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EFT Essentials

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Informed Consent Form

Informed Consent Form for Live My Stress Solution Sessions. Please read and sign this form before your first session. It is a requirement for the use of the My Stress Solution system.

Introduction. My Stress Solution is a unique virtual online coaching service. It enables you to have a live session any time you want. All practitioners listed in My Stress Solution are certified by EFT Universe / Energy Psychology Group, Inc. You can start your live real-time session with any practitioner who is currently online at a time and place of your own choosing.

My Stress Solution is set up to be simple and intuitive to use. After creating a free user ID, you log on, choose the length of session you want, make your payment, and go live. The My Stress Solution service is provided by Energy Psychology Group, Inc. By using it you consent to the Terms of ServicePrivacy Policy, and Copyright notice.

The purpose of this form is to inform you (“the client”) about the nature of online coaching services, the potential risks and benefits of these services, and to ensure your safety. Please read it carefully and sign it before your first session. Completion of this form, and agreement with the Terms of ServicePrivacy Policy, and Copyright notice, are a requirement for your use of the My Stress Solution system.

A. Privacy and Confidentiality

Disclosure of Personal Information. Maintaining client confidentiality is extremely important to coaches and organizations. Your My Stress Solution coach will take extraordinary care to prevent unnecessary disclosure of your personal information. Information about a client is released only with his or her permission – with the following exceptions:

1) If the coach believes that someone is seriously considering or likely to attempt suicide;

2) if the coach believes that someone intends to assault another person;

3) If the coach believes someone is engaging or intends to engage in behavior which will expose another person to a potentially life-threatening communicable disease;

4) if the coach suspects abuse, neglect, or exploitation of a minor or incapacitated adult;

5) if the coach believes that someone’s mental condition leaves the person gravely disabled.

Anonymity, Computers and the Internet. Although the internet provides the appearance of anonymity and privacy in coaching, privacy is more of an issue online than in person. You as a client are responsible for understanding the potential risks of confidentiality being breached through unencrypted email, lack of password protection or leaving information on a public access computer.

Other potential risks of breaching confidentiality could include messages failing to be received if they are sent to the wrong address, being sent to spam by an email service, or if they are overlooked by the coach. Confidentiality could be breached in transit by hackers or internet service providers or at either end by others with access to the client’s account or computer.

Clients accessing the internet from public locations such as a library, computer lab, or café should consider the visibility of their screen to people around them. Position yourself to avoid others seeing your screen. Using cell phones can be risky in that signals are scrambled but rarely encrypted.

The coach has a right to his or her privacy and may restrict the use of any copies or recordings the client makes of their communications. Clients must seek the permission of the coach before recording any portion of a session and/or posting any portion of a session on internet websites such as Facebook or YouTube.

The client is responsible for securing their own computer hardware, internet access points, chat software, email and passwords that are encrypted, secure, and HIPAA compliant when possible. If encryption is not made available to client, client should be aware that they are risking unauthorized monitoring of transmissions and/or records of Internet coaching sessions.

Review of Sessions. As a client, you agree to work with your coach using the My Stress Solution server. Any session may be reviewed by the My Stress Solution supervisor and Internet service provider. Your coach will not respond to personal concerns via regular email.

If you wish to use email or texts as a way to “journal” the insights you have between sessions, you understand that your coach may not review these outside of a My Stress Solution session.

Please determine who has access to your computer and electronic information from your location. This would include family members, co-workers, supervisors and friends and whether or not confidentiality from your work or personal computer may be compromised due to such relationships.

Communicate only through a computer the use of which you are assured is confidential. At the end of sessions, be sure to exit the session and close the browser window. If you use your smartphone for My Stress Solution sessions, be aware that tracking services may be enabled on your device.

Your coach may have to consult with other professionals regarding clients, however in these cases the client’s name and other identifying information is never disclosed. The client’s identity remains completely anonymous, and confidentiality is fully maintained.

B. Non-Verbal Cues and Clarifying Communication

The client should be aware that misunderstandings are possible with text-based modalities and real-time internet chat, since non-verbal cues are relatively lacking. Even with video chat software, misunderstandings may occur since bandwidth is always limited and images lack detail. Coaches are observers of human behavior and gather much information from body language, vocal inflection, eye contact and other non-verbal cues. If you have never engaged in online coaching before, have patience with the process and clarify information if you think your coach has not understood you well. Be patient if your coach asks periodically for clarification.

C. Benefits of Virtual Coaching Sessions

The potential benefits of receiving virtual coaching sessions through My Stress Solution include:

1) being able to receive sessions any time a coach is available;

2) never having to leave messages with intermediaries, and avoiding voicemail and phone tag;

3) the ability to extend the length of your session to meet your needs;

4) the possibility of feeling less inhibited than you might in in-person sessions.

D. Potential Risks of Virtual Coaching Sessions

While your sessions are conducted on a secure server, you are responsible for creating and using additional safeguards when the computer used to access services may be accessed by others such as keeping personal information and passwords secret, and maintaining security of your wireless network.

Other risks include the possibility that any of the links in the chain connecting you with your coach may fail in the middle of a session. This might be because of a laptop running out of power, an outage at an internet service, a service interruption of the video stream at My Stress Solution, a power outage, and so on

E. Dual Relationships & Social Media

Relationships in which a person is both a friend and client are not permitted by the coach’s ethics code, unless you were friends with your coach before becoming a client. Therefore your coach will not accept any invitations via social networking sites such as Facebook, Twitter, Linkedin or Pinterest.

F. Alternatives to Virtual Coaching Sessions, Termination & Referrals

Online coaching may not be appropriate for many types of clients, including those who have a high level of anxiety about the risks of internet coaching, clients with active suicidal/homicidal thoughts, clients who are experiencing active manic/psychotic symptoms, clients whose mental health issues lie outside the coach’s scope of practice, and clients who are minors. If you fall into any of these categories we recommend you consult a local licensed mental health practitioner for in-person sessions. Many state and local agencies will treat low-income clients on a sliding scale fee.

Your coach will terminate the session if he or she believes she cannot help you, and if you are verbally abusive in any way. Inappropriate behavior will also result in a lifetime ban from any and all products and services offered by Energy Psychology Group, Inc. If your coach terminates your session, he or she may refer you to a licensed mental health provider.

G. Proxies

The coach only provides sessions to clients who are legally in a position to consent to these services. Clients who are not in such positions include children under the age of consent (age 18 in most cases) or clients who have a legally appointed guardian.

H. Emergency Procedures

If you have a crisis and need to speak to a counselor immediately, do not use My Stress Solution. Instead, call 911 or your local emergency mental health services, or go to the emergency room of your local hospital. Other crisis services include: www.Befrienders.org,1-800-SUICIDE or 1-800-273-TALK. Deaf clients can call 1-800-799-4TTY.

I. Records

The coach will maintain records of online coaching services. These records can include reference notes and session recordings. These records are confidential and will be maintained as required by applicable legal and ethical standards. The client will be asked in advance for permission before recording any session.

J. Service Interruptions and Refunds

If the My Stress Solution service goes down while you are in the middle of a session, your remaining purchased minutes will remain available to you. You can apply them to your next session. No refunds are available for minutes already purchased or sessions already completed. I have read and agree to the terms listed above in the Informed Consent form.