CLIENT DISCLOSURE & AGREEMENT
CLIENT: Before we begin, please read this agreement and then sign and date it. This will let me know that you have read and that you understand what is written here. This form will ask you about your present condition for which you seek coaching as well as any other issues you might have. It also sets out the context in which you will get the outcome you want. It also covers some of the issues of law governing our relationship
Time Line Therapy® – is either coaching or complementary health care under the laws of a number of states and provinces: The person you will be working with is not licensed. That means that he/she is not a medical Doctor, psychiatrist, psychologist, M.F.T.(marriage and family therapist), or M.S.W. (master of social work), and you acknowledge that you have never worked with a licensed person for this problem. (If you have and-or have been prescribed medication to take for this problem, I will give you a letter for your doctor to sign, which informs him/her of what I do, before we start the process.) This short note simply demonstrates that your health care provider is informed of your decision to engage in Time Line Therapy® techniques.) If you have been prescribed medication for the condition for which you are seeking help, many clients have needed the assistance of their doctor to titrate their medication down after successes with Time Line Therapy techniques®. Furthermore, nothing that happens when we meet should be construed as, nor should you believe that it is a substitute for the advice of a licensed person.
What to Expect: your coach or complimentary health care practitioner has been trained and certified in Time Line Therapy® at the Practitioner, Master Practitioner and Trainer levels and will be doing this technique along with Neuro Linguistic Programming (NLP) and Hypnosis. The session(s) will probably be different from what you might have expected. In total, we will not spend a lot of time talking about the problem, just gathering information about it. In fact, most of the session(s) are about other things.
It is very important for us to discover the internal thought process of HOW you create the problem. That means that we are looking for your strategy, or how you structure the problem. Because our focus is on the structure, that means that, once we discover it, we can move on and focus on having the problem disappear very quickly.
Because of this, your Time Line Therapy® Master Practitioner may cut short your answers or even talk about your problem, in ways that you have never considered. She may even ask you questions that you do not totally understand consciously, in order for your Unconscious Mind to make the changes you want at the unconscious level. It is important to do this so that we can reduce the time taken for the therapeutic process.
If you have been in a coaching, NLP or other kinds of sessions before, expect that this one will be very different, and quite a bit shorter.
This is the process: We begin with you telling me the problem. I will ask you for examples of the problem and other questions to discover HOW you do it in your head. I will also probe to discover the source of the problem-the precipitating event(s). Sometime before the end of this part of the session, I will ask you what has to happen so you will know the problem is gone.
After the Session: I will probably assign you some very specific tasks to do. If assigned, these tasks are, absolutely, a fundamental part of the process. They may take up to several days or weeks to complete. The tasks are directly related to the circumstances that created the problem. YOU MUST DO THEM. If you do not, then neither you, nor I, can predict the outcome. Certainly, any guarantees will not be valid if you do not do the tasking exactly as assigned.
The second thing that is important, is that you will need to stubbornly focus on what you want. The people who are the happiest overall in life are those who recognize that you have a choice; to focus on what you don’t want or, to focus on what you do want. You can focus on negative emotions and things that make you feel bad, or you can focus on positive emotions and things that make you feel good. It is your choice. After the session, YOU MUST FOCUS ON WHAT YOU WANT.
This is Coaching or Complementary Health Care and Therapy Your Time Line Therapy® Master Practitioner is a legal Complementary Healthcare Provider, and not a licensed Medical Doctor, psychiatrist, psychologist, M.F.T., or M.S.W. The services you receive are not licensed in this province, nor are they regulated by a governmental body. The self-regulated holistic treatments and client-centered disciplines in which your Master Practitioner is trained and in which she has experience include, consulting and coaching, Time Line Therapy® techniques, Neuro Linguistic Programming (NLP) and Hypnosis. I will always provide only those services in which I have been trained, and if I find that I cannot help you, I will refer you to a licensed person who can assist you. During your sessions we will use one or more of the following techniques:
Time Line Therapy® techniques: The techniques are a process of active imagination where the client imagines floating above his/her Time Line and letting go of his/her negative emotions and or limiting decisions (or limiting beliefs). Then, the client is also asked to imagine creating events in his/her future that support his/her goals or outcomes. Time Line Therapy® techniques have demonstrated results in a broad variety of presenting problems. It is a powerful technique which allows clients to make long-lasting changes in a very rapid way. Your practitioner is certified as a Time Line Therapy® Master Practitioner and Trainer by the Time Line Therapy® Association.
