Informed Consent for Services-Rebecca Wood

= Pursuant to SB 577 California State Senate Bill and Section 2053.5 and under Section 2051, 2052, or 2053 I______Rebecca Wood___________ declare prior to providing any complimentary services the following: In plain language: ❖ Services are NOT provided by a practicing and licensed physician. ❖ The treatment is alternative or complementary to healing arts services licensed by the state. ❖ The services to be provided are not licensed by the state. The nature of the services to be provided: Community Referrals as Appropriate for Mental Health Services: As a Trainee Marriage and Family Therapist with nearly half of the graduations requirements meet, I am trained well enough to match clients with licensed professional referrals in a complied and/ or researched list of available resources in their community. Spiritual Advisor: Dream and vision collaborative reflection based on a method taught by my indigenous elders growing up and supplemented by my study in spiritual and depth psychology at Antioch University. Business Advising: Specializing in spiritual-service/health/wellness sectors I graduated with a B.A. in Business Management and Administration with a specialization in Entrepreneurship with a 3.9 GPA and owner operation of multiple start-up projects. Expressive Art: Support in the facilitation of creative expressive art aimed at relaxation and authenticity. Mindfulness: Guided mediation seems to help create and cultivate a sense of wellbeing. Recordings or scripts may be utilized during the experience. Eco-Art Experiences: Adapted from Eco-Art Therapy principles of nature-based art creation in which creatively nature is used as the subject; the setting, the material, or a combination of the three. The Goal of my application of this approach in this context is to support a sense of love, peace, and belonging cultivated internally and externally throughout the art-making process. The Theory of Treatment Upon Which the Services are Based Symbolism and Serendipity From the Soul: Carl Jung studied culture and religions throughout time and the world. He popularized the reality that symbolism and serenity are powerful tools for understanding the Soul. Art creation is healing- The simple act of creating art from a non-judgmental stance has healing effects documented by medical research such as stimulating the parasympathetic nervous system Mindfulness has health benefits-benefits of mindfulness incorporating with art or natural process has documented positive effects on overall well-being such as increased focus, better mood, and more. Nature is a part of us- Nature is a source of suffering and healing-creating space for the expression of this reality can validate unacknowledged strengths and pains related to connection to the natural and constructed world around us Peer mentoring: A Peer Mentor is someone with lived experience either through their own Mental Health and Life Experiences or supporting someone very close to them such as a family member through life-disrupting symptoms. Adding to the Peer mentor model is the idea of the Wounded Healer. I practice a positive perspective and which we all hold inside us a Healer waiting to be born. Qualifications Relating to the Services Artist/Artist in Residence Experience – 13 years of professional creative experience that includes various artists in residence positions in wellness settings. Experience creating or instructing using the following mediums: painting, pencil, pen and ink, leatherwork, indigenous crafts, fiber and textiles, seed beading, natural artifacts, and more. Spiritual and Depth Psychology Major-Antioch University- 40 units of graduate clinical psychology coursework including- Eco-psychology, Artistic Spiritual Depth Psychology, Life as Practice: Spiritual Development in Daily Living, Professional Laws and Ethics, Perspectives of Trauma, Treatment Methods, psychopathology, Grant writing, and more. Mentored by Various Spiritual Elders From the age of about 10, I was around sweat lodges lead by sun and bear dancers in an intertribal ceremonial community. Here I learned about the indigenous perspective of spirituality and healing. Many elders took the time to teach me and I am eternally grateful and willing to pay forward teachings in appropriate contexts. I also spent time with a Krishna Monk who passed mantras to me that I cherish and this moment was part of the beginning of my love-centered mediation practice.

The aboved named person acknowledges that Pursuant to SB 577 California State Senate Bill and Section 2053.5 and under Section 2051, 2052, or 2053 I______Rebecca Wood___________ declare prior to providing any complimentary services the following: In plain language: ❖ Services are NOT provided by a practicing and licensed physician. ❖ The treatment is alternative or complementary to healing arts services licensed by the state. ❖ The services to be provided are not licensed by the state. The nature of the services to be provided: Community Referrals as Appropriate for Mental Health Services: As a Trainee Marriage and Family Therapist with nearly half of the graduations requirements meet, I am trained well enough to match clients with licensed professional referrals in a complied and/ or researched list of available resources in their community. Spiritual Advisor: Dream and vision collaborative reflection based on a method taught by my indigenous elders growing up and supplemented by my study in spiritual and depth psychology at Antioch University. Business Advising: Specializing in spiritual-service/health/wellness sectors I graduated with a B.A. in Business Management and Administration with a specialization in Entrepreneurship with a 3.9 GPA and owner operation of multiple start-up projects. Expressive Art: Support in the facilitation of creative expressive art aimed at relaxation and authenticity. Mindfulness: Guided mediation seems to help create and cultivate a sense of wellbeing. Recordings or scripts may be utilized during the experience. Eco-Art Experiences: Adapted from Eco-Art Therapy principles of nature-based art creation in which creatively nature is used as the subject; the setting, the material, or a combination of the three. The Goal of my application of this approach in this context is to support a sense of love, peace, and belonging cultivated internally and externally throughout the art-making process. The Theory of Treatment Upon Which the Services are Based Symbolism and Serendipity From the Soul: Carl Jung studied culture and religions throughout time and the world. He popularized the reality that symbolism and serenity are powerful tools for understanding the Soul. Art creation is healing- The simple act of creating art from a non-judgmental stance has healing effects documented by medical research such as stimulating the parasympathetic nervous system Mindfulness has health benefits-benefits of mindfulness incorporating with art or natural process has documented positive effects on overall well-being such as increased focus, better mood, and more. Nature is a part of us- Nature is a source of suffering and healing-creating space for the expression of this reality can validate unacknowledged strengths and pains related to connection to the natural and constructed world around us Peer mentoring: A Peer Mentor is someone with lived experience either through their own Mental Health and Life Experiences or supporting someone very close to them such as a family member through life-disrupting symptoms. Adding to the Peer mentor model is the idea of the Wounded Healer. I practice a positive perspective and which we all hold inside us a Healer waiting to be born. Qualifications Relating to the Services Artist/Artist in Residence Experience - 13 years of professional creative experience that includes various artists in residence positions in wellness settings. Experience creating or instructing using the following mediums: painting, pencil, pen and ink, leatherwork, indigenous crafts, fiber and textiles, seed beading, natural artifacts, and more. Spiritual and Depth Psychology Major-Antioch University- 40 units of graduate clinical psychology coursework including- Eco-psychology, Artistic Spiritual Depth Psychology, Life as Practice: Spiritual Development in Daily Living, Professional Laws and Ethics, Perspectives of Trauma, Treatment Methods, psychopathology, Grant writing, and more. Mentored by Various Spiritual Elders From the age of about 10, I was around sweat lodges lead by sun and bear dancers in an intertribal ceremonial community. Here I learned about the indigenous perspective of spirituality and healing. Many elders took the time to teach me and I am eternally grateful and willing to pay forward teachings in appropriate contexts. I also spent time with a Krishna Monk who passed mantras to me that I cherish and this moment was part of the beginning of my love-centered mediation practice.