HYPNOTHERAPY & COACHING DISCLOSURE FORM

Hypnotherapy and mind-body coaching can help clients calm their nervous system, achieve freedom from restrictive thoughts, beliefs, rumination, intrusive thoughts, and unwanted behavior patterns, as well as improve or obtain complete resolution of conditions that are neuroplastic in nature such as chronic pain, anxiety, and other chronic health conditions. This work can also help cultivate inner resources for problem solving, achieving goals, restoring the authentic self, and fulfilling potential. The therapeutic use of hypnotherapy and mind-body coaching can elicit information and insights from the deeper mind, and utilize the power of one’s inner creative resources. The practitioner utilizes information gathering, discussion, and methods dealing with underlying issues whenever appropriate, with the goal of achieving effective and lasting results.

Hypnotherapy involves a relaxed mental state, similar to meditation, daydreaming, or being absorbed in a book or movie. Many people experience a deep sense of calm, mental clarity, relaxation, and an enhanced ability to vividly imagine or visualize scenarios. In this state, we have access to a part of our mind that is open to ideas and solutions. The client's attention is focused inward, while they remain aware of what is going on in the world around them.

Coaching involves partnership between the practitioner and the client in a thought-provoking and creative process that inspires the client to fulfill their potential, gain self-understanding and insight, live authentically, examine and potentially re-write life scripts, improve relationships and communication skills, practice self-care, and set healthy boundaries. It is designed to facilitate the creation/development of personal, professional, relationship, or life goals and to develop and carry out a strategy/plan for achieving those goals. Mind-body coaching integrates somatic tools such as Somatic Tracking and other methods that engage both the mind and the body, the conscious and subconscious mind. 

Client is solely responsible for creating and implementing their own physical, mental, and emotional well-being, decisions, choices, actions, and results arising out of or resulting from the hypnotherapist/coach and client relationship. Services to be provided do not include the practice of medicine or psychotherapy. Hypnosis and coaching are non-diagnostic, and are not a substitute for medical treatment, but a complimentary modality that engages the mind, body, and spirit for optimal healing, performance, and well-being.

Mimi Pettibone is a certified hypnotherapist and coach and has acquired the following education, training, experience, and qualifications to perform the services offered to her clients:

  • Registered Hypnotherapist, credential # 60158793
  • Certified Clinical and Transpersonal Hypnotherapist & Advanced Guided Imagery practitioner (400+ hours of training)
  • Pain Reprocessing Therapy (PRT) Certification
  • Narcissistic Abuse Treatment Coach via Dr. Ramani Durvasula
  • Certified Transactional Analysis Practitioner (270 hours training) by the United States of America Transactional Analysis Association (USATAA, currently NATAA). T.A. is a social psychology of relationships, interpersonal communication, intrapsychic communication, games, and life scripts.
  • Attachment, Trauma, & Spirituality (1-year training) with Dr. Diane Poole Heller
  • Certified: NLP Practitioner (Neuro-Linguistic Programming), Sleep Coach, Master Level Dream Worker, and Meditation Facilitator
  • Advanced Voice Dialogue Facilitator, Gestalt Practitioner, Focusing Facilitator, Shadow Work, and programs taught by Dr. John Gottman (relationships) and Dr. Bessel van der Kolk (trauma)
  • HIPPA Compliance Training
  • Certified Telehealth Practitioner

Mimi Pettibone is a certified telehealth practitioner. If you wish to record your session and the meeting is via video, it is recommended to use a separate device to record audio as video conferencing platforms may not be HIPPA compliant due to how they store recordings.

I have received a copy of this disclosure and understand the information described above. I have also read of the hypnotherapist/coach’s education, training, experience, and other qualifications regarding the services to be provided.