Collaborative Divorce Coach Consent for Service Form

Collaborative Divorce Coach Consent Form


This document contains important information about the professional services and business policies of Ben Stich, LICSW, M.Ed. By signing this agreement, you give permission for me to provide divorce coaching services for you. Please read this information carefully and note any questions so they can be discussed.


The goal of the collaborative team is to help the divorcing couple achieve a marital dissolution that minimizes the negative economic, social, and emotional consequences the family often experiences in the traditional adversarial divorce process. In order to accomplish this goal, licensed mental health professionals, attorneys and financial specialists work together as a team to help the couple address the emotional, legal and financial aspects of divorce.


Divorce coaches are licensed mental health professionals. Collaborative Law Coach facilitation is a focused, goal-oriented and systemic process. In individual and joint meetings, the coaches work with the couple to:

1.) Identify goals, clarify interests and positions
2.) Make effective use of conflict resolution and communication skills to help:

  • Reduce misunderstandings
  • Provide communication strategies
  • Reduce emotional intensity
  • Problem-solve
  • Overcome obstacles
  • Develop effective co-parenting skills when children are involved

The collaborative process is based on the belief that families can complete their divorce in an emotionally healthy way when the couple interacts and communicates with each other in a respectful, honest and open manner. Effective communication and self-management skills are taught to the couple by the coach. The couple uses these new skills in their settlement discussions, and in their post-divorce co-parenting, when children are involved.


Divorce coaching is an opportunity to define and implement a plan for how to craft your divorce negotiation and establish your post-divorce co-parenting relationship. Divorce coaching involves a joint effort between client and coach. Progress and success in the collaborative process may vary depending upon the particular issue being addressed, and can depend upon many factors, including your motivation, effort, and other circumstances, such as interactions with family, friends, or others.

You may experience uncomfortable or distressing feelings such as unhappiness, anger, guilt and frustration during this process. These can be a natural part of divorce. You will make important personal decisions in the collaborative process in which agreements are shaped by the parties and are unique to each family’s circumstances. This requires flexibility by both parties so that a fair and mutually equitable agreement can be achieved. While a successful outcome cannot be guaranteed, your commitment to the process is essential for a positive and collaborative outcome.

Please ask for clarification about any questions you might have about the services being provided at any time during the process. Your initial impression about the plan, suggested procedures and goals, and your feelings about whether you are comfortable with me are all important to the process and our client-coach relationship. If at any time while we are working together it appears that you would benefit from collateral work with other professionals such as a psychotherapist outside of the Collaborative team, I will discuss this with you and the Collaborative team, and if agreed upon provide you with the names of appropriate professionals. Likewise, if at any time you request a different Collaborative Law Coach I will provide a referral.


Both parties agree to sign confidentiality waivers with the Collaborative Law Coach to allow collaborative communication with all of the professionals on the Collaborative Law team. The purpose of having signed waivers is to enable full communication among the collaborative team members so as to facilitate the team approach. Email is often used by the team to schedule professional meetings or meetings with you. This exchange of information may occur in electronic form.

Should either party elect to withdraw from the Collaborative Law Process, all materials, including all content (written and oral) of all Collaborative team meetings and communication with or between any member of the Collaborative team will remain confidential and may not be used in any court proceedings.

The parties agree not to take Ben Stich, LICSW, M.Ed to court, not to subpoena Ben Stich, and not to depose Ben Stich.

While the role of coach is different from the role of social worker, I am a licensed independent clinical social worker. Except where confidentiality waivers have been signed, the confidentiality of communications between you and me is important and is protected by the laws and ethical standards for social workers, with some mandated exceptions. Disclosure is required when I have reason to believe that you are in danger of hurting yourself or someone else; in cases of suspected child or elder abuse and/or neglect; or pursuant to a legal proceeding. With these exceptions, information given in the collaborative divorce process will not be shared with anyone outside of the collaborative team without the client’s written permission.

A social worker has a legal and ethical responsibility to act to protect endangered individuals from harm when his or her professional judgment indicates that such a danger exists. If such a situation should arise, it is my policy to discuss these matters with a client before acting, unless, in my professional opinion, there is a good reason not to do so.

If I have a reasonable suspicion of child abuse or neglect of a dependent or elder adult (age 65 or older) I am required by law to file a report with the designated protective agencies.

