<p> K A T T Y C O F F R O N, Ph.D. MFC 50027, LPC 228</p><p>Informed Consent – Couples Therapy Live Supervision</p><p>As you may remember from my informed consent, in order to provide the best possible therapy treatments for my clients, I at times seek supervision. At this time, I would like to have my EFT supervisor, Sandy Jardine, MS, LPC, provide live supervision of one or more sessions with you. </p><p>Sandy has 30 years of experience working with couples and is a seasoned EFT supervisor in Arizona. You can read more about Sandy at http://couples-counseling-phoenix.com/meet- sandy/. Sandy is a licensed therapist and will follow the same confidentiality guidelines as I do. </p><p>While you will be essentially two therapists in your session, the fee for your session is the same, and I will be responsible for all supervision fees.</p><p>If you give consent, the process will be as follows:</p><p>Prior to the live supervision session, I will provide a very brief synopsis of our work together to Sandy, and I will let her know where I need the most help in facilitating our work in the EFT process. </p><p>At our planned live supervision session time, Sandy will join us via Skype or similar technology. I will give you the opportunity to meet her face-to-face via Skype, and then when that is done, I will transition the audio to my earbud and she will watch and hear our session via Skype video. She will be my co-pilot, and will guide my interventions with you to deepen our work and provide the best services possible to you.</p><p>After our session is complete, Sandy will provide me with guidance to help our work progress. I will also share any feedback she has for you to help you grow as a couple. </p><p>My hope of course is that you both will find this process supportive and beneficial to your relationship. If at any point during the live session you feel uncomfortable and wish to stop the live supervision process, we will do so.</p><p>Signature ______Date ______</p><p>Signature ______Date ______</p><p>1 2 4 4 P I N E S T R E E T # 2 0 3, P A S O R O B L E S, C A, 9 3 4 4 6 P H O N E : ( 8 0 5 ) 9 7 5 – 8 3 9 9 ------W W W . K A T T Y C O F F R O N . C O M</p>