🔹 Informed Consent for Coaching Services

Provided by Stacy Bania LCSW operating under Bridge Back to You LLC – Coaching Role Only

1. Nature of the Relationship

You are engaging with me in a coaching relationship, not a therapeutic one. Although I am a Licensed Clinical Social Worker (LCSW), I am not acting as a therapist in this capacity, and these services are not psychotherapy, mental health counseling, or a substitute for such services.

2. Purpose of Coaching

Coaching is a collaborative, goal-oriented process intended to support personal, professional, or performance development. This may include identifying goals, developing action plans, accountability, or enhancing well-being—but it is not intended to treat, diagnose, or manage mental health conditions.

3. Distinctions Between Coaching and Therapy

• Coaching focuses on present and future-oriented goals and does not involve diagnosis or treatment of mental health disorders.

• Therapy focuses on the resolution of emotional or psychological issues, often involving the past, trauma, or mental health diagnoses.

• Coaching clients should seek a licensed therapist for any mental health issues or crises.

4. Scope of Services

I will not:

• Provide in-depth clinical assessments, diagnoses, or treatment plans.

• Submit documentation for insurance reimbursement.

• Manage mental health crises.

If mental health concerns arise, I may refer you to a licensed mental health professional, I cannot take you on as a therapy client if I have provided coaching services to you.

5. Confidentiality

Coaching is not bound by HIPAA, but I am committed to maintaining your privacy. However, please understand that coaching services are not legally protected in the same way that therapy is.
Exceptions to confidentiality include:

• Imminent risk of harm to self or others

• Suspicion of abuse or neglect

• Legal requirements (e.g., subpoena)

6. Professional Boundaries

I operate under the ethical standards of my coaching practice, not my clinical license. I do not represent that coaching is provided under the jurisdiction of my LCSW license. No part of this relationship should be construed as a clinical or therapeutic service.

7. Fees and Policies

Payment is to be rendered on date of service for the price agreed upon at consultation.