Coaching Agreement and Informed Consent

COACHING AGREEMENT AND INFORMED CONSENT

SERVICES:

The services provided by Jack Ito Ph.D.(the “Coach”) include coaching on topics decided jointly with you, the “Client.” The purpose of coaching is to develop and implement strategies to help you reach personally identified goals of enhanced relationships, personal performance and life satisfaction. Many clients focus on relationships, however, coaching may address a wide variety of goals including specific personal projects, life balance, job performance and satisfaction, or general conditions in the client’s life, business, or profession.

PAYMENT PROCEDURE:

Coaching fees are paid securely prior to your first coaching session. Services must be paid for in advance, or they cannot be provided.

FEEDBACK:

If, at any time, you feel that your needs are not being met or you are not getting what you want out of the coaching, please tell me, so we can discuss your needs and adjust your coaching program, as needed. We will continue to work on the goals that you define unless you want to stop, which we will do whenever you ask.

CALL PROCEDURE:

The Client will be called by the Coach at the pre-arranged time and telephone number as scheduled. There are no additional fees for the coach to call the client. Clients may also choose to call the Coach, at their own expense, at the designated coaching time. When using Skype or Zoom, there is no additional charge for the use of a web camera for face to face contact.

SESSION TIME:

Coaching is scheduled at the mutual convenience of the Coach and the Client. The day and time for the next call will be scheduled at the close of each coaching session.

SINGLE SESSION CONSULTATIONS

Single session consultations must be used within 31 calendar days. If E-mail support is included with your consultation, it begins from your session and extends for the next 5 business days.

“30 Day” AND “1 Month” COACHING PACKAGES:

“30 Day” and “1 Month” coaching packages must be used within 31 calendar days. If E-mail support is included in your package, it begins from your first session and is included for each business day until the end of your package. There are no limits to the number of sessions you can have within a week. For example, if you must miss a week, you can plan to have an extra session in one of the other weeks.

“30 Day” and “1 Month” coaching packages must be used within 31 calendar days. If E-mail support is included in your package, it begins after your first session and is included for each business day until the end of your package. There are no limits to the number of sessions you can have within a week. For example, if you must miss a week, you can plan to have an extra session in one of the other weeks. Unused sessions after the coaching package has expired will be lost.

CANCELLATIONS:

The Coach has arranged his schedule to accommodate your reserved time and to make you a priority. Please remember that you must give 24 hours prior notice if you need to cancel or change the time of an appointment, otherwise you will be charged for the session in full. Although emergencies are an inevitable part of life, you are still responsible for compensating the Coach for setting aside the time in his schedule.

TERMINATION BY CLIENT:

The Client may end the coaching relationship by e-mail. The Client may receive a refund for unused services at the following rates: 100% refund minus a $75 administration fee prior to the first session, provided a minimum of 24 hours notice is given. A 50% refund will be given following the first session, provided at least 24 hours notice is given before the 2^nd session. 25% refund after the 2^nd session, provided at least 24 hours notice is given before the 3^rd session. After the 3^rd session, no refunds will be given. The Client agrees to give the Coach 7 calendar days to process the refund.

TERMINATION BY COACH:

If the Coach deems it necessary for any reason to discontinue services, the Coach will provide the client a refund for unused services at the following rates: 100% refund prior to the first session; 75% refund prior to the second session; 50% percent refund prior to the 3^rd session; 25% refund prior to the 4^th session. The Coach agrees to process the refund as soon as practical and no later than 7 days from termination. Common reasons for termination are morally reprehensible behaviors such as criminality, affairs, spousal abuse, etc., which would make working on reconciling dubious. Another common reason is the discovery of a psychological problem or addiction which requires treatment and amelioration prior to working on reconciliation.

CONFIDENTIALITY:

As a clinical psychologist, I protect the confidentiality of the communications with my clients, including my coaching clients. I will only release information about our work to others with your written permission, or if I am required to do so by a court order. There are some situations in which I am legally obligated to breach your confidentiality in order to protect others from harm, including, (1) If I have information that indicates that a child or elderly or disabled person is being abused, I must report that to the appropriate state agency and (2) if a client is an imminent risk to him/herself or makes threats of imminent violence against another person, I am required to take protective actions. These situations rarely occur in coaching practices, but if such a situation does occur, I will make every effort to discuss it with you before taking any action.

