Husband's name *

First Name

Last Name

Wife's name *

First Name

Last Name

I understand that we'll have a brief introduction meeting before the training sessions start.

Yes, got it.

I've got questions about this.

We understand and agree: *

This training does not involve counseling. It is not diagnosis and treatment of mental, emotional, or addictive conditions. If such issues, and others like abuse, are suspected or revealed, facilitators may refer clients for professional counseling consultation in addition to or in lieu of the training. In this relationship, we do not represent ourselves as professional counselors, but as trainers who facilitate relationship learning and communication via tools and information which they have been trained and certified to use and teach.

We also understand and agree to the following: *

There are some situations where this training is not advised. Spousal abuse is one. It is well established in domestic violence literature that disclosure of honest thoughts and feelings to an abuser in counseling sessions can lead to verbally abusive reprisal and in some cases physical abuse. Therefore, we will inquire privately of both partners concerning a history or ongoing experience of abuse. When ongoing abuse is discovered, we provide referrals to competent local professionals where available, and to domestic violence shelters and/or resources. www.domesticviolence.org is a good resource, as is www.thehotline.org, provided by the National Domestic Violence Hotline (1-800-799-SAFE).

We at See Beyond have an obligation to protect client confidentiality. We follow both a moral code and a professional code of ethics (ICF) and maintain that integrity. There are exceptions to confidentiality. We do not release information that we are in a coaching relationship with a client without written consent, unless we are required to do so by a court order or other legal obligation. We do have a legal obligation to break confidentiality if either spouse is judged to be a danger to him/herself or others. This means the following: (1) If a coaching client makes threats of violence against another person or is in imminent danger to himself or herself or (2) If a coaching client provides information or if we believe the client indicates he or she is abusing an elderly person, disabled person, or child, we have the legal obligation to notify the proper agencies. Certain topics may be shared, without identifying information, to other coaching or mental health professionals for training, consultation or supervision purposes.

Just checking . . . *

I, the husband, have read and understood the information on this page—or will ask about it.

I, the wife, have read and understood the information on this page—or will ask about it.

We work for a non-profit agency or live on a North African local salary.

Yes

No