The BraveOne Community Intimacy Anorexia & Intimacy Deprivation Group Agreement
Please review and fill out the form.
Welcome to the Intimacy Anorexia & Intimacy Deprivation Group. We can’t wait for you to get started! Please review the following information carefully. We want you to be familiar with policies/procedures so that things can run smoothly. Please read this very carefully so that there are no misunderstandings later on. If you have any questions please email the BraveOne Team at info@braveone.com. We’ll be happy to assist you.
Warmly,
The BraveOne Team
PROCEDURE/CONFIDENTIALITY:
The Intimacy Anorexia & Intimacy Deprivation Group is a valuable, private, and confidential group. I agree to treat each meeting with the upmost respect and care. I agree to have my camera on the entire time and understand that there are no exceptions. If I need to step away, I will leave my camera on while I’m gone. I will not join the call with other people in the room. I will not join the call from a location where I don’t have complete privacy. I understand that this is not a time for children or other adults to be present, even if I have headphones on. Having any other person present is a breach of privacy and confidentiality. If this circumstance occurs, I understand that the BraveOne Coach will ask me to immediately close my session and join when I have privacy. I will join from a quiet and confidential place where I can concentrate on connecting together. I will make sure my face is well lit so I can be seen clearly by my Coach and group members. I will join each session with a good internet connection and use a good device that is fully charged so I can be seen and heard easily by my Coach and group members. I will not eat, move around, drive, be in a moving vehicle either by myself or with others, or do anything else that could potentially be distracting when the Intimacy Anorexia & Intimacy Deprivation Group is in session. I will be on time. will come to the call prepared with questions about Intimacy Anorexia & Intimacy Deprivation and challenges I may be experiencing.
I understand that group members names and any comments or discussions that occur within the group are strictly confidential. By typing my name below I agree to maintain confidentially of all members of the group.
I understand that Dr. Sheri and the staff of the BraveOne Community may be considered mandated reporters; thus, required to report to the proper authorities any of the following:
- Any reasonable suspicion of physical or sexual abuse of a child, minor, elder, or an adult with a disability.
- When a participant communicates a threat of bodily injury to others.
- When a participant may be a threat to herself or has plans of suicide.
I understand that I will receive a link to access the group session each time before the meeting.
I understand that the BraveOne Team is unable to follow up or manage other resources and assure that they’re in alignment with the BraveOne Community. So, I agree not to post any resources that are outside the BraveOne Community on the group messaging app including organizations, podcasts, episodes, radio shows, videos, recordings, retreats, intensives, conferences, events, seminars, summits, communities, mentoring, coaching, classes, groups, sessions, websites, links, posts, meditations, workouts, blogs, books, documents, and downloads. If I post an outside resource, I understand I’ll be gently reminded by my coach and asked to remove it from the feed.
PROTECTING GROUP CONNECTION & NO SIDE CONVERSATIONS:
I understand that protecting my group connection & guarding against side conversations while my group is in their healing process maximizes the benefits of the group coaching while protecting the safety of each participant from unhealthy alliances or gossip. I understand that it’s very common when participating in group coaching, that relational dynamics of family of origin, unhealed wounds come to the surface, let me know, often via felt pain, that something needs attention & healing. I understand I might feel triggered by someone or I might trigger someone else. I might feel irritated by certain personalities or temperaments as they might remind me of someone that has hurt my heart. When safe, group coaching is done, an invitation for deeper relational healing within the group context can take place. To that end, in order to best support group dynamics, growth, pain and opportunity to heal, I understand that the Intimacy Anorexia & Intimacy Deprivation Group does not allow side conversations between members of the group to happen outside of the face-to-face group sessions or group messaging app.
I acknowledge that I may have come into a Intimacy Anorexia & Intimacy Deprivation Group session with an already established friendship with one of my other group members. Or that I might develop a friendship with a member of my group during the BraveOne Intimacy Anorexia & Intimacy Deprivation Group session. So, I agree to the following:
- I agree that I won’t discuss any information about someone else in my Intimacy Anorexia & Intimacy Deprivation Group outside of my group sessions or my group messaging app.
- I agree that I won’t discuss any personal & confidential information that was discussed in the Intimacy Anorexia & Intimacy Deprivation Group or group messaging app outside of my group sessions or my group messaging app.
- I understand that I’m free to share my story.
