1:1 Coaching Application

1

Name* This field is required.

First Name

Last Name

2

Email* This field is required.

example@example.com

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Pronouns

4

Location/Timezone

5

Do you understand this is coaching, not therapy?* This field is required.

Yes, I understand this is coaching support, not clinical treatment

No, I was looking for therapy services

I'm not sure about the difference

6

Are you currently in therapy or have recent therapy experience?* This field is required.

Yes, currently in therapy

Yes, recently completed therapy (within past year) 2

Yes, but it's been more than a year

No, I haven't done therapy work

7

Are you currently in mental health crisis or need immediate clinical support?* This field is required.

No, I'm stable and seeking implementation support

Yes, I need immediate clinical care

I'm not sure

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If you answered yes to needing clinical care, please seek appropriate support first. If you're in crisis, contact your therapist, call 988, or seek emergency services.

9

What draws you to between-session coaching support?* This field is required.Share what gap you're hoping to bridge between your therapy insights and daily life

10

Which coaching container interests you most?* This field is required.

Reintroduction Series (6 weeks, $777) - Gentle exploration of coaching support

Homecoming Hours (12 weeks, $1,111) - Intensive daily support with unlimited voice notes

I'm not sure - would like guidance during our call

11

Do you understand the investment for gentle coaching?* This field is required.

Yes, I understand the pricing and am prepared for this investment

I have questions about pricing

I would need a payment plan

12

Do you currently have the time and energy to meet weekly for 45 minutes?* This field is required.

Yes

No

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Tell me about your therapy experience and what kind of additional support you're seekingHelp me understand your healing journey and where you are now

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What's your current capacity for implementing new practices and attending weekly sessions?Share honestly about your bandwidth right now

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What kind of support do you feel you need most in those 167 hours between therapy sessions?Be specific about what you hope coaching will provide

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What does "gentle support" mean to you?Help me understand what feels safe and supportive for your nervous system

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Is there anything that might get in the way of you committing to weekly sessions and gentle implementation work?Financial, time, emotional capacity, etc. - honesty helps us both

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Is there anything else you'd like me to know about your healing journey, what you're seeking, or how you want to be supported?Share whatever feels important

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Please confirm your understanding:* This field is required.All Required

I understand this is coaching, not therapy or clinical treatment

I understand Barbara holds an LMSW but works exclusively as a coach in this capacity

I have appropriate mental health support (therapy/medical) for clinical needs

I will not rely on coaching for crisis intervention or mental health emergencies

I understand coaching complements but doesn't replace professional mental health care

I'm applying because I want support implementing therapy insights in daily life

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* This field is required.