Waiver Release from Liability, and Indemnity Agreement
Please read & be prepared to sign in a separate email.
Welcome to my Somatic Experiencing® practice & coaching sessions.
Somatic Experiencing (SE™) is a naturalistic form of healing that will help you learn how to settle and release physiological activation from your body. Very often this process helps people to reduce stress and return to a sense of regulation and mastery in their lives. SE will support you in learning how to attend to uncomfortable sensations in your body and gently unwind them through your conscious attention. SE is particularly useful in managing stress because so many of the symptoms are physiological. If you would like to read more about SE, visit Somatic Experiencing International (SEI) at www.traumahealing.com or read In an Unspoken Voice by Dr. Peter Levine. During an SE session, I may also draw upon therapeutic movement, and Somatic Touch/NeuroAffective Touch.
I am a Somatic Experiencing Practitioner (SEP) certified through Somatic Experiencing International (SEI). I am trained in Somatic Touch. I am an ERYT500 [hour yoga instructor] and trainer and Reiki 1 Practitioner.
If you are working with a therapist and would like to work with me Somatically, I will ask you to sign a release so that I might discuss your progress with your primary therapist. This is to ensure that we function as a good team working for your benefit.
Benefits and Risks
SE may offer you many benefits such as an increase in your ability to self-soothe, feel embodied and empowered. However, there may also be risks as there is with any treatment that focuses on healing trauma. Although SE is designed to help you resource and work with manageable amounts of discomfort, you may experience challenging feelings, images, or thoughts. Furthermore, as with any stress reduction treatment, there can be no guarantee that you will reach your goals. That said, many people report that SE has helped them tremendously and has created positive change in their lives. Learning how to reorganize “body memory” is often vital to learning how to relax and calm your nervous system.
Confidentiality
Everything that you share with me will remain confidential. However, there are a few reasons I am required to break confidentiality by law:
If you are of danger to yourself and have an active plan to harm yourself, I will contact emergency services for a wellness check and/or a 72-hour hold. If you are planning to seriously harm another person, I am required to contact the person threatened, if possible, as well as the police department. If I learn of child or elder abuse, I will contact protective services immediately. If I learn of a child abuser from a person’s past who is actively still around children, I am mandated to report him or her. If you are a minor, I am required to share important information with your parents regarding your emotional health. This is not the case if the information you share would put you at extreme physical risk from a caregiver. Breaches in confidentiality will occur along with the same guidelines for adults (see above) but will include a report if you are having a sexual relationship with an older peer or an adult, and you are under 16 years of age.
With the wonders of technology, we can meet online. Please be aware that although it is unlikely, online communications are never fully secure. By signing this document, you acknowledge that you are entering into this format with awareness of its limitations.
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Phone Calls and Emergency Contacts
** I provide non-emergency service.
**If you have an immediate emergency, please call your local emergency hotline or 911.
In most cases, calls will be returned within 48 hours during regular working hours, Monday-Friday, unless I am out of town. I will generally tell you when I will be away from the office.
For some clients, one check-in message and response can be helpful or necessary at certain times. Please keep these messages to one message cycle and let me know if you want a call back or if we can wait to discuss the issue at our next session.
I will not accept texts as forms of communication other than for scheduling. One short email per week is permitted. We can discuss the contents during our next session. I will not respond via email and will only do so in person. If this level of contact in between sessions is not enough, we can discuss the possibility of bi-weekly sessions until you feel ready for once-a-week meetings. These limits are important so that I can be fully available to you professionally and can have thoughtful, resonant, and meaningful interactions with you.
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Fees and Services
Fees for services are due at the time services are rendered, unless otherwise discussed (stripe, rebekkamars.com, cash, Venmo, & Paypal @rebekka.mars are all accepted).
50- 55-minute Somatic Experiencing session rates are $150 - $175 per 50-75-minute session.
Sessions begin at the time of the scheduled appointment and generally run on time, though there is a 15 minute overlap window that is discussed at the start of each call.