Neuro Linguistic Programming (NLP): NLP is a model of communication – how we communicate to self and others-and how that communication creates and affects our behavior. As a study, it is a synthesis of cognitive and behavioral philosophies which focus on the information coming in through the neurology (cognitive) and the programs we run inside our heads to produce the behaviors (behavioral) we do. Your practitioner is certified as an NLP Practitioner and Master Practitioner by the Atlantic NLP under the standards of the American Board of Neuro Linguistic Programming and as an NLP Trainer, Trainer of NLP Coaches, Trainer of Time Line Therapy™ techniques and Trainer of Hypnotherapy by the Tad James Co., LLC under the standards of the ABH –American Board of Hypnotherapy, the ABNLP- American Board of Neuro Linguistic Programming, the TLTA- Time Line Therapy ™ Association, and the Coaching division of ABNLP- Coaching Division of the American Board of Neuro Linguistic Programming.
Hypnosis: This is the use of trance to make changes at the unconscious level. Hypnosis has been used to produce unconscious change with clients since 1843. I am trained and certified as a Hypnotherapist by the American Board of Hypnotherapy. Since hypnosis may be used during your session, for your safety you should make sure that you are totally wide awake before driving or doing any other activity that may require concentration. Your practitioner is certified as a registered Master Hypnotherapist and Trainer of Hypnotherapy by the American Board of Hypnotherapy.
Confidentiality: I keep all information I receive from you, confidential, and do not disclose it to persons outside my company. All client information is kept strictly confidential and is for my internal use only. (Importantly, I am required in some provinces to share information about child abuse with stated bodies who oversee such matters). I am a member in good standing of five different regulating bodies with very high standards in terms of code of Professional Ethics (ABH –American Board of Hypnotherapy, ABNLP- American Board of Neuro Linguistic Programming, TLTA- Time Line Therapy ™ Association, the Coaching division of ABNLP- Coaching Division of the American Board of Neuro Linguistic Programming, and RITMA-Regroupement des Intervenants Thérapeutiques en Médecine Alternative).
Your Guarantee: All work that I do is guaranteed. That means that you will receive the support and follow-up to ensure that you get the results you wanted and which were agreed upon. The guarantee works like this:
You must finish the program. That means, attend every session. You must go through the entire process all the way to the end.
You must do the tasking before the first session and after the sessions, and you need to do it fully and completely (100%).
Having done this and allowed some time (say up to 2 weeks) for the process to integrate then, I agree to work with you until your problem is gone at no charge beyond the initial session.
Your Choice, Your Responsibility: During the sessions, I will offer you advice and other ways of looking at your problem and its’ solutions for your consideration, you hereby agree that whatever we discuss is only my perspective and is not binding upon you, nor is it a prescription. If you want to discuss my suggestions with someone else, you should discuss them with a licensed health care provider. It is your responsibility to communicate your results to me. My liability is limited to the amount paid to me for the coaching sessions.
Fees: All sessions are charged at the same hourly rate + tax. If you need to cancel a scheduled appointment, 24 hours of notice is mandatory. Last minute cancellations will lead to you being charged for the time booked since the agreed upon time could not be offered to another client.
Client's Name: (print)_________________________________
Client’s Signature:____________________________________ Date:__________________
if Client is a minor;
Client's Name (print)____________________________________
Parent or Guardian's name (print)___________________________
Parent or Guardian's signature:_____________________________ Date: ___________________
Marthe L. Richard, SUCCESS TRAINER - NLP Excellence PNL