WelcomeINFORMED CONSENT
Thank you for choosing to participate in Relationship Decision Consultation.
This document explains the nature of the consultation services being provided, the structure of the consultation process, your rights and responsibilities as participants, the limits of confidentiality, financial policies, and other information necessary for you to make an informed decision about participating.
Please read this document carefully. Questions are welcome at any time before or during the consultation process.
Participation in Relationship Decision Consultation indicates that both partners have reviewed this document, understand its contents, and voluntarily agree to participate.
Purpose of Relationship Decision Consultation
Relationship Decision Consultation is a structured, short-term consultation service designed to help couples who are uncertain about the future of their relationship make an intentional, informed, and accountable decision regarding their next steps.
Many couples find themselves emotionally stuck between reconciliation and separation. Rather than remaining in prolonged uncertainty, this consultation provides a structured process for clarifying relationship dynamics, identifying barriers to healthy functioning, exploring each partner's perspective, and determining an appropriate path forward.
The purpose of this service is not to persuade couples to remain together or to separate. Instead, the consultation is designed to support thoughtful decision-making based upon each partner's values, willingness, and the realities of the relationship.
Nature of the Service
Relationship Decision Consultation is provided by a Licensed Marriage and Family Therapist using professional knowledge, clinical experience, relational assessment, attachment theory, systems theory, and evidence-informed consultation practices.
This service is consultative in nature.
Although professional clinical judgment is utilized throughout the process, this service is not intended to establish an ongoing course of psychotherapy, provide long-term treatment, or resolve longstanding relational concerns within four sessions.
Instead, the consultation is designed to answer one central question:
"What is the healthiest and most responsible next step for this relationship?"
Recommendations may include, but are not limited to:
Pursuing ongoing couples therapy
Continuing personal growth independently without therapy
Individual therapy for one or both partners
Separation or divorce (“ethical decoupling”)
Additional assessment
Other community resources
No recommendation is predetermined.
Consultation Structure
Relationship Decision Consultation consists of four scheduled sessions. There is no prescribed minimum time for each consult. Some may last 30 minutes. Some may go over an hour. I make every effort to honor everyone’s time (including mine), by ending the consultation at a maximum of 75 minutes.
Session One - Joint Relationship Consultation
This meeting focuses on understanding the history of the relationship, identifying presenting concerns, clarifying goals for the consultation, and establishing expectations.
Session Two - Individual Consultation – Partner A
This session provides an opportunity to understand Partner A's personal experiences, attachment patterns, concerns, hopes, and perspectives regarding the relationship.
Session Three - Individual Consultation – Partner B
This session mirrors Session Two and focuses on understanding Partner B's experiences and perspectives.
Session Four - Joint Decision Consultation
During the final consultation, observations from the consultation process are integrated, feedback is provided, and recommendations are discussed. The consultation concludes with identifying an agreed-upon direction and discussing appropriate referrals or next steps.
Scope of Services
Relationship Decision Consultation may include:
Attachment style assessment
Identification of relational patterns
Psychoeducation
Systems-based conceptualization
Decision support
Professional recommendations
This consultation does not include:
Ongoing couples therapy
Court evaluations
Custody recommendations
Expert witness services
Mediation
Legal advice
Crisis counseling
Emergency mental health services
Psychological testing
Diagnosis
Relationship Decision Consultation Is Not a Guarantee
No professional can guarantee that:
A relationship will improve
Reconciliation will occur
Separation will occur
A particular decision is "correct"
The purpose of this consultation is to improve clarity—not predict the future.
Both partners remain fully responsible for any decisions made regarding their relationship.
Professional Neutrality
The consultant does not advocate for reconciliation or separation.
Instead, the consultant's role is to facilitate an honest evaluation of the relationship while supporting thoughtful and ethically responsible decision-making.
Recommendations are based upon professional observations made during the consultation process and should not be interpreted as legal advice or directives.
