and the more you put into it the more you will get out of it. Ask me questions, bring resources to the table that you’ve found, and share your insights along the way with me._____

I have read and agree to the working agreements above and below, and will honor them during our client support relationship.

Client (Print/Sign)_________________Date_____________

STATEMENT OF INTENT

All Self-Inquiry support services delivered by Maryanne Comaroto, utilizing principles, methods and tools of the SHOMI® Method Self Inquiry Practice, are meant to challenge, uplift, and support you psychologically. This self-inquiry method is not psychotherapy. If you feel you are psychologically stressed to the point that it is interfering with your ability to function, please seek the additional help you need. Self-inquiry is not an alternative to clinical therapy, rather a body oriented , psycho-spiritual practice. In that spirit, please read the following and sign below should you agree to each statement and wish to proceed:

• I understand that the support services I will be receiving from Maryanne Comaroto are not offered as a substitute for clinical mental health care. I also understand that Maryanne Comaroto is not acting as a psychotherapist, and does not purport to offer mental health care. _______

• I understand that Maryanne Comaroto will maintain the confidentiality of our communications only to the extent defined by the laws of the states in which each of us resides. _________

• I understand and agree that I am fully responsible for my well-being during my support calls and subsequently, including my choices and decisions. _______

• I understand that all comments and ideas offered in my support sessions are solely for the purpose of aiding me in achieving my defined goals. I have the ability to give my informed consent, and hereby give such consent to Maryanne Comaroto to assist me in achieving such goals. ________

• I hereby release, waive, acquit and forever discharge Maryanne Comaroto and SHOMI, LLC, their agents, successors, assigns, personal representatives, executors, heirs and employees (collectively “SHOMI,LLC”) from every claim, suit action, demand or right to compensation for damages I may claim to have or that I may have arising out of actions, omissions, or commissions taken by myself or by SHOMI,LLC, as a result of the advice given by SHOMI,LLC, or otherwise resulting from the coaching relationship contemplated hereunder. I further declare and represent that no promise, inducement, or agreement not herein expressed has been made to me to enter into this release. The release made pursuant to this paragraph shall bind my heirs, executors, personal representatives, successors, assigns, and agents.

I have read the statements above and I understand and agree with the points contained therein:

Client ________________ Date _____________

CONFIDENTIALITY AGREEMENT

The conversations that we have within our sessions are confidential and will be protected as such. Information will be shared outside of our sessions only with your written consent or in the event that a Court Judge demands it; however, the following are instances where I would be obligated by law to break our confidentiality agreement without your permission:

• If it is assessed during your participation in coaching sessions that abuse or neglect of children or elders is occurring.

• If in my presence you threaten to kill or harm yourself or another individual, and I am convinced that you will act on this threat, or that you may lose control of your actions.

• If at any time during the course of our sessions, I determine that you are a danger to yourself, I will inform you of that opinion and make every effort to keep you from endangering your life. In some cases, this may include notifying the police or family members.

• Unauthorized recording of sessions is prohibited.

 

Client Signature _______________________Date___________

 

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