FACTS ABOUT BIBLICAL COUNSELING
THE CONCEPT OF BIBLICAL COUNSELING: Biblical counseling is committed to the position that
Scripture provides the only authoritative guide for what we are to believe and how we are to live (2 Timothy 3:16-17). The Biblical Counselor is trained in the use of Scripture and the principles of biblical counseling. He or she does not base his or her counsel on man’s wisdom, opinions, experience, or concepts of behavior, (Isaiah 55:8-11) but seeks to bring the full range of Biblical truth to focus on the counselee's need (Hebrews 4:12). At Reigning Grace Counseling Center (hereafter known as RGCC) we emphasize the importance of change at the heart level.
THE SCOPE OF BIBLICAL COUNSELING: Biblical counseling deals with the entire range of problems
confronting mankind including: broken marriages, parent child relationships, fear, depression, alcohol and drug abuse, tension, anxiety, worry and any other problems that may result in mental and/or physical immobility. In short the Biblical Counselor is equipped to deal with any problem dealing with ourselves, our relationship to God or our fellow man (2 Peter 1:3).
MEDICAL NEEDS: Biblical counselors believe in the total health needs of the counselee. Your
counselor may recommend that you have a full or specified medical examination. If medical assistance is required, counseling will continue in conjunction with medical advice.
1) RGCC is a biblical counseling and teaching ministry. The purpose of RGCC is the equipping of the saints by the administration of the Word of God to their particular problem. RGCC is not staffed by licensed psychologists or psychiatrists, nor does it prescribe medications. RGCC should be considered a faith-based healing and teaching ministry rather than anything associated with the medical professions.
2) As a person using the services of RGCC you must understand that if taking prescription anti-depressants or psychotropic medications you are to remain on them unless you consult with your prescribing doctor and he or she is in agreement that you terminate them.
3) If you have persistent thoughts of suicide RGCC urges you to seek medical help and if you talk of suicide during a session you will be referred to the proper authorities.
LENGTH OF COUNSELING: The initial counseling session will last 60-90 minutes. Subsequent sessions
will be one hour per week and will continue for six to twelve sessions. If you respond quickly to Biblical counsel the number of counseling sessions may be lessened. However, if the counselor does not observe definite change in the first few weeks, he or she will seek to identify the cause of the failure, discuss it with you in order to help you to correct it.
ELEMENTS OF BIBLICAL COUNSELING
Your counselor will use all of his/her skill in applying Biblical principles to enable you to glorify God in your life and to enable you to gain victory over the problems that are depriving you of the peace and joy that God has promised to you in His Word. Your counselor will concentrate in three areas that are necessary for Biblical change to take place.
Hope - In Jesus Christ we have a great High Priest who has suffered and been tempted in all
things, yet He never sinned. Because of Christ, even though you may be facing every sin common to man, you can have victory. God has promised that He will not let you be tempted beyond your endurance and that He will provide a way for you to have victory in the midst of your temptation (I Cor. 10:13; Heb. 4:14-16).Change
- In Christ we can learn how to lay aside the old selfish ways of living and put on the new ways of living in a manner worthy of the Lord Jesus Christ. We can learn to please God in every area of our lives. We can learn to live a godly life and to live in such a way that we will be increasing in our knowledge of God and our ability to relate to others. Biblicalcounseling will enable you to make practical changes. (Eph. 4:20-24; Col. 1:10).
Practice - We need to prove ourselves to be doers of God's Word and not merely hearers of
the Word. It is only in the actual practice of the Scriptures shall we be blessed in what we do, and only then will we please the Lord (James 1:22-25; Proverbs 28:13).APPOINTMENTS & WAITING PERIOD: Your appointments will be scheduled with your counselor by
calling 816-694-1677 or through the counseling center's email. RGCC does biblical counseling by appointment only. We have a limited number of appointments available and frequently there is a waiting list. It is important, therefore, that once you make an appointment you keep it. If you have to cancel please do so by the preceding Friday.
LOCAL CHURCH INVOLVEMENT: In order to achieve lasting victory over the problems of life, it is vital
that each person become established in a consistent Christian walk. The Lord has provided the local church as the discipleship center (Hebrews 10:24-25). Therefore, it is important that counseling sessions be accompanied by church attendance, participation in a group Bible study and other discipleship activities in your local church.