- I also understand that me sharing my story does not include my reaction, feelings or experiences with or about my Intimacy Anorexia & Intimacy Deprivation Group or another member in the group.
- I agree that if I do have a reaction, feeling or experience that I want to discuss about my Intimacy Anorexia & Intimacy Deprivation Group or a group member, that I will ONLY discuss it within my small group session or messaging app and NOT with a friend or friends that I’m in the Intimacy Anorexia & Intimacy Deprivation Group with.
- If I violate these terms and discuss information about my group or a small group member with my friend, I’ll be required to bring that conversation back to the class.
- I agree to place the safety and protection of my Intimacy Anorexia & Intimacy Deprivation Group and its members at the highest level.
- I understand that this applies during the 8-week session and during the time my group messaging app is open.
I agree not to contact my group members outside of my Intimacy Anorexia & Intimacy Deprivation Group sessions and group messaging app set up by my Coach (if applicable) during the 8-week and during the time my group chat is open (if applicable). I understand that doing so is a violation of this agreement.
MEETINGS:
There will be 8 meetings, each meeting will last 90 minutes. I agree that if I am sick or going to miss a meeting, I will let my BraveOne Coach know. I understand that there will be no makeup meetings.
OFFICE HOURS:
I understand that the BraveOne Community office is based in the United States and is open Monday through Friday. There are no weekend hours. I understand that if I send them something via email on Thursday night or Friday, they will most likely respond on Monday.
DECISIONS:
I understand that I am responsible for the decisions I make about my work in the Intimacy Anorexia & Intimacy Deprivation Group. My BraveOne Coach and the BraveOne Team are happy to share opinions, offer resources, or make referrals. However, it is up to me to decide which, if any, to act upon.
I understand that if I decide to take a recommendation my BraveOne Coach or other group members give, it is my choice and I take full responsibility for it. If I decide to work with someone based on a referral, I understand that the workings of that relationship will be entirely separate from my relationship with the BraveOne Community, the Intimacy Anorexia & Intimacy Deprivation Group, it’s staff, and it’s BraveOne Community Coaches.
I understand that I may stop attending the Intimacy Anorexia & Intimacy Deprivation Group at any time. If I choose to do so, I understand that my fees will not be refunded.
MY COMMENTS:
At the end of the 8 weeks in the Intimacy Anorexia & Intimacy Deprivation Group, I understand that I will be asked to write a few comments about my time in the Intimacy Anorexia & Intimacy Deprivation Group as an evaluation. I understand that it helps the BraveOne Community staff to see what I liked about the process, what results I received overall, and anything else I would like to add. I understand that the BraveOne Community may use my comments in the form of a client testimonial to share with others who are thinking of participating in an Intimacy Anorexia & Intimacy Deprivation Group. I understand that it is my responsibility to let the BraveOne Community staff know if I do NOT want my comments used from the closing evaluation. This DOES NOT include any and all comments made during the Intimacy Anorexia & Intimacy Deprivation Group. Those will ALWAYS remain confidential and will never be shared by the BraveOne Team.
PROBLEMS:
I understand that the BraveOne staff want me to be satisfied with my Intimacy Anorexia & Intimacy Deprivation Group experience. I agree that if my BraveOne Coach ever says or does something that upsets me or doesn’t feel right, I will bring it up either to my BraveOne Coach or to the BraveOne staff. All comments can be emailed to info@braveone.com.
DIVERSITY:
I understand that the Intimacy Anorexia & Intimacy Deprivation Group is open to all participants regardless of their faith orientation. Some elements of the teaching draw from references to God and from a Christian-based philosophy, which may influence the teaching/group support I receive in the Intimacy Anorexia & Intimacy Deprivation Group.
I understand that participants in the Intimacy Anorexia & Intimacy Deprivation Group come from all ranges of trauma experiences, varied beliefs, lifestyles, orientations, socioeconomic, age, and spiritual faith experiences. Healing comes as we curiously enter into understanding a person’s experience from a non-judgmental stance. It is requested that we refrain from trying to fix another person or impose beliefs that we deem may be best for that individual. The devastation that comes by way of existential trauma, relational trauma, socioeconomic trauma, spiritual/faith trauma has the ability to be processed and worked through within an environment of safety.
