Application for Intro Couple's Session
Hello! 

Thank you for your interest in working with me. Please each answer the following questions, in separate forms, to help me to determine if it makes sense to move forward with an intro session. If there is a question you are uncomfortable answering, please feel free to mark n/a. While it is possible you may receive a reply from my assistant, please rest assured that your answers will kept confidential and will only be read by me. Replies can take up to a few weeks, but usually sooner. All inquires will receive a response. If you are uncomfortable inputting your answers here you can send them to jessica@jessicagraham.com. If you require more security email me for my Proton Mail address. 

I am a certified ReBloom somatic trauma resolution/post-traumatic growth guide, specializing in C-PTSD, and a certified Grief Recovery specialist. I am also trained and qualified to offer Brainspotting,  a powerful trauma-resolution modality, with roots in EMDR.  I am the author of Good Sex: Getting Off without Checking Out and Being (Sick) Enough: Thoughts on Invisible Illness, Childhood Trauma, and Living Well When Surviving is Hard. I also offer tools and techniques for chronic pain and illness, and have personal experience with both. I am neurodivergent friendly, and have been diagnosed with autism and ADHD myself. As for meditation, I am a senior teacher in Shinzen Young's meditation system, and was trained to teach directly by him. I have also studied with Adyashanti and Michael W. Taft, along with various teachers at many residential meditation retreats. 

Our romantic relationships are often where we become most activated, and where we tend to project our childhood traumas and attachment wounds. I bring my skills and expertise in this area to my couples coaching as needed. I also offer containers that include 1:1 sessions for one or both of you, and that is a special passion of mine. 

I'm looking forward to connecting with you!

With warmth and gratitude - 

Jess
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Email *
Name *
Pronouns (optional)
Your Partner's name  *
Age  *
Time zone *
Please list the days and times that are best for you in the next few weeks. I do not see clients on weekends or Tuesdays after 3pm ET, and my Friday hours are limited. 
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How did you find out about my couples work? *
What aspects of your relationship are feeling really good? *
What aspects of your relationship are feeling most challenging? *
Have you recently experienced any big loss or life transition? *
Do you have any chronic illnesses or experience chronic pain? Do you experience migraines or seizures? *
Keeping in mind that my priority will always be safety and consent in this work, are you in a place in your life where you have the capacity to delve into the sometimes challenging material that can arise in this type of work (ie. experiencing strong emotions, changes to relationship dynamics, processing past experiences, psycho-spiritual side effects, integrating new ways of operating, etc.)? *
Have you been diagnosed with any mental illness or personality disorder? If so, are you currently being treated for this? This will absolutely not disqualify you, but as I am not a therapist it's important that I know you have additional support if needed. I also need to be sure that working with you is within my scope of practice.  *
Understanding that we will not delve into anything highly triggering and we will move at a slow and safe pace in this intro session, do you agree with the following: I acknowledge and understand this intro session is no way a substitute for medical diagnosis and/or treatment of any kind. I acknowledge and understand that I am responsible for all aspects of my health and wellbeing, and that meditation and working with trauma may involve physical, mental, intellectual, and emotional activity that may be strenuous and destabilizing. I acknowledge that it is my sole responsibility to exercise my own judgement in choosing to participate in this intro session.  *
Are you currently or have you previously worked with a couples coach, guide, or therapist? If so, what worked great for you and what didn't? *

Because money is an area that holds a lot of stress for many, it's important to me that you know the cost of my services before we meet. I feel that when practitioners don't share prices up front, it can create a nervous system response that is not conducive to a fruitful intro session. 

This intro session is a full 60 - 90 minute session, not a sales call. The intro session is a gift. My intention is that even if we choose not to work together, the session is helpful for you. 

I do not sign up new clients until after we have each taken a few days to consider if it's a match. 

I offer 3 and 6 month containers. You will have my support throughout our work together. 

My offerings range between 4K and 16K, with varying levels of support, including spot calls, text support, 1:1 sessions and a 4 hour couples workshop. 

I do offer payment plans, and have a limited number of sliding scale spots. Feel free to ask about this. 

I am only able to offer the intro sessions to those who are  ready to invest in the work. Thank you for your understanding. 

Are you able to invest time and money into this process at this time? 

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What would feel like a miracle for your relationship in the next 3 - 6 months? *
What or who makes you feel happy and safe? *
What are three things you love about your partner?
Are you willing to dedicate time each week, outside of sessions, to do homework together? This can include intimacy practices, writing exercises, structured conversation, and more. 
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Are you ready to change patterns in your relationship, even if that means periods of growing pains and stepping into unknown territory together? 
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Is there anything else you’d like me to know about you before we meet? Share as much or as little as you like. *
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