ACCOUNTABILITY PARTNER: It is our desire to return the care of hurting people to the church which
is why RGCC is invested in community outreach and why we are willing to disciple people from outside our own fellowship. Through our education classes we equip others in the body of Christ to disciple those in their own circle of influence.
Our ministry experience has shown it is beneficial and in some cases essential to involve a concerned friend or family member in the time that our counselees spend in an intensive discipleship or Biblical counseling relationship with us. Because of
our commitment to the local church as the long term care provider of each individual believer, as well as the multiple benefits we have seen listed below, we strongly recommend that each individual or couple coming to RGCC for help come with an accountability partner (or accountability partners for a couple).
The purpose of this is to expose others to the principles of biblical counseling and provide an extra resource of friendship to those in need.
Please inform your church’s leadership about your intent to seek biblical counsel. We would appreciate the opportunity to work with your leadership for your benefit and God’s glory.
MATERIALS NEEDED AND EXPECTATIONS: You will need a notebook and your Bible at all sessions, including the first session. The biblical counselor counsels from their theology, not
psychology, so we also recommend that you obtain a Study Bible to assist you in your studies of the Word. We have found any version of the MacArthur Study Bible to be of great assistance in helping our counselees understand key theological concepts. Be sure to bring the Bible with you each time. Come with high expectations. You will find hope and encouragement even during your first session. We are confident that the Word of God has solutions to all of life’s problems (2 Timothy 3:16,17; 2 Peter 1:3), and that includes an answer to the difficulty that prompted you to come.
CONTACT POLICY: Our desire is to help you in the process of biblical growth and change. We
understand that there are times you may have a question or situation that arises between your scheduled appointments. We welcome your questions in these cases. However, our counselors have been inundated with email and phone calls from people wanting our counselors to counsel via email and over the phone. It has become necessary to request that our counselees reserve phone calls and emails for emergency issues or short clarifications about your counseling. Thank you for your cooperation in this area!
CONSENT TO COUNSEL: We ask all individuals to read and sign our Consent to Counsel Form that is
found in the back of the information packet. This form must be returned before you begin your counseling sessions. This form enables the counselee to affirm that he or she understands that all of our counseling is entirely based on the Word of God.
I have read the above Facts on Biblical Counseling and I acknowledge my understanding of those facts as explained in this document. I also understand that the counseling I receive at Reigning Grace Counseling Center (RGCC) will be based on the counselor’s understanding of the Bible.
Personal Data Inventory
General Information
Name:________________________________________ Today’s Date:_______________
Please list any other names you have used previously:
Birth Date: ________________ Age:___________
Full Address:___________________________________________________________________ Primary Phone: ______________________
Education (highest level completed): ________________________________________________
Degrees/Certificates: ________________________ Other Training:_______________________ Employer (current or last): ____________________________ Position: ____________________ # Years Employed Here: ______ Employer’s Location: _____________________________________ Past occupations (positions & employers):
Does your present work satisfy you? If not, please explain:
Emergency Contact __________________________________ Relationship:________________ Address: _________________________________________ Phone: ____________________ Referred here by: _______________________________________________________
Marital Status (check all that apply):
Marriage Information
Name of spouse: ______________________________ Age: ______ Religion:_______________ Education: ________________________ Employer/occupation:__________________________ Wedding date & state: _________________ Age when married: You _____ Your spouse ______ Length of dating/engagement relationship: _______________ Length of marriage: ___________ Have you ever been separated? Date & Length: ______________________
Has either of you ever filed for divorce? Date: _____________ Is your spouse willing to come in for counseling if asked?
Briefly describe any previous marriages for you and your spouse(s):
Your Total # Marriages: _______ Spouse’s Total # Marriages:______
Health Information:
Current health issues: ____________________________________________________________ Primary Physician (name & facility):________________________________________________ Date of last medical examination: ____________________
Results:
Hospitalizations or surgeries: Type and date of surgery/reason for hospitalization:
Do you now, or have you ever had, seizures or convulsions? If yes, when, and under what condition caused them?
List all current medications (prescription and over-the-counter). List name and purpose of each.