PERSONAL RESPONSIBILITY:
I understand that I am responsible for my own results in connection with the Intimacy Anorexia & Intimacy Deprivation Group. I understand that if I choose not to implement things I’ve learned in the Intimacy Anorexia & Intimacy Deprivation Group, I may not see the progress I’m hoping for.
I understand the maximum benefit will occur with consistent attendance and at times I may feel conflicted about my Intimacy Anorexia & Intimacy Deprivation Group as the process can sometimes be uncomfortable. Continuing through the Intimacy Anorexia & Intimacy Deprivation Group can lead to personal insight and growth.
I understand that the group is impacted by my presence and am committing to attend all 8 Intimacy Anorexia & Intimacy Deprivation Group sessions.
If I have been advised by my physician or psychiatrist to use medication of any kind, I agree to continue using my medications as prescribed during the course of this Intimacy Anorexia & Intimacy Deprivation Group.
I further understand and acknowledge that the Intimacy Anorexia & Intimacy Deprivation Group is not psychiatric treatment, and that no doctor-patient or therapist-client relationship is established by my participation in this Intimacy Anorexia & Intimacy Deprivation Group.
I agree to cooperate fully with the staff of the BraveOne Community & my BraveOne Coach, and I understand that failure to do so may result in removal from the Intimacy Anorexia & Intimacy Deprivation Group.
RELEASE OF INFORMATION:
I authorize the BraveOne Community, it’s coaches, supervisors, and BraveOne Team to release and disclose information to other coaches, supervisors, and BraveOne Team members within the BraveOne Community for the purpose of coordinating care.
NO MEDICAL ADVICE, MENTAL HEALTH COUNSELING, OR INSURANCE REIMBURSEMENT:
The BraveOne Community and its Coaches are not intended to provide mental health treatment, and does not constitute a client/therapist relationship. I understand that the BraveOne Community is a membership site and the Company, nor its employees, members, representatives, coaches, and agents do not provide diagnosis. I understand that the BraveOne Community does not provide any type of superbill or receipt for services. The BraveOne Community does not work with insurance companies and does not provide any type of paperwork for insurance reimbursement and as a result of this I understand that I may not be reimbursed by my insurance company and agree to take on the responsibility of payment for services rendered regardless.
FEES:
I understand that I am responsible for the total cost of the Intimacy Anorexia & Intimacy Deprivation Group. I agree to notify the BraveOne staff if my payment information needs to be updated or adjusted in any way. In the event any method of payment of fees and/or expenses proves nonredeemable or non-transferable by a U.S. bank or financial institution, I agree to pay an insufficient funds fee of $35. I understand that I am responsible to pay for all Intimacy Anorexia & Intimacy Deprivation Group sessions in advance regardless of my attendance. I understand that Intimacy Anorexia & Intimacy Deprivation Group fees are non-refundable.
COPYRIGHT OF MATERIALS:
I understand that materials provided to me during the Intimacy Anorexia & Intimacy Deprivation Group are copyrighted. Under no circumstances can the copy in these documents be used or reproduced in whole or part without the express written permission of BraveOne Community, Inc. and Dr. Sheri Keffer. The absence of a copyright notice on any given page or material should NOT be construed as an absence of copyright. These copyrights have been successfully defended in the past, and it is the policy of the BraveOne Community and BraveOne Community, Inc. to aggressively defend all intellectual properties.
STATEMENT OF UNDERSTANDING:
I understand that any fees are non-refundable and that the Intimacy Anorexia & Intimacy Deprivation Group sessions will not be rescheduled if I cannot attend.
RELEASE OF LIABILITY:
By typing my name below, I agree that I am a voluntary participant in the Intimacy Anorexia & Intimacy Deprivation Group. I agree to release and discharge as well as agree to indemnify and hold harmless Dr. Sheri Keffer, BraveOne Community, Inc., Karene Dodson/Integral Solutions, all BraveOne Community Coaches, their officers, directors, employees, agents and subcontractors, against all actions, causes of actions, claims, demands, costs and expenses and liabilities of any nature whatsoever that I may suffer directly or indirectly during the course of or as a result of my participation in the Intimacy Anorexia & Intimacy Deprivation Group.
On this date, I entered into a relationship with BraveOne Community, Inc., Dr. Sheri Keffer, and the BraveOne Team. I have read and agree to the policies and procedures above. A copy of this document will be emailed to me at the address provided.
Copyright © 2024 Dr. Sheri Keffer. All Rights Reserved.