The Healing Separation: Agreement Form (Page 3 of 6) in pdf

Denver Psychotherapy and

Noeticus Counseling Center

Consultation Services, LLC

and Training Institute

Innovative Approaches to Counseling and Change ™

™

Resources for Personal and Professional Growth

A Healing Separation ideally should include some quality time together on a regular

basis. Some people will enjoy their new-found freedom and desire very little quality

time. On the other hand, when the person needing more emotional space separates,

he or she may want more time together. This may be confusing to the person who

didn't desire the Healing Separation. Partners who feel suffocated emotionally

desperately want out. But when they get out of what feels like a tight place, the need

for emotional space is decreased tremendously.

It is important that the time together be quality time and that it be spent creating a

new relationship. When the old pattern starts occurring in whatever forms that may

take, one solution is to end the quality time together and be apart. There are

arguments for and against a continued sexual involvement with each other. Ideally

sexual contact will enhance intimacy and make the separation less stressful and

hurtful. Sex can, however, result in more problems, such as creating confusion for the

potential person being left if the person leaving is just trying to “let me down easy.”

3. Personal Growth Experiences:

Partner A agrees to participate in:

____ individual counseling

____ couple/marriage counseling

____ other personal growth experiences (reading books, journaling, exercise

program, growth group)

____ other: ______________________________

Partner B agrees to participate in:

____ individual counseling

____ couple/marriage counseling

____ other personal growth experiences (reading books, journaling, exercise

program, growth group)

____ other: ______________________________

4. Relationships and Involvements Outside of the Relationship:

Partner A agrees to:

____ develop a support system of important friends

____ become more involved socially with others

____ remain emotionally monogamous

____ remain sexually monogamous

____ become involved in clubs, church singles groups, etc.

____ other: ______________________________

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The Healing Separation: Agreement Form Page 3