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2023 KOSTA 개인 상담 신청서
안녕하세요! 상담 신청을 위한 중요한 질문들이오니 잘 읽고 답변해주세요.
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1
Waiver of Liability (상담 동의서)
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The undersigned, seeking a biblical life coaching adhered by KOSTA/USA, hereby acknowledges his or her understanding of the following conditions and further releases to the life coaching program, its mentors, and staffs, from any liability or claim arising from the undersigned’s participation in the above-mentioned the life coaching program: 1) It is understood by the participant that the life coaching program will be provided by supervised mentors, not as licensed therapists; 2) That all programs provided during KOSTA Conference is in accordance with the biblical principles adhered to its ministry and are not necessarily provided in adherence to any local or national psychological or psychiatric association; 3) That no representation has been made, either expressly or implied, that the life coaching, as conducted by the mentors, is accepted as customary psychological and/or psychiatric therapy within the definitional terms utilized by those professions. 4) Certain statements may not be protected as privileged communications under law. Do you agree with Waiver of Liability?
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2
I hereby agree to the following conditions:
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1) I assure to keep confidential information from the mentoring session. (저는 세션 중 거론된 상담가의 정보 포함, 개인적인 내용은 비밀로 지키기로 약속합니다.) 2) I am committed to resolving/adjusting/rectify my problems by coming into obedience to the Word of God. (저는 세션 중 거론된 문제를 하나님의 말씀인 성경 안에서 풀어나가기로 약속합니다.) 3) If I am dissatisfied in any way with the session, I will first discuss it with the program staff directly. (세션의 결과에 불만이 있을 경우, 상담실 스태프와 먼저 상의를 먼저 할 것을 약속합니다.) 4) Mentors and mentees have a right to report the session if they notice severe life-threatening situation. (상담가와 내담자는 세션 중에 생명에 지장이 있는 응급상황이 감지될 경우 관련 기관에 신고할 수 있는 권리가 있습니다.) *** If you have any questions about these guidelines, please consult with the KOSTA staff or one of our mentors. (위의 내용에 질문이 있을시에는 상담실 스태프나 상담자님께 상의해주시면 감사하겠습니다.) I, (아래 자신의 이름 서명), affirm the accuracy of the personal information provided herein, and have read the information above and agree to the conditions set forth therein that the life coaching I receive will be based on the mentor’s understanding of the Bible as the Word of God and its practical applications.
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3
성별
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Gender
남(male)
여(female)
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이름
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Name
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나이
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Age
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6
조번호
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Group #
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7
상담실에서 연락받을 e-mail address
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상담실에서 연락받을 전화번호
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9
희망상담가
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Preference of Counselor
Male / 남자상담가
Female / 여자상담가
No preference / 상담실추천
Other
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10
희망 상담 시간-2순위
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Preferred Time to Meet
화요일 오전 (LGS 시간)
화요일 오전 (오전 전체집회 끝부분 & 점심식사 시간 일부)
화요일 오후 (세미나 1)
화요일 오후 (브아시간)
화요일 오후 (세미나 2)
수요일 오전 (LGS 시간)
수요일 오전 (오전 전체집회 끝부분 & 점심식사 시간 일부)
수요일 오후 (세미나 1)
수요일 오후 (브아시간)
수요일 오후 (세미나 2)
목요일 오전 (LGS 시간)
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11
개인 상담 세션 운영을 위해서 많은 노력과 인력이 요구됩니다. 꼭 상담이 필요하신지 확실하지 않다면 코스타 컨퍼런스 기간 동안 현장에서 운영되는 멘토링을 통해서 고민하시는 부분에 대한 도움을 받으실 수 있습니다. 또한 개인 상담 신청을 접수하신 후 상담가님과 매칭되신 후에는 상담 세션을 취소하거나 시간을 변경하실 수 없습니다. 이에 동의하며 신청서를 계속해서 작성하시겠습니까?
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12
전문 상담, 심리치료를 받으신 적이 있으신가요?
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Have been treated for a psychiatric, emotional, or mental illness?
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13
코스타 상담실에서 상담을 받으신 적이 있으신가요?
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Have you ever experienced the KOSTA life coaching?
없음 (None)
1회 (Once)
2-3 회 (2-3 times)
4회 이상 (More than 4)
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YES라고 답하셨다면 어떤 일로 상담을 받으셨나요?
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15
원하는 상담 분야
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Desired KOSTA life coaching topics
관계 (Relationship)
중독 (Addiction)
내적치유 (Inner Healing)
정신 건강 (Mental Health)
정신 질환 (Mental Disorder)
바운더리 (boundery)
성격 문제 (Personality Issues)
감정 제어 (Emotional Disregulation)
집중 장애 (Distraction)
다문화 문제 (Multicultural Issues)
가정 불화 (Family issues)
Other
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16
상담분야-진로
Career Issues--원하는 상담분야에서 진로를 선택하셨을 경우 작성해 주십시오.
진로 선택 (Career Choices)
소명
대화하기 원하는 특정 분야가 있다면 표기해 주십시오.
