The Awakened Therapist Podcast: Consultation Application
Thank you for your interest in joining The Awakened Therapist Podcast! I created this podcast to give you and listeners an opportunity to explore and understand therapy clients through a mindfulness-based transpersonal approach. As a gestalt therapist and teacher, I weave together principles of neurobiology, developmental trauma, subtle energy, innate spirituality, intuition, psychology, and creativity through gestalt experiments. 

Because this style of counseling is still new to the general field of psychotherapy, case consultation will include a combination of exploring one client you are working with as well as some education for listeners who may not be familiar with this work. Each episode will be about 40 min. We will begin by connecting and conversing together, followed by your presentation of your case and my offering of support. In the form linked here, Considerations for Case Consultation, you will find an outline of some things I will be curious about as you share your case. 

In order to protect the anonymity of your clients, your identity will be concealed and we will use audio recordings only. Please do not share any of your client's identifying information, including their name. 
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Email *
Do you have training in gestalt therapy?  *
Do you have training in transpersonal counseling?  *
Do you have your own mindfulness practice?  *
Do you have masters degree or higher in the field of counseling? *
Do you hold a license to practice? *
How long have you been practicing?  *
In what setting do you see clients? *
Is there anything about your client that you'd like me to know about before we record your episode? 
How would you like me to introduce you? For example, "a therapist who specializes..." or "a therapist who is passionate about..."
If you answered the above question, would you like me to keep this information confidential?
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We will meet on zoom so we can see one another, but only the audio will be used. A good audio recording requires an external microphone. By checking this box, you are agreeing to arrive to this meeting on your computer with an external microphone set up and minimal noise in the background.  *
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Case consultation is not a substitute for supervision. These episodes are intended to be used for educational purposes and do not imply a supervisor/supervisee relationship. Any and all actions you take with your client fall under your licensure. 

By checking the box below, you acknowledge you understand that Harmony Kwiker is not your supervisor and you are not practicing under her license.  
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By checking the box below, you agree to the following: 

I consent to the audio recording of my case consultation and grant to Harmony Kwiker and The Institute for Spiritual Alignment LLC the right to copy, reproduce, and use all or a portion of the recording (the “consultation”) for any purpose whatsoever, including the use of any printed matter in conjunction therewith and further concede all rights to the produced media for potential future use in advertising, speeches, books, webpages, and all other forms of public distribution without remuneration and in perpetuity. I understand that my identity and my client's identity will be kept anonymous, and any identifying content that would break privilege will be not be discussed or used in the use of this podcast or in the future. 

Release

I release Harmony Kwiker and The Institute for Spiritual Alignment LLC from any claims that may arise regarding the use of the Interview including any claims of defamation, invasion of privacy, or infringement of moral rights, rights of publicity, or copyright. I acknowledge that I have no ownership rights in the work. 



Harmony Kwiker and The Institute for Spiritual Alignment is not obligated to utilize the rights granted in this Agreement. I have read and understood this agreement and I am over the age of 18. This Agreement expresses the complete understanding of the parties.

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A copy of your responses will be emailed to the address you provided.
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