In most legal proceedings, a client may assert the Provider-Client privilege to protect information about his or her consultation. However, certain court proceedings or other legal activity may limit a social worker’s ability to maintain confidentiality. If you are involved in a legal proceeding, please speak with your attorney about the limits of confidentiality.

While this summary of exceptions to client confidentiality should prove helpful in informing you about the potential breaches of confidentiality, you should be aware that the laws governing these issues are often complex, and I am not an attorney. I encourage our active discussion of these issues. However, if you would like more specific advice, formal legal consultation is advisable.


Technology: If online sessions occur we will use Zoom. Before your first scheduled session, you agree to download and install the software and/or apps from Zoom necessary for your participation at: To familiarize yourself with how to operate Zoom tutorials are available at I recommend using a computer if you have one available to you. You will need a secure WiFi or Ethernet connection for your computer. Despite best efforts there are times technology may fail to operate properly. If that happens, please take the following steps:

  1. Log out of Zoom and log back in
  2. Call Ben at 617-872-7721 for troubleshooting help

Privacy: Only the people engaged in the Collaborative process may join an online session. You agree to disclose immediately when someone else is in the room off-camera and take measures to ensure no one else can overhear the session. You will not allow your children to hear any portion of the session. If a child walks in the room you will immediately inform the group and turn your volume off until the child is out of earshot.

Prohibition on Recording: You, or anyone on your behalf, may NOT audio or video record any Collaborative Divorce session or portion thereof. In the event that you learn of an audio or video recording of any session, you will take immediate action to destroy the recording and inform the attorneys, spouse, financial neutral, and me. You will not disseminate the recording to third parties. You further agree that you will not transmit a live or deferred video or audio relay of the online mediation sessions to third parties.

Respectful Online Communication: You agree to always keep your video on during a session unless otherwise approved by the coach. If you need a break you will request it of the coach. Due to the nature of the online forum, it is especially important to allow each participant to finish their comments or statements before responding. The audio portion of the technology will only allow one person to talk at a time. In addition, the online format can amplify and exaggerate sound so maintaining a regular speaking voice is important. If I request use of the “mute” feature while someone else is speaking you agree to do so.

You agree to present yourself in the same business-like manner you would if you were in an office conference room. To that end, you will not participate in a session while driving, under the influence of alcohol or other substances, and ensure your background is neutral (ex. free from things that could upset the other party, such as a photo of a significant other).


My divorce coaching fees are $250 per hour (or, $125/hour/person if the fee is split). This fee is applied to the time I spend on your behalf, whether it is with you individually or together, in a meeting with you and the Collaborative Attorneys, or conferring with the attorneys, as appropriate. Examples of professional time for which you will be billed include telephone calls, meetings and travel time, preparation, and correspondence (including email). Payments may be made in cash, check (made out to Ben Stich) or by debit card.

Payment for services is expected prior to the time services are rendered. An initial prepayment deposit of $3,000 is required (or, $1,500/person). An additional $2,000 (or, $1,000/person) will be required whenever the prepayment deposit balance falls below $500. Unused funds will be returned at the termination of services.


One business day, or 24 business hours advance notice of cancellation is required if you cannot attend a scheduled meeting. When you make an appointment, that time is reserved for you. If you are unable to make an appointment, cancellation by phone is expected. You will be charged the full fee for appointments not cancelled with at least one business days-notice.


Although I check my voice mail often, I am not available for immediate emergencies, nor am I available 24-hours a day. If you require this kind of professional support, please let me know and I will refer you to other mental health professionals who offer this service.

If a situation should arise in which you believe that immediate help is needed and I am not available, I suggest that you call your primary care physician or any hospital emergency room. You can also call 911.


If either party decides that the collaborative process is no longer viable and elects to terminate the status of the case as a collaborative law matter, he/she agrees to, in writing, immediately inform the other party and attorneys. The divorce coach also reserves the right to withdraw from the case.

In the event of a termination, all incurred fees are immediately due and payable. Upon request, referrals will be offered to facilitate the client’s transition out of the collaborative divorce process.


While the collaborative process is not a guarantee of success and cannot eliminate past disharmony and irreconcilable differences, it offers a positive method toward a more healthy and cooperative solution to marital dissolution. For couples with children, it assists them towards a positive and healthy co-parenting relationship.

Collaborative Divorce Coach Consent Form

I read, I understand, and I agree to the terms of Mediation and Family Service's Collaborative Divorce Coach Consent Form.