I offer 30- and 90-minute sessions which are prorated and reflected on the booking site.
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Cancellations
If you decide that you need to cancel a session, please call/text me 24 hours before. If you do not cancel, I will expect you to pay for the missed session in full. This means that if you have an appointment at 11:00 am on Tuesday, you would need to cancel by 11:00 am on Monday. This will allow me time to reschedule other clients who could benefit from the availability. These policies apply to me also. I will call you with at least 24-hours-notice if I need to reschedule. If for any reason I miss our scheduled appointment without notifying you, I will provide your next session free of charge.
True emergency situations that cannot be foreseen can be negotiated (sudden illnesses, accidents, or unpredicted loss of childcare).
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SE Session Format
SE sessions are done seated in a chair or couch depending on your preference. You will be asked to share an impression of the sensations that you feel in your body, such as tightness, heat, shakiness, expansion, relaxations, etc. I will teach you ways to track, or follow, these sensations with your awareness and come to a place of rebalance.
Touch-Informed Consent
Somatic Experiencing and Somatic Touch are not a form of massage. Somatic Experiencing and Somatic Touch are a vital therapeutic bridge to mind--body integration. The use of Somatic Touch creates an environment of Somatic support, attunement, and safety for the body-mind. I may offer you touch support for the following reasons: grounding, containment, support, mobilization, or awareness building. I may also offer table work if I feel it would be therapeutically supportive. Using touch can often reconnect clients to their breath and a deeper sense of aliveness.
Consent is extremely important to me. You will always be asked before being touched and have the right and my full support to decline. If you do not feel comfortable with touch, or if the session does not call for it, session work will not include touch.
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Confirmation
It is a great honor for me to work with you Somatically and support you in your healing. I hope to teach you skills that will help you reduce stress in your life, increase your sense of stabilization and increase your emotional capacity. It takes strength and courage to explore greater self-awareness, and I feel privileged to support you in reaching your goals.
Client Name (Printed): _____________________
Client Signature): _________________________
Date: _________________
Thank you, Rebekka Mars
By participating in in person or virtual sessions with Rebekka Mars I hereby agree to the following:
1. Participation implies that you have read and agreed to the terms and conditions outlined in this Waiver + Liability Release.
2. That I am participating in an online coaching session offered by Rebekka during which I will receive information and suggestions about living.
3. In consideration of being permitted to participate in the session, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the session with Rebekka.
Commitment
You are joining this program because you want a mentor, supporter, and accountability partner as you move further into your body + mind connection using yoga as the medium. As your coach, you have my word that I am 100% committed to you being taking the dive deeper into yoga to the capacities we discuss.
Coaching
The service to be provided by Rebekka Mars is virtual coaching. Coaching-- which is not therapy nor counseling-- may address specific career successes, personal projects, life balance, or general conditions in the client’s life or profession. I understand that this program does not include therapy per say and by signing this agreement, I am releasing Rebekka Mars of any personal liability.
Outcome
You are fully responsible for your results in this session. While we are absolutely convinced that you will derive great benefits from this session/Program and that You should learn more about your growth as you desire, We of course cannot guarantee that you will attain any profound shifts or gains as a result of this coaching Program. As with any personal adventure, each person’s success depends on many factors, including your personal motivation, time commitment, how effectively you implement the strategies taught, and your efficiency in following up on each phase. The cost of this Program is an “investment” in yourself as a human being, and, as with any investment, there is both great potential for a great return on your investment, and a risk there is no return on this investment.
4. In further consideration by participating in the session, I knowingly, voluntarily and expressly waive any claim I may have against Rebekka Mars for injury or damages that I may sustain as a result of participating in the session.
5. I, my heirs or legal representatives forever release, waive, discharge and covenant not to sue for any injury or death caused by their negligence or other acts.
6. I understand that It is my responsibility to verbally let Rebekka Mars know if I have any conditions that would prevent me from being advised in any particular way.
7. I have read the above release and waiver of liability and fully understand its contents. My participation in class indicates that I voluntarily agree to the terms and conditions stated above.