Genesis Christian Mediation: Family MediationThank you for taking the steps to mend and heal your family's relationships. Name * First Name Last Name Email * Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Mailing address (if different from above) 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? * What are some of your questions about the mediation process? * How did you contribute to this conflict or difficulty you are experiencing in your family? * What are the emotions and perceptions you are bringing into mediation? Please help us understand. * Please list the family members directly involved with the conflict. * Please list others, though not involved directly, who might be affected by the conflict. * 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 Have you tried mediation before? * Yes No I am currently seeing a counselor or therapist * Yes No Do you seek spiritual or cultural guidance of any kind from a group or organization? * Yes No Please list the group, church or organization. Have you retained or consulted an attorney? * Yes No Please provide the name and contact information for the attorney you've consulted: 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!