Have you had any of the following physical problems? Please check:
Heart Problems __________ Bulimia __________ Menstrual irregularities __________ Liver problems __________ Anorexia __________ Kidney problems __________ Visual problems __________ Hallucinations __________ Head injury/concussion __________ Sensory distortion __________ Change in sex drive __________ Stroke __________
Weakness __________ Seizures __________ Fatigue __________
Problems walking __________ Brain Tumor __________ Heat/cold sensitivity __________ Unusual hair loss __________ Multiple Sclerosis __________ Rashes __________
Parkinson’s disease__________ Bowel/bladder __________ Memory Problems __________ Blackouts __________ Nausea/vomiting __________ Episodic distortions __________ Amnesia __________ Weight Change __________ Tremors __________
Impotence __________ Personality change __________ Thyroid dysfunction __________ Physical change __________ Déjà vu __________ Diabetes __________
Constant hunger __________ Food cravings __________ Hypoglycemia __________ Headaches __________ Allergies __________ Pneumonia __________ Dizziness __________ Cancer __________ Stiff Neck __________ Speech Problems __________ High blood pressure __________ Incoordination __________
Lung problems __________ Fever __________ Changes in Consciousness __________ Daily caffeine consumption:______________________ Average Sleep/Night: _________ hours
Recent weight changes: Approximately ____ pounds in about ____ weeks
List previous surgeries (those which required anesthesia):
Women Only
Have you had any menstrual difficulties? ______________________________________ Do you experience tension, tendency to cry, or other symptoms to your cycle?
Please explain: ___________________________________________________________ Is your husband willing to come to counseling? ____________________________
Is he in favor of your coming? ______________ If no, explain:
(coffee, tea, caffeinated drinks, etc.)
Religious Background
What religion do you associate with: _______________________ Non-Religious Denomination/sect preference, if any:_________________________________________ Church presently attending (Name & Address);__________________________________
_____________________________ Phone number: _______________________ How often do you attend church? __________ Are you actively involved? ___________ Describe your current involvement: ___________________________________________
________________________________________________________________________
Are you a member? How long have you attended? ___________
Pastor’s name: _________________________________________________ Does your pastor know of your decision to seek biblical counseling?
Permission to consult with pastor?
Have you been/are you under Church Discipline?
If so, what church? ______________________________________________ Name of previous churches and reason for leaving:
________________________________________________________________________ ________________________________________________________________________
Father’s Religion: ____________________ Mother’s Religion: ____________________ Describe your own understanding of God:
________________________________________________________________________ ________________________________________________________________________
Level of confidence in God: _______% Do you pray to God? Never Occasionally Often Are you forgiven by God? Would you go to Heaven if you died? Yes No Not sure How frequently do you read the Bible? Never Occasionally Often
Do you have a relationship to Jesus Christ? If so, how did this relationship come about?
________________________________________________________________________ ________________________________________________________________________ Please explain any recent changes in your religious life: _________________________________ ________________________________________________________________________ God’s expectations of you currently: ________________________________________________ Greatest spiritual need at this point: _________________________________________________
Circle All That Apply
Have you participated in… Masonic Lodge │ Scientology │ Séances │Mysticism │ Satanism
Out-of-body Experiences or Trances │ Meditation │ Occult │ Cult Magic Mediums/Channelers │ Ouija Board │ Tarot Cards │ Spells or Curses
Divination │ Communication with Spirits │Witchcraft / Wicca │Sorcery
Family Information
Name of Father: _______________ Living? Y / N Mother: _______________ Living? Y / N Describe parents’ involvement in your life: ________________________________
Parents were (circle all that apply): Never Married Married Separated Divorced Remarried You age when parents separated: ______ Your age when parents divorced: ________ Were you raised by anyone other than your biological parents?
If so, please explain:
List your siblings from oldest to youngest, including yourself.Mark step-siblings with an asterisk (*)
Children
SC= your stepchild, no biological relation to youPersonality Information
Circle any of the following words which best describe you currently:
Have you ever experienced…
A severe emotional upset, nervous breakdown or life-changing crisis?
Hallucinations (not chemically-induced)?
Suicidal… thoughts? │ …plans? │ …attempts?