As you are probably aware, it is impossible to protect the confidentiality of information which is transmitted electronically. This is particularly true of e-mail and information stored on computers connected to the internet (unless you use encryption and other forms of security protection), and if you use a cordless or cell phone, someone with a scanner could hear you talking.

COACHING AND PSYCHOTHERAPY:

Your coach is mental health professional who is trained to help people learn new skills and make significant behavior changes. He is here to offer skills in the areas of communication, problem-solving, and behavior change. He does this through a service called “Coaching”, in which you come to him for help in making decisions and implementing them, in order to achieve goals that you decide for yourself.

In addition to being a Coach, I am also a psychologist with training and experience in diagnosing and treating emotional and psychological problems. Although there are some similarities between Coaching and psychotherapy, I will not conduct psychotherapy with my coaching clients. These are different activities, and it is important that you understand the differences between them. Although both coaching and psychotherapy use knowledge of human behavior, motivation, behavioral change, and interactive counseling techniques, there are major differences in the goals, focus, and level of professional responsibility.

As your Coach, my job is to help you to use information and skills (1) to make decisions about which changes you would like to achieve (including list of coaching targets/goals), (2) to develop a personal “action plan” in order to make those changes, (3) to implement your action plan and make the behavioral changes, and (4) to develop strategies to maintain the changes you have made. I will support, encourage, teach, and help you to stay “on track” toward your goals.

You, the Client, set the agenda for your coaching, and your success will depend on your willingness to define and take risks and try new approaches. You can expect your Coach to be honest and direct, asking straightforward questions and using challenging techniques to help you move forward. You are expected to evaluate your own progress, and if the coaching is not working as you wish, you should immediately inform your Coach so we can both take steps to correct the problem. Like any human endeavor, coaching can involve feelings of distress and frustration which accompany the process of change. Coaching does not offer any guarantee of success.

Psychotherapy, on the other hand, is a health care service. Its primary focus is to identify, diagnose, and treat nervous and mental disorders. The goals include alleviating symptoms, understanding the underlying personality dynamics which create symptoms, changing the dysfunctional behaviors which are the result of these disorders, and helping patients to cope with their psychological problems. It is usually reimbursable through health insurance policies (while coaching is not, at present).

Psychotherapy patients are often emotionally vulnerable. This vulnerability is increased by the expectation that they will discuss very intimate personal information and will expose feelings about themselves that are understandably sensitive. The past life experiences of psychotherapy patients have often made trust difficulty to achieve. These factors give psychotherapists greatly disproportionate power that creates a fiduciary responsibility to protect the safety of their clients. The coaching relationship is designed to avoid this power differential.

Because of these differences, the roles of Coach and psychotherapist are often in potential conflict, so I believe that it is ethically inappropriate, under most circumstances, for me to play both roles with a client. If I am your Coach, I cannot be your therapist. This means that if either of us recognizes that you have a problem that would benefit from psychotherapy, I will refer or direct you to appropriate resources. In some situations, I may insist that you enter psychotherapy, and that I have access to your psychotherapist, as a condition of my continuing as your Coach.

It is also important to understand that Coaching is a professional relationship. While it may feel at times like a close personal relationship, it is not one that can extend beyond professional boundaries, either during or after our work together. Considerable experience shows that when boundaries blur, the hard-won benefits gained from the coaching relationship are endangered.

MUTUAL NONDISCLOSURE:

The Coach and Client mutually recognize that they may discuss future plans, business affairs, customer lists, financial information, job information, goals, personal information, and other private information. The Coach will not voluntarily communicate the Client’s information to a third party except as needed for collections or resolving disputes. In order to honor and protect the coach’s intellectual property, the client likewise agrees not to disclose or communicate information about the Coach’s practice, materials, or methods to any third parties.

DISPUTE RESOLUTION:

Any controversy or claim arising out of or in relation to this agreement, or the breach of this agreement, shall be settled by arbitration, which will occur via telephone by an arbitrator that we mutually agree upon. The costs of the arbitration shall be borne by the losing party.