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: a Coach working towards licencure as Marriage and Family Therapist I have meet the graduations requirements from an accredited university to apply to be a therapist, my application is processing. 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 – 15 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. Masters Degree in Clinical Psychology Specializing in Spiritual and Depth Psychology 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.