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Healing Separation

This page is ​your homework assignment to carve out a path for how to treat the wounds of your relationship. It is a time where some degree of space is needed to reflect and do personal work while you are in therapy.  The information can be tailored to how both you and your partner will establish a neutral zone to work towards mutual respect, honesty and healthy communication.  

Our Healing Agreement

Conflict and fractures in a relationship can often be a very challenging experience, which may result in increased stress and anxiety for both partners. Some structure and awareness can help improve the chances of success. This healing agreement attempts to provide structure and guidelines to help make this time a more constructive experience, and to greatly enhance the growth of the relationship rather than contributing to its demise. 

For the sake of clarity throughout this Agreement Form, the following distinctions will be made:

A. Commitment

With the awareness that our relationship is at a point of crisis, we choose to try working on healing boundaries to obtain a better individual perspective of the future of our relationship. In choosing, it is acknowledged there are aspects in our relationship that are destructive to us as a couple and as individuals. Likewise, we acknowledge there are positive and constructive elements in our relationship which could be called assets and upon which we may be able to build a new and different relationship. With this in mind, we are committed to do the personal, social, psychological, and spiritual work necessary to make this a healing time. We agree that at some future time, when we have experienced the personal growth, self- exploration, and differentiation possible, we will make a more enlightened decision about the future of our love relationship. 

 

B. Goals 
Each of us agrees to the following goals:

  • To provide time and emotional space outside of the relationship in order to enhance my personal, social, spiritual, and emotional growth. 

  • To better identify needs, wants, and expectations of the relationship. 

  • To explore what basic relationship needs and to help determine if these needs can be met in this relationship. 

  • To individually consider the social, economic, and/or parental stresses 

  • To determine if I can work through my process and recognize the changes I need to make. 

  • To separate out my issues, which have probably become convoluted.

  • To provide an environment to help our relationship heal, transform, and evolve into a more loving and healthy relationship.                          

 

Specific Decisions

1. Length of time:
We agree we will begin on (month and day) _______________and end on (month and day) _______________. 

Most couples have a sense of how long they will need or want should be. It may vary from a few weeks to six months or longer. The length of time agreed upon may be re-negotiated at any time by the initiation of either partner.

2. Time to be Spent Together
We agree to _____spend time together _____ not spend time together. This time might be spent talking, parenting together, and/or sharing our individual personal growth processes. We agree to discuss and reach an agreement. What do I need specifically regarding the time we spend together as a family or as a couple?

3. Personal Growth Experiences:

Partner A agrees to participate in:
____ individual counseling
____ couple/marriage counseling
____ other personal growth experiences 
____ other: ______________________________ 

 

Partner B agrees to participate in: 

____  individual counseling 

____  couple/marriage counseling 

____  other personal growth experiences 

____  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 

___other: ______________________________ 

 

Partner B ___________agrees to: 

___develop a support system of important friends become more involved socially with others
___remain emotionally monogamous
___remain sexually monogamous

___other: ______________________________    

 

5. Living Arrangements:

Partner A agrees to: 

____ remain in the family home
____ move and find an alternative living arrangement
____ alternate living with partner so the children can remain in family home 

____ other: ______________________________ 

Partner B agrees to: 

____  remain in the family home 

____  move and find an alternative living arrangement 

____  alternate living with partner so the children can remain in family home 

____  other: ______________________________ 

 

6. Financial Decisions: 

Partner A ________________agrees to:
___maintain joint checking account jointly 

___maintain joint checking account 

___separately open new checking account
___pay auto expenses
___pay household living expenses
___pay child support of $_________ monthly pay home mortgage and utilities
___pay medical and dental bills
___other: ______________________________ 

 

Partner B ________________agrees to:
___maintain joint checking account jointly 

___maintain joint checking account 

___separately open new checking account
___pay auto expenses
___pay household living expenses
___pay child support of $_________ monthly pay home mortgage and utilities
___pay medical and dental bills
___other: ______________________________ 

7. We agree to:

____  joint custody 

____  solo or physical custody 

____  the following schedule for the children from this date through__________.

Describe the way parenting has been working or not working:

 

Describe what you need from the other:

 

Describe agreed upon boundaries regarding sex:

 

Describe agreed upon boundaries regarding finances:

 

___I agree to make weekly goals and spend time working on what I have heard from my partner in session.

 

___I agree to meet weekly with my therapist and identify my goals to my partner.

 

We agree to the following suggestions:

  • Both parents remain committed to maintaining a good quality relationship with each child involved. Each child should continue to feel loved by both parents. 

  • Parents should be open and honest with the children 

  • The parents will help the children see and understand that this is an adult problem and that the children are not responsible for the problems in the parent's love relationship. 

  • The parents will not express anger or negative feelings towards the other parent through the children. It is very destructive to children to become caught in the emotional crossfire of the parents. 

  • The parent will avoid forcing the children to take sides in the parental arguments concerning differing attitudes and viewpoints. 

  • The parent will not put the children in a position of spying and reporting on the behavior of the other parent. 

  • Both parents will remain committed to working with each other on parenting the children and to effectively co-parent with as much cooperation as possible.

 

We have read and discussed the above and agree to the above terms of the agreement. Each of us furthermore agrees to inform the other partner of any desire to modify or change any terms in the agreement, or to terminate the agreement. 

 

Additional mutual agreements include:

Partner #A _______________________________________ Date ________________________ 

Partner #B _______________________________________ Date ________________________ 

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