Other
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17
예전만큼 사람들과 어울리는 것이 즐겁지않다.
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I don't enjoy being around people as much as I used to.
Not at all like me
Somewhat not like me
Neutral
Somewhat like me
Extremely like me
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내 자신이 가치없게 느껴진다 (내 존재가치를 발견하기 어렵다.)
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I feel worthless (I don't find much value in myself).
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19
내 삶의 소망이 없다고 느껴진다 (내 삶의 미래가 잘 보이지않는다.)
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I feel hopeless (I don't see a future in my life).
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20
나는 고립되어 있고 외롭게 느껴진다.
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I feel isolated and alone.
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21
나는 슬픈 날이 그렇지 않는 날보다 더 많게 느껴진다.
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I feel sad more days than not.
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22
나는 생을 마감하고 싶은 생각을 한다.
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I have thoughts of ending my life.
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23
나는 수면 문제를 겪고 있다.
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I have sleep difficulties.
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24
나는 평소 걱정을 멈추는 것이 어렵다.
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I feel like I can’t turn my mind off.
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25
나는 극심한 압박이나 공포를 느낀다.
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I have spells of terror or panic.
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26
큰 이유없이 심장이 뛴다.
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My heart races for no good reason.
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27
나는 자주 긴장상태에 있다.
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I feel tense.
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28
나는 사람들이 나를 좋아하지 않을 것을 염려한다.
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I am concerned that other people do not like me.
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29
나는 사람들의 시선을 의식한다.
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I feel self-conscious around others.
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30
나는 모르는 사람들과 만나는 자리를 가급적 피한다.
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I avoid a situation where I am surrounded by people I don't know.
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31
나는 최근 평소만큼 집중이 잘 되지 않는다.
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I am not able to concentrate as well as usual.
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32
동기부여 되는 것이 어렵다.
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It is hard to stay motivated.
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33
내 일을 지속하는 것이 어렵다.
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I am unable to keep up with my work.
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34
내가 무엇을 하든지 잘 해낼 자신이 있다.
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I am confident I can succeed in whatever I do.
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35
나는 내가 원하는 것이상으로 아래와 같은 행동을 떠올리거나 생각한다. (해당 사항 모두 선택)
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I think about _____________ more than I would like to. (Check all that apply)
None
Disordered eating (섭식문제)
Internet Use (인터넷사용)
Game (게임)
Cell Phone (핸드폰사용)
Videos (동영상)
Alcohol (술)
Smoking (담배)
Drugs (마약)
Sexual life (성생활)
Shopping (충동구매)
Self-injurious behavior (자해)
Other
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36
나는 아래와 같은 행동을 할때 통제가 되지 않음을 느낀다. (해당 사항 모두 선택)
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I feel out of control when I _____________. (Check all that apply)
None
Disordered eating (섭식문제)
Internet Use (인터넷사용)
Game (게임)
Cell Phone (핸드폰사용)
Videos (동영상)
Alcohol (술)
Smoking (담배)
Drugs (마약)
Sexual life (성생활)
Shopping (충동구매)
Self-injurious behavior (자해)
Other
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37
나는 아래와 같은 행동을 한 후에 종종 후회하곤 한다. (해당 사항을 모두 선택)
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I often regret after _____________. (Check all that apply)
None
Disordered eating (섭식문제)
Internet Use (인터넷사용)
Game (게임)
Cell Phone (핸드폰사용)
Videos (동영상)
Alcohol (술)
Smoking (담배)
Drugs (마약)
Sexual life (성생활)
Shopping (충동구매)
Self-injurious behavior (자해)
Other
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38
나는 술을 마시면 무슨 일이 있었는지 기억이 나지 않는다.
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When I drink alcohol I can't remember what happened.
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39
내 성질/화를 통제하는데 어려움이있다.
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I have difficulty controlling my temper.
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40
나는 쉽게 화가 난다.
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I get angry easily.
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41
나는 말다툼에 자주 개입된다.
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I frequently get into arguments.
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42
나는 가끔 물건을 부수거나 치고 싶은 생각이 들곤한다.
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I sometimes feel like breaking or smashing things.
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43
나는 내가 나를 통제하지 못해서 폭력적인 행동을 할 수도 있다는 두려움을 느끼곤한다.
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I am afraid I may lose control and act violently.
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44
나는 다른 사람을 해치고 싶은 생각을 한다.
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I have thoughts of hurting others.
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45
개인상담 매칭과 상담 장소 연결은 로비에 있는 상담데스크를 방문해주셔야 완료 됩니다. 모든 연락은 신청서에 알려주신 개인 이메일로 보내드립니다.
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개인 상담 세션은 LGS, 세미나, 브아 시간에 동일하게 진행이 됩니다. 희망 상담 시간에 스케줄 컨펌이 되지 않을 수 있으며, 세미나 혹은 브아 시간에 매칭이 될 경우 개인 상담 세션이 우선이 되어 미리 신청하신 세미나/브아 세션에서 제외 되실 수 있음을 알려드립니다.
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