Homicidal… thoughts? │ …plans? │ …attempts?
Physical/mental/emotional abuse? Rape or inappropriate touch?
In the last year, have you suffered the loss of someone who was close to you? Explain:
First exposure to pornography (age): ____ Use of pornography: A Lot Medium A Little None
Have you used drugs for other than medical purposes? If so, what drugs? Is this current or past drug use?
How many alcoholic beverages do you consume, and how often? Other Pregnancies (that you fathered or carried)
# of miscarriages: ____ # of abortions: _____ I could have other children that I haven’t met…
(men only)
Relative(s) you are closest to:
Active Ambitious Self-Confident Persistent Nervous Hardworking Impatient Impulsive Moody Often-Blue Excitable Imaginative Calm Serious Shy Easy-Going Good-Natured Introvert Likeable Leader Quiet Hard-Boiled Submissive Self-Conscious Lonely Sensitive Outgoing other____________________
Have you ever had alcohol-related problems or struggled to control drinking?
Have you ever been told you are “alcoholic?” If yes, how long ago? ________ Have you ever struggled with non-chemical1 addiction(s)?
Explain:
Do you currently use any nicotine products (cigarettes, pipe, chew, nicotine gum/patches, etc.)? __________________________ Length of use: _____________ Have you ever used drugs, medication, or other chemicals for non-medical purposes?
Explain:
Have you or others noticed any changes in your personality (anger, mood swings, withdrawal) thinking and memory, or work habits?
Explain:
Have you ever had a severe emotional upset? Explain:
Have you had any close family/friends/co-workers commit suicide? If yes, list who, their relation to you, and when:
Have you ever felt people were watching you? Do people’s faces ever seem distorted?
Do you ever have difficulty distinguishing faces?
Do colors ever seem too bright? Too dull? Are you sometimes unable to judge distance?
Have you ever had hallucinations? Are you afraid of being in a car? Is your hearing exceptionally good? Do you have problems sleeping?
1 Such as gambling, sexual activity, overeating, overworking, shopping, romance, pornography, the Internet, sports or hobbies, cutting/self-mutilation, anorexia or bulimia, TV, codependency, etc.
Circle any words that indicate issues that you are experiencing:
Your strengths: Your weaknesses:
Other Professional Support
Are you currently working with any other counselor or therapist?
Have you ever participated in psychotherapy or counseling in the past?
Please list all (past & current) counselors, therapists, psychologists, and psychiatrists you have had. Include any times when you have been admitted to metal health facilities.
1. Name & Organization: __________________________ Location: __________________
Approximate Beginning & End Dates: ________________ to _________________ Initial reason for seeking help: _______________________________________________ Please list any diagnosis you received and any medication you were prescribed:
________________________________________________________________________ What was the outcome of the counseling/therapy? Was it helpful? If not, why not?
Anger Anxiety/Fear Bitterness Children Conflict
Communication Depression Finances Grief Guilt/Shame In-Laws Health Lifestyle Lying Self-Injury Memories Emotions
Marriage Sex/Lust Sleeping Addictions/Habits Eating Issues Fatigue Abuse/Violence Major Changes Moodiness Impotence
2. Name & Organization: __________________________ Location: __________________ Approximate Beginning & End Dates: ________________ to _________________ Initial reason for seeking help: _______________________________________________ Please list any diagnosis you received and any medication you were prescribed:
________________________________________________________________________ What was the outcome of the counseling/therapy? Was it helpful? If not, why not?
3. Name & Organization: __________________________ Location: __________________ Approximate Beginning & End Dates: ________________ to _________________ Initial reason for seeking help: _______________________________________________ Please list any diagnosis you received and any medication you were prescribed:
________________________________________________________________________ What was the outcome of the counseling/therapy? Was it helpful? If not, why not?
Legal Issues
Have you ever …been arrested? Y/N …been under a restraining order or ex parté? Y/N …had a warrant? Y/N State circumstances & dates: ____________________________________________________ Have you ever been imprisoned? Date & Length: _______________________ Are you on probation or parole? Length: _____________________________ Are you involved in any legal cases? Explain: _________________________
Briefly answer the following questions:
1. What brings you to counseling? Please write a quick summary of your main concerns.
…How long have you had these concerns?
