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RELATIONSHIP SUPPORT
Informed Consent Agreement

This form explains what relationship support involves, what you can expect from me, and what I ask of you in return. Please read it carefully before we begin, and ask me anything that is unclear before you sign.

PURPOSE OF RELATIONSHIP SUPPORT

Relationship support is for people who want a clearer, more workable way of relating, whatever form that relationship takes. Sessions use guided conversation, practical exercises and structured tools to help you improve communication, deepen connection and work through the specific issues you are facing. The aim is to build a way of relating that works for your particular relationship.

WHO THIS IS FOR AND WHAT IT INVOLVES

Relationship support can involve one person, a couple, or people in other relationship structures, including nonmonogamous and polyamorous arrangements. Sessions can happen in person, online, or as a home visit. A single session runs for 55 minutes; a double session runs for just under two hours. We agree the format and frequency together, and it can change as the work develops.

MY TRAINING AND HOW I'M ACCOUNTABLE

I hold a degree in applied counselling psychology, and my approach to relationship support draws on that training alongside years of shamanic and somatic practice. Relationship support itself is coaching, not therapy. It focuses on the present and future of your relationship, rather than diagnosing or treating mental health conditions. If something comes up that would be better held by a registered mental health professional, I will say so and help you find the right referral.

I am not registered with the Health Professions Council of South Africa (HPCSA). My work includes shamanic practice, explicit work with sexuality, and psychedelic integration, all of which sit outside what HPCSA registration covers. My accountability comes through membership of the Safety Network, an independent accountability body for practitioners working in this field. If you have a concern about our work together that you would rather raise outside our sessions, you can mail them at thesafetynetwork.

CONFIDENTIALITY

Everything you share in sessions is kept confidential. There are three exceptions:

  • if there is a risk of harm to you or someone else

  • if I am legally required to disclose information

  • if you give written consent for me to share information with a third party

VOLUNTARY PARTICIPATION AND YOUR RIGHT TO WITHDRAW

Your participation in relationship support is voluntary. You can withdraw at any time, without penalty, and without needing to justify the decision. If you decide to stop, please let me know, ideally in person or by message, so we can close things off properly.

OUR AGREEMENT ABOUT ENDINGS AND REPAIR

Relationship support work can bring up material that feels raw, especially when it touches old wounds or sets off a fear response. It is common to feel an urge to cancel, go quiet, or stop altogether when this happens, particularly if the work is touching something painful.

If you feel triggered, want to pause, or are thinking about ending the work, we agree to meet at least once to talk it through before we stop altogether. I call this a repair session. It gives us a chance to talk about what's happening together, rather than ending abruptly with things left unresolved.

This agreement doesn't change your right to withdraw at any time, set out above. It simply means that when things get hard, we agree to talk about it first, in the room, instead of one of us disappearing from the process.

PRACTITIONER'S RESPONSIBILITIES

  • To provide a safe, supportive and non-judgemental space for the work.

  • To offer guidance, tools and structure suited to your relationship and your goals.

  • To respect your confidentiality and your autonomy.

  • To name directly any pattern, dynamic or risk I notice that needs attention.

  • To honour the repair session agreement above if you want to end the work.

YOUR RESPONSIBILITIES

  • To take an active part in sessions.

  • To be open and honest in what you share.

  • To follow through on agreed strategies and exercises between sessions.

  • To respect the process and your partner's perspective, even where you disagree.

  • To let me know if you want to pause or end the work, so we can meet for a repair session first.

LIMITATIONS OF RELATIONSHIP SUPPORT

Relationship support can be highly effective, but it does not guarantee a particular outcome. What it achieves depends on your commitment, your openness to change, and the effort you and your partner put into the process between sessions as well as during them.

PROTECTION OF YOUR INFORMATION

Any personal information you share with me is collected and stored in line with the Protection of Personal Information Act (POPIA). It is used only for the purposes of our work together and is not shared with third parties without your written consent, except where required by law.

FEES AND CANCELLATION POLICY

​Fees are set out in the fee schedule I have provided separately. If you need to cancel or reschedule a session, please give at least 24 hours' notice. Sessions cancelled with less notice than this may be charged in full.

ACKNOWLEDGMENT AND CONSENT

​By signing below, you confirm that you have read and understood this form, including the agreement about repair sessions set out above, and that you consent to take part in relationship support on these terms.

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