Use of Touch. Therapist is trained in Somatic Experiencing and Bioenergetics, two modalities that sometimes include the use of touch in the therapeutic process. Therapist will not use touch in the therapy process unless Patient consents in writing separately from this Agreement. If Therapist does use touch after receiving such consent from Patient, touch only will be employed in each instance if:
Use of Touch. You understand the application and teaching of the Energy Techniques and Method may include light touch. Touch can be a potential problem in a healing relationship if you have had a history of paranoia, have been diagnosed with borderline personality disorder, have been sexually or physically abused, or have suffered from other types of trauma. Please let me know if you fall into any of these categories prior to our starting our work together. We can discuss any emotional risks associated with touch that may be of concern to you. Furthermore, if you have any misgivings, doubts, or any negative reactions to any physical contact, it is very important that you let me know as soon as possible so that we can discuss your concerns. You understand you have a choice about these techniques that involve touch. Education and Training Degrees: Bachelor of Arts BA in English Literature, Xxxx Xxxxxxxxxx College Master of Arts MA in Philosophy, Colorado State University Master of Arts MA in Biblical Counseling, Colorado Christian University Doctor of Philosophy PhD in Human Communication, University of Denver Work Experience: Psychotherapist in Private Practice 1995 to present EMDR Training 2017 Certified Master Level Splankna Practitioner 2011 Instructor of Speech at University of Denver 2001 to 2004 Intern for City of Denver Board of Ethics 2002 Instructor of Philosophy Colorado State University1988-2001 Acknowledgment and Consent to Receive Services By signing this document and any attachments hereto, you agree that I have disclosed to you sufficient information to enable you to decide to undergo or forgo any of the approaches and other services I offer. You understand that you are freely choosing to take advantage of my services and would otherwise have the option of using conventional health care services exclusively, provided by another professional health care provider of your choosing. You understand that your consent to the nature of our sessions is given voluntarily, without coercion, and may be withdrawn at any time in the future. Further you understand if you choose to use the Energy Techniques or Method as part of our work together, that they are a relatively new healing approaches and the extent of their effectiveness, as well as their risks and benefits are not fully known, and you agree to assume and accept full responsibility for any and all risks associated with using the Energy Techniques or Method as part of our work together. You represent that you a...
Use of Touch. Therapist is trained in Somatic Experiencing and Bioenergetics, two modalities that sometimes include the use of touch in the therapeutic process. Therapist will not use touch in the therapy process unless Patient and Representative both consent in writing separately from this Agreement. If Therapist does use touch after receiving such consent from Patient and Representative, touch only will be employed in each instance if: (i) Therapist first inquires of Patient if touch would be acceptable, and Patient assents verbally; and (ii) the therapeutic purpose of the touch is stated in advance by Therapist. In no case shall Therapist employ touch in a way that goes beyond the scope of his competence, beyond the scope of his practice, or beyond the scope permitted by the applicable licensing authorities.