2. What have you already done about these concerns? What have been the results?
3. Please describe any significant events occurring at that time.
4. What do you want us to do? What are your expectations and goals in coming here?
5. From whom do you normally receive advice for problems? (check all that apply)
6. Were you referred here by someone?
7. My involvement in counseling was placed on me as a requirement: If so, please explain:
8. What, if anything, do you fear?
Counseling Agreement
1) I hereby voluntarily consent to such biblical counseling/discipleship as is deemed necessary or helpful by Reigning Grace Counseling Center (hereafter known as RGCC).
2) I understand this counseling/discipleship is theologically based, and will address the spiritual reasons for alcohol and drug abuse in addition to education on use and abuse of alcohol and other substances, providing biblical solutions, counsel and mentoring to help me overcome substance abuse and other problematic behaviors. 3) I understand sobriety is expected as a part of this program and I agree to abstain from using alcohol and other
illicit (mood/mind altering) substances or using drugs of any kind not prescribed to me. Should I return to using drugs or alcohol in any quantity during my participation with RGCC I will promptly (on my next visit) discuss it will my counselor or RGCC staff.
4) Counseling hours will be determined by cooperation between the RGCC staff and the counselee.
5) The benefits of receiving counsel from RGCC may include, but are not limited to, understanding key alcohol and drug concerns such as drunk driving, rebellion toward legal systems and law enforcement, relapse prevention, improved prayer life and communication skills with others; better relationships; increased
understanding of biblical goals and values; and learning to conducting ones self in a manner that glorifies God. 6) I agree to actively participate in the counseling process, which may include, but is not limited to: individual
counseling and discipleship and small group meetings and instruction on alcohol and substance abuse related issues.
7) I understand the goal is to have a Christ-centered sobriety program that includes church attendance and support. This could be a Bible study, small group, or church fellowship on a weekly basis. While we suggest making Faith Community Church your place of fellowship and support during your participation with RGCC (for continuity of the message), your own Bible-believing church may be acceptable.
8) Family members or significant people in your life may be asked to participate in Family Round Table discussion if deemed appropriate and necessary by RGCC staff.
9) I understand that continuity is important in the counseling/discipleship process, therefore I agree to attend all scheduled appointments and small group meetings.
10) I understand that no promise or guarantee has been made to me by RGCC of sobriety either in whole or part. I understand RGCC will instruct me in heart change and mind renewal that hold the possibility of freeing me from the desires of the flesh that hold me captive to drugs and alcohol, and that my success will depend largely on my application of these principles to my life.
11) I understand that failure to complete the RGCC program may or may not result in my return to using drugs and alcohol, life problems, and/or negative circumstances.
12) I understand that alcohol or unauthorized drug use may result in my termination from the RGCC program. 13) I agree to provide 24 hour notice if I must cancel an appointment.
14) I understand that if my participation with RGCC is under court order or to satisfy legal authorities I will be required to submit to random, supervised drug screens at the discretion of my counselor, and the fee for the drug screens will be my responsibility.
15) I understand I may be referred for appropriate medical treatment if deemed necessary by my counselor or RGCC staff.
16) I understand that because RGCC counsels from a theological basis it is neither a State Mandated facility nor a “treatment facility” and does not accept insurance payments or State funds and does not operate under State or
Federal guidelines. I understand that I am responsible for the cost of drug screens should they be required or deemed necessary by my counselor or RGCC staff. I further understand fees and cost of materials are not refundable.
17) This agreement will be in force until such a time you complete counseling/discipleship, or terminate
counseling/discipleship either by mutual agreement with the RGCC staff, or through your own decision, or for 6 months, whichever comes first.
18) You may withdraw from this agreement in writing at any time with the understanding that to do so you are concluding your counseling/discipleship relationship with RGCC.
Dated ___________________________ Signed _____________________________________________________
(COUNSELEE SIGNATURE)
Dated ___________________________ Signed _____________________________________________________
CONSENT TO COUNSEL
Our Goal—Our goal in providing Christian counseling is to help you meet the challenges of life in a way that
will please and honor the Lord Jesus Christ and allow you to enjoy fully His love for you and His plans for your life.
