Genesis Christian Mediation: Couple’s Relationship Skill BuildingThank you for taking the steps to mend and heal your relationship. Name * First Name Last Name Email * Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country MEDIATION FIRST STEPS You will need to enter "none" or "n/a," if you have no response for a section. I'm Ready! List one or two goals during this process of mediation * Do you have any concerns or fears? * Are there any mental health or trauma/abuse concerns we should be aware of? * Do you have other information or thoughts which you did not share in the consult which you would like us to know or be aware of? * Please watch this YouTube video. Keep in mind there is no sound and there is a lot of information presented. You will be asked to respond to the content. View the video here. Done! What in the video caught your attention? * What is the most difficult area of listening for you? * THE FIVE LEVELS OF LISTENING WITH OSCAR TRIMBOLI Read the following document, or listen to the podcast which you just watched summarized in 2 minutes. Please read/listen and then respond to these questions. We often listen differently with our eyes as opposed to our ears: I'm Ready! Read the transcript of Episode 52: The Five Levels of Listening Or Listen to the podcast. Oscar makes much of listening to yourself. How did this idea impact you? * View the podcast here. What stood out to you the most from what you read/listened to here? How does this impact you differently from watching it in the brief video? * What resulted in a recent situation for you, when basic listening was ignored in favor of a quick response or a reaction? * What is your takeaway from this podcast about listening? * CONFLICT STYLES ASSESSMENT In this section you will be asked to explore and record where you land in a conflict style. I'm Ready As you take the assessment, avoid using #3 in your responses more than twice. Type your Dominant Style (lowest score or tied lowest scores) and include the name(s) of the style and score View the assessment here. My Backup Style -- include name(s) and score (next lowest score) * My Least Used Style -- include name and score for highest score * PERSONALITY TYPE The Enneagram is one of many personality inventories. It approaches personality from the place of weakness, viewing the dominant personality is an act of self protection. We invite you to take the inventory following the link and then record your dominate type below. I'm Ready Follow this link and enter the "number" which is most dominate for you. * View the assessment here. As you read about where you landed "type wise" do you connect with this or not? How does it feel to you to be in this personality type? * THE FOUR HORSEMEN I'm Ready! Watch this video and answer the following questions. Which of the four areas do you struggle with the most? * View the video here. How have you seen one of these impact your relationship? * When watching this video, did it bring up any specific moment or situation for you? What was it? * THERAPY AND SUPPORT HISTORY I'm Ready I am currently seeing a counselor or therapist * Yes No I am currently seeing a counselor or therapist * Yes No Name of Individual Therapist We are currently seeing a marriage counselor/therapist? * Yes No We have previously seen a marriage counselor/therapist? * Yes No Name of marriage counselor/therapist How did you hear about Genesis Christian Mediation? * Personal Referral Internet Search Counselor Church/Pastor Other Organization Other Source Please share the name of the counselor, church/pastor, personal referral, or other referral source. Thank you!