Confidentiality
Confidentiality is protected in accordance with applicable federal and Kentucky law governing licensed mental health professionals.
Information disclosed during consultation will not be released without written authorization except when required or permitted by law.
Examples include:
suspected abuse or neglect
imminent danger to self, or imminent danger to others
court orders when legally required
Because this consultation involves two participants, confidentiality operates differently than individual services. The identified clients are the relationship and both participating partners.
Individual Sessions and Information Sharing
Individual consultations are conducted to better understand each partner's experiences, concerns, and perspectives.
Because the purpose of these meetings is to support the relationship consultation rather than establish separate therapeutic relationships, information shared during individual sessions may be incorporated into the overall consultation process when clinically relevant.
Clients are encouraged to avoid requesting that significant information affecting the consultation remain permanently hidden from their partner.
The consultant reserves the right to determine how confidential individual disclosures will be handled in order to preserve the integrity and fairness of the consultation process.
If significant undisclosed information materially affects the consultation (for example, an undisclosed affair, plans to leave, financial deception, or safety concerns), the consultant may require that the information be disclosed before continuing the consultation. If disclosure is refused and the omission prevents an ethical consultation process, services may be suspended or terminated. In such cases, appropriate referrals will be provided. No refund will be available.
Risks
Possible risks include:
Emotional discomfort, Grief, and/or Anxiety
Increased relationship conflict
Recognition of previously unacknowledged concerns
Recognition that reconciliation may not be appropriate
Recognition that substantial work would be required to continue the relationship
Potential Benefits
Possible benefits include:
Greater clarity
Improved communication
Better understanding of relationship dynamics
Increased self-awareness
Identification of attachment patterns
Reduced decision paralysis
Appropriate referrals
Confidence in moving forward
Referrals
Relationship Decision Consultation is designed to help determine the next appropriate step.
Following completion of consultation, referrals may be provided to:
Couples therapists
Individual therapists
Family attorneys
Mediators
Financial professionals
Community resources
Acceptance of any recommendation remains entirely voluntary.
Fees and Financial Policies
The consultation is offered as a four-session professional service.
The consultation fee is: $1,500
Payment is due: At leat seven (7) days before the first scheduled conjoint session.
If payment is not received before that time, the consultation may be terminated with no opportunity to reschedule.
Missed appointments and cancellation policies:
Payment is due prior to the first session.
There are, therefore, no missed appointment fees.
Cancellations must occur 48 hours before the scheduled session. Make up sessions are not guaranteed.
Less than 48 hours notice for cancellation may be cause for termination. Make up sessions are not offered for less than 48 hours notice of cancellation.
A missed session without any communication before the session time will result in immediate termination of the consultation.
No refunds will be provided for any reason once the full service fee has been paid.
Insurance is not billed for this consultation.
Clients are responsible for all fees associated with the consultation.
Records
A professional consultation record will be maintained in accordance with Kentucky law and applicable professional standards.
Records may include intake materials, consultation notes, assessments, recommendations, correspondence, and signed consent documents.
Telehealth
Sessions are conducted virtually, and clients agree to comply with the separate Telehealth Consent document.
Client Responsibilities
Participants agree to:
Participate honestly
Attend scheduled sessions
Treat one another respectfully
Notify the consultant of safety concerns
Make their own decisions regarding the future of the relationship
*If during the consultation partners enter into high conflict, arguments that cannot be redirected, yelling, belittling, or namecalling, the session will be immediately terminated and the live video call disconnected. A make up session is not guaranteed. No refund is available.
Acknowledgment & Consent
When completing the Intake Form, each partner will acknowledge the following.
We have read this document.
We understand the purpose and limitations of Relationship Decision Consultation.
We have had an opportunity to ask questions.
We understand that recommendations may include reconciliation, additional therapy, or separation.
We voluntarily agree to participate.
YOU MAY NOW PROCEED TO THE TELEHEALTH CONSENT AND THEN THE INTAKE FORM.