Commitment to Biblical Counseling—
I myself am convinced, my brothers, that you yourselves are full of goodness, complete in knowledge and competent to instruct one another (Romans 15:14).
All Christians struggle with sin and the effect it has on our lives and our relationships. Whenever believers are unable to overcome sinful attitudes or behaviors through personal efforts, God calls them to seek assistance from other believers, and especially from church leaders, who have the responsibility of providing pastoral counseling and oversight (see Romans 15:14; Galatians 6:1-2; 2 Timothy 4:1-2; Hebrews 13:17; James 5:16). Therefore, this church encourages and enjoins its people to seek counsel from and confess sins to each other, and especially to our leaders.
We believe that the Bible provides thorough guidance and instruction for faith and life (2 Timothy 3:16-17). Therefore, our counseling is based on scriptural principles rather than those of secular psychology or psychiatry. Unless they specifically state otherwise, none of those who counsel in this church are trained or licensed as psychotherapists or mental health professionals, nor should they be expected to follow the methods of such specialists.
God calls our leaders to set an example for us “in speech, in life, in love, and in faith and purity” (1 Timothy 4:12). Therefore, we expect them to treat counselees with every respect and
courtesy, and to avoid even the appearance of impropriety or impurity during counseling (Ephesians 5:3). We also expect counselees to promptly report any conduct that fails to meet this standard. (We practice the principle of men counseling men or women counseling women and we take extra measures of accountability when we have to make exceptions. Please be aware of this as it could affect your appointment scheduling.)
To prevent our counselors from being placed in situations that might compromise their biblical and ethical commitments, we, the people seeking biblical counseling, agree that we will not try to compel them to testify in any legal proceeding or otherwise divulge any confidential information they receive through pastoral counseling or ministry (Proverbs 11:13, 25:9).
There are occasions when our counselors do not have sufficient time to meet with every person who asks for counseling. At such times we expect our counselor to refer them to another source of godly counsel.
Professional Advice—
In the process of Biblical counseling there are often times when there is a need for significant advice with regards to legal, medical, financial or other technical areas. In those cases you well be encouraged to seek independent professional counsel. Our pastoral and lay counselors will be happy to cooperate with such advisors and help you to consider their counsel in the light of relevant scriptural principles.Commitment to Limited Confidentiality—
A gossip betrays a confidence, but a trustworthy man keeps a secret (Proverbs 11:13).
The Bible teaches that Christians should carefully guard any personal and private information that others reveal to them. Protecting confidences is a sign of Christian love and respect (Matthew 7:12). It also discourages harmful gossip (Proverbs 26:20), invites confession (Proverbs 11:13), and thus encourages people to seek needed counseling. Since these goals are essential to the ministry of the gospel and the work of the local church, our counselors will carefully protect all information that they receive through pastoral counseling, subject to the following guidelines.
DUTY TO WARN
Although confidentiality is to be respected as much as possible, there are times when it is appropriate to reveal certain information to others. In particular, when our leaders believe it is biblically necessary, they may disclose confidential information to appropriate people in the following circumstances:
when a leader is uncertain of how to counsel a person about a particular problem and needs to seek advice from other leaders in our church or, if the person attends another church, from the leaders of that church (Proverbs 11:14);
when the person who disclosed the information, or any other person, is in imminent danger of serious harm unless others intervene (Proverbs 24:11-12). This includes suicidal intent with a plan or homicidal intentions with a plan;
when a person refuses to repent of sin and it becomes necessary to promote repentance through accountability and redemptive church discipline (Matthew 18:15-20); or,
when leaders are required by law to report suspected abuse (Romans 13:1), including abuse of children and the elderly.
Team Counseling—RGCC
is a ministry devoted to teaching whereby we train others to counsel biblically (2 Timothy 2:2, Romans 15:14). We often utilize a team counseling concept that includes our advanced students or other counselors participating in sessions.By signing below I indicate that I have read the Consent to Counsel Form and the Facts on Biblical Counseling document. I acknowledge my understanding of the above statements and agree to biblical counseling as explained in these documents:
Dated ___________________________ Signed _____________________________________________________
(NOTE: Parent or Guardian must sign for a child)
Counselor: I have reviewed this information with the counselee.
Dated ___________________________ Signed______________________________________________________
