Life Coaching Client Consent & Information Form

I am Joanna Jacobson, LCSW, CAP in the State of Florida, and a Certified Sex Addiction Therapist.

In my clinical role, I specialize in working with recovering sex and pornography addicts, and supporting spouses and partners of addicts heal intimate partner betrayal trauma.

In addition to my being a clinical Psychotherapist, I have over 10 years of experience in providing Life Coaching and Business Coaching support.

If you are a client new to coaching, or a current therapy client transitioning from Psychotherapy to Life Coaching, please review the following information, sign and date, and return to me before your first session.

Please do not hesitate to ask questions regarding the following information; I am happy to answer any questions you may have.

Kindly and in Support,

Joanna Jacobson

What is Life Coaching and how is it different from Counseling?

Life coaches help the clients they work with focus on identifying and moving towards personal and, at times, professional goals. Through focused coaching support, clients can learn healthy and helpful ways of navigating through challenges in creating a life they feel excited about.

It may be interesting to learn that life coaching is rooted in clinical theory, often drawing on the work of Dr. Carl Rogers, Dr. Alfred Adler, and Dr. Carl Jung.

Rogers, Adler and Jung saw individuals as fully capable artists of their lives, and frequently involved their clients in goal setting and life planning. These are all tenets and approaches in today’s life coaching methods.

Coaching takes the best of those approaches, along with a new type of assistance for clients, such as:

• Working with the client to help them define life dreams and goals
• Formulating a plan that will foster and grow the client’s skills and talents
• Helping the client navigate difficult challenges in reaching their goals
• Teaching tools and providing materials to assist the client
• Helping the client with focus and accountability
• Providing structure, encouragement and support
• Providing intentional and empathetic listening

Is a Life Coach the same as a Therapist?

Experienced coaches have similar qualities to counselors, in that coaches listen, observe, encourage and customize their approach to individual client needs.

However, there are differences between coaches and therapists. For example, a life coach partners up with the people they work with to help the client improve and enhance the quality of their lives in helping the client move forward. Coaches do not analyze the past.

A therapist works with and counsels a client dealing with emotional challenges, mental illness, trauma, grief and loss, and relationship issues. A therapist often draws on the client’s past history in order to help the client heal. This also improves the quality of the client’s life.

Additionally, a life coach works actively with the client in order to create solutions and strategies; they believe the client is naturally creative and resourceful. Often times, the coach’s role is to provide support so that the client can further develop their inherent skills, confidence and creativity.

Similar to therapists, life coaches support their coaching clients via in person or phone session in order to help the client create their best personal and professional life.

Through specific strategies and skills, the coach helps you define your goals and create the life you envision. Coaches help you focus, provide direction, compassionately challenge you, motivate you and celebrate with you. 

What happens if I need a Therapist vs. a Life Coach?

If after our first session, or at some point during our coaching work together, it is apparent that you would be better supported by Psychotherapy, and you are not located in Florida (the State I am licensed in as an AASECT Certified CSAT Sex Therapist), I will do my best to provide you with clinical referrals in your area, and will refer you out to a therapist.

If you are located in the State of Florida, and would prefer to work with me in my Psychotherapists’ role, we can discuss this and, as long as it best supports what you hope to achieve in counseling, and falls under my scope of practice, I may provide therapeutic support for you.

In my coaching role, it is important to understand that while I may draw on particular aspects from both disciplines from time-to-time, such as intentional listening, affirming, encouraging, reflecting, and supporting with empathy, I do not work in both roles at the same time with clients. This would be considered operating in a “dual role.” Providing counseling and coaching at the same time is not something that clinical therapists engage in, nor should a life coach without clinical training and licensing provide psychotherapy to coaching clients.

Though I am a Licensed Therapist, and though Life Coaching has aspects that are similar to counseling, should we work together, it is important for you to understand that my role and work as a Life Coach is separate than my role as a Psychotherapist or Business Coach.

Finally, I do not provide Business Coaching for former clinical clients.

If you feel that Life Coaching would be of support, you are welcome to schedule a session. You can do that directly with me at joannablasi@gmail.com.

Please read the following information and initial, sign and date the signature page (last page), and return all pages to me before your first Life Coaching session.

Please ask any questions you have prior to signing:

I agree to inform Joanna Jacobson LCSW CSAT if I would like to transition to Psychotherapy at any point in our coaching work together.

Initial Here 

I understand that should I request a transition in working with Joanna Jacobson, LSCW as a Psychotherapist, that Joanna Jacobson, LCSW does not provide clinical services outside of the state of Florida where she is licensed.

I understand that email, texting and phone cannot be guaranteed as confidential, and by contacting, sending or receiving forms or information via phone or Internet is done at my discretion and I will assume the risk involved. Initial Here

I understand that while I will be working with Joanna Jacobson, LCSW  as a Life Coach, because of the license that she holds, Joanna Jacobson, LCSW  is a mandated to report the following:

1. Suicidal Ideation or threats to harm oneself
2. Homicidal Ideation or threats to harm someone else
3. Child abuse (sexual, physical, emotional, verbal or neglect)
4. Elder abuse (sexual, financial, physical, emotional, verbal or neglect)
5. Dependent Person abuse (sexual, financial, physical, emotional, verbal or neglect)
6. Downloading or distributing, or filming, texting or sharing child pornography, sex with minors (a minor is a child under the age of 18)

I understand that Charlene Lewis, LCSW CSAT provides life-coaching sessions via phone and it is my responsibility to keep track of my sessions and call in on the scheduled day and time of my session.

Unless I have requested a sliding scale, I agree to the life coaching session fee of $250 per 50-minute session, and understand that the fee is due and payable on the day of my individual coaching session (this does not apply to group coaching).

I agree to honor my sessions and understand that the cancellation policy is 72 hours in advance of my session or the full fee is due. I will pay any monthly payment fees for group on or before the 1st day of the month.

I agree to honor contact boundaries out of my life coaching sessions, and will not abuse email, texting or calling outside of our coaching work, unless it has been scheduled, as the relationship is professional in nature. I agree to keep communications in group coaching sessions and on group forums in full confidence.

I agree to assume any risk and liability as the result of my life coaching work with Joanna Jacobson, LCSW, and my signature below confirms that I am working with her at my own request, and that I clearly understand the difference between life coaching and Psychotherapy services. 

I understand that I am free to terminate coaching services at any time, or request a transition to Psychotherapy, or a referral to a Psychotherapist. I understand Joanna Jacobson, LCSW CSAT  is a mandated reporter.

I understand that my choices as the result of working with Joanna Jacobson, LCSW, and the consequences of my choices, positive or negative, are mine alone, and that I will not legally hold Joanna Jacobson, LCSW   personally or professionally responsible for my coaching outcome and choices, nor will I hold Sound Mind Miami LLC., The Return2Intimacy.com or Local Marketing Technologies LLC, or any other person, organization, structure, assets, or affiliates associated personally or professionally with Joanna Jacobson, LCSW , legally or financially liable for the results of my work with Joanna Jacobson, LCSW.