Agreement and Consent to Receive Mental Health Coaching

Welcome to my coaching practice. This document constitutes a contract between us (the “AGREEMENT”) and you should read it carefully and raise any questions and concerns that you have before you sign it.

The services to be provided by Gregory D Kilpatrick, MSMFT. are coaching or tele-coaching. The fee for coaching sessions will be charged at the agreed upon rate (generally $40, unless another rate is agreed upon below) per 20-minute session. You are required to give 24 hours’ notice if you need to cancel or change the time of an appointment. Otherwise, you will be charged for the session in full.


In addition to being a coach, I am also a Registered Associate Marriage and Family Therapist in California with training and experience in diagnosing and treating emotional problems. While there are some similarities between coaching and psychotherapy, they are very different activities and it is important that you understand the difference between them. Psychotherapy is a health care service and is usually reimbursable through health insurance policies. This is not true for coaching. Both coaching and psychotherapy utilize knowledge of human behavior, motivation and behavioral change, and interactive counseling techniques. The major differences are in the goals, focus, and the level of professional responsibility.

The focus of coaching is development and implementation of strategies to reach client-identified goals of enhanced performance and personal satisfaction. Coaching may address specific personal projects, relationship issues, life balance, job performance and satisfaction, or general conditions in the client’s life, business, or profession. Coaching utilizes personal strategic planning, values clarification, brainstorming, motivational counseling, and other counseling techniques.

The primary foci of psychotherapy are identification, diagnosis, and treatment of mental and nervous disorders. The goals of psychotherapy include alleviating symptoms, understanding the underlying dynamics which create symptoms, changing dysfunctional behaviors which are the result of these disorders, and developing new strategies for successfully coping with the psychological challenges which we face. Most research on psychotherapy outcomes indicates that the quality of the relationships is most closely correlated with the therapeutic process. Psychotherapy patients are often emotionally vulnerable. This vulnerability is increased by the expectation that they will discuss very intimate personal data and expose feelings about themselves about which they are understandably sensitive. The past life experiences of psychotherapy patients have often made trust difficult to achieve. These factors give psychotherapists greatly disproportionate power that creates a fiduciary responsibility to protect the safety of their clients and to, “above all else do no harm.”

The relationship between the coach and client is specifically designed to avoid the power differentials that occurs in the psychotherapy relationship. The client sets the agenda and the success of the enterprise depends on the client’s willingness to take risks and try new approaches. The relationship is designed to be more direct and challenging. You can count on your coach to be honest and straightforward, asking powerful questions and using challenging techniques to move you forward. You are expected to evaluate progress and when coaching is not working as you wish, you should immediately inform me so we can both take steps to correct the problem.

In some situations, I may insist that you initiate psychotherapy and that I have access to your psychotherapist as a condition of my continuing as your coach.

It is also important to understand that coaching is a professional relationship. While it may often feel like a close personal relationship, it is not one that can extend beyond professional boundaries both during and after our work together. Considerable experience shows me that when boundaries blur, the hard won benefits gained from the coaching relationship are endangered.


I will only release to others with your written permission or in response to a court order. There are some situations in which I am legally obligated to breach confidentiality in order to protect you or others from harm. If I have information that indicates that a child or elderly or disabled person is being abused, I must report that to the appropriate state agency. If a client is an imminent risk to him/herself or makes threats of imminent violence against another, I am required to take protective actions. These situations are quite rare in coaching practices. If a situation occurs in our relationship, I will make every effort to discuss it with you before taking any action. Further, I do disclose information in the course of regularly held consultation with a mental health professional.

As you are no doubt aware, it is impossible to protect the confidentiality of information that is transmitted electronically. This is particularly true of e-mail and information stored on computers that are connected to the internet, which do not utilize encryption and other forms of security protection.
I have read and understand this Agreement and Consent to Receive Coaching Services from Gregory D Kilpatrick, MSMFT carefully. I understand and agree to comply with them. *
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