Intake Form for Somatic Work | breathtakingpath

Somatic Sex Education uses breath, movement, sound, and touch to offer new insight into your erotic capacity, to become more connected to your pleasure and your body, and to support healing from sexual wounding.

While sex therapy can be a great way to address certain issues, somatic sex education focuses on teaching you about your sexuality and your relationship to it through your own body. That’s powerful work, and it requires a strong container to be able to explore the learning edges where growth happens. There are many different elements that we use to create that container.

One of the most important elements of this modality is that I will never do anything that you don’t want to do. While I might offer suggestions, I will only provide touch that is actively invited. You can say no to anything, at any time, even if you had previously said yes to it. I welcome and invite your guidance to ensure that your experience is meeting your goals.

I am very mindful of confidentiality and privacy. I will never disclose any information about you, including the fact that we’re working together, without your written consent or a legal order. You are always welcome to share anything about your experiences with anyone you choose.

Please complete Part 2

Do you have a spiritual practice or a sense of the sacred that is part of your life? What is the role of sexuality within this, if any?

On a scale of 0-10, how well do you accept your body as it is? (0 = No acceptance 5 = Moderately accepting 10 = I love and accept my body exactly as it is). Add any other details about your body-image you would like to share.

What else would you like me to know about your current desire patterns, including gender identity, sexual orientation, self pleasuring practices, fantasies, use of porn, or any other information that you feel may be important for me to know.

Please share any previous experience with sex therapy/or sexual bodywork.

Please share any experiences you have had with sexual assault or trauma that you feel might affect our work together. Please make note if you would like to have this conversation over the phone or in person.

How would you like to feel at the end of our work together?

What questions do you have for me? What would you like to know about somatic sex coaching, my experience and background, or anything else that might affect our work together.

I understand that any touch will be given only at my request and solely for my own benefit, education and pleasure.

I agree to guide touch to ensure that it is always beneficial, educational and pleasurable for me.

I understand that I am responsible for communicating verbally if I change my mind about something I have previously given consent for.

I understand that sessions involve one way touch, which means I will not be touching or trying to touch the facilitator.

Professional conduct is expected at all times within the container of the client-practitioner relationship. I understand that these sessions are about me, my own internal experience, and intended to deepen my relationship with myself.

I understand that somatic sex coaching can inspire many different feelings and thoughts, all of which are welcome during a session. I know that Darya is not a therapist.

I agree to be an active participant in my process.

I understand that payment is due at the session.

I am over 18

Thanks for submitting!

BREATHTAKING PATH

QUESTIONNAIRE FOR SOMATIC SEX EDUCATION SESSION

• Breathtaking Path • 2022