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Couples Relational Work
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Couples Relational Work
About
Programs
Contact

Couples Consultation Application

Both partners must complete this application individually before the consultation is confirmed. This consultation is designed for couples in Brisbane who are prepared to make one final structured, adult attempt before deciding the future of their relationship. Please answer honestly.

Name

Email

Readiness

1. Are you both willing to attend the consultation together?

Yes No

2. On a scale of 1–10, how committed are you to making one deliberate attempt before deciding to separate?

3. Are you willing to examine your own contribution to the current dynamic — not just your partner’s?

Yes No

4. Are you prepared to take responsibility for your behavioural patterns during conflict?

Yes No

Current Relationship Pattern

5. Briefly describe the recurring conflict cycle you find yourselves in.

6. Have you previously engaged in couples counselling or marriage counselling?

No Yes

6.a. What was helpful?

6.b. What was not?

7. Are either of you currently considering separation?

Yes No Unsure

Automatic Responses

8. When conflict escalates, I typically:

Become critical or confrontational Withdraw or shut down Attempt to control or fix Avoid the conversation Other (briefly describe)

9. What did you learn about handling conflict in your family growing up?

10. In moments of stress, do you feel your reactions are automatic rather than intentional?

Often Sometimes Rarely

Scope & Suitability

11. I understand this is structured relational coaching and adult development work — not clinical therapy or crisis intervention.

Yes No

12. Are there any current legal matters or safety concerns that may impact this work?

No Yes (briefly explain)

13. I am willing to engage respectfully during the consultation.

Yes No

Privacy & Confidentiality Acknowledgment

All information provided in this application and during the consultation process is treated as private and confidential and managed with professional discretion.

I understand and acknowledge this.

Final Reflection

Why does this relationship deserve one final structured attempt?

The Mental Switch provides coaching and performance-based development services. It does not offer clinical therapy, psychological treatment, medical advice, or crisis services. All information shared is treated as private and confidential and managed with professional discretion. If you require mental health or medical support, please consult a registered healthcare professional.

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