Christ-Led Inner Healing & Theophostic Prayer Ministry Liability & Informed Consent

 

RELEASE OF LIABILITY FOR PRAYER MINISTRY SERVICES

FOR AND IN CONSIDERATION OF The International Christian Counselling Association & Immanuel Restoration Ministries, dba The ICCA/IRM Group of Charities and ICCA-IRM Group's Counselling director R.H. (Ray) Gaglardi; provision of ministerial and prayer services, the undersigned, being legally competent and fully authorized and empowered to do so, does hereby RELEASE, ACQUIT, AND FOREVER DISCHARGE The International Christian Counselling Association & Immanuel Restoration Ministries, dba The ICCA/IRM Group of Charities and ICCA-IRM Group's Counselling director R.H. (Ray) Gaglardi and all participating prayer ministers connected to said ministry, from any and all actions, courses of action, claims, demands, damages, costs, loss of service, expenses and compensation, on account of any and all known and unknown personal injuries, mental anguish or agitation, and damage claims to person or property resulting from or arising out of or related to ministerial services and/or prayer ministry provided by The International Christian Counselling Association & Immanuel Restoration Ministries, dba The ICCA/IRM Group of Charities and ICCA-IRM Group's Counselling director R.H. (Ray) Gaglardi and/or agents, representatives and/or employees in any way affecting the undersigned parties.

By law, there are certain situations in which information about individuals undergoing such ministry may be released with or without their permission. These situations are as follows:

  • Where children are currently being physically abused, neglected, or sexually abused, the proper authorities must be notified.
  • In emergency situations where there may be danger to the client or others as with homicide or suicide, confidentiality may be broken.

The undersigned parties fully understand that the ministerial services to be provided are Biblical in nature, and freely enter into such ministerial services with full knowledge of the nature of the services they are about to receive. The undersigned parties further state that they are accepting the preceding of their own free will and accord, and have not been unduly influenced or persuaded by anyone to participate in this prayer ministry. The undersigned parties state that they are seeking ministry from The International Christian Counselling Association & Immanuel Restoration Ministries, dba The ICCA/IRM Group of Charities and ICCA-IRM Group's Counselling director R.H. (Ray) Gaglardi of their own free will, and fully understand that all prayer ministry is advisory in nature and that decisions and actions taken by said undersigned parties based on anything said by The International Christian Counselling Association & Immanuel Restoration Ministries, dba The ICCA/IRM Group of Charities and ICCA-IRM Group's Counselling director R.H. (Ray) Gaglardi are ultimately their own decisions and actions, and that said undersigned parties take full responsibility for their decisions and actions.

The undersigned further AGREE to indemnify, have and hold harmless The International Christian Counselling Association & Immanuel Restoration Ministries, dba The ICCA/IRM Group of Charities and ICCA-IRM Group's Counselling director R.H. (Ray) Gaglardi, it's Board of Directors, it's agents, including any residences, any offices or any churches where prayer ministry may take place, and any employees from any and all claims and damages of every kind to person or property arising out of or attributed to the spiritual, psychological, and/or mental problems which brought the undersigned to The International Christian Counselling Association & Immanuel Restoration Ministries, dba The ICCA/IRM Group of Charities and ICCA-IRM Group's Counselling director R.H. (Ray) Gaglardi, or to the undersigned at any point after the date of this release.

IT IS FURTHER UNDERSTOOD AND AGREED that this waiver and release constitutes an admission and acknowledgment by this undersigned that they have received no warranty, guarantee, or promise of any particular result either expressed or implied, from The International Christian Counselling Association & Immanuel Restoration Ministries, dba The ICCA/IRM Group of Charities and ICCA-IRM Group's Counselling director R.H. (Ray) Gaglardi, it's agents, representatives, employees, or Board of Directors. The undersigned parties acknowledge and agree that the very nature of their problems (s) is necessarily such that no specific result (s) can be promised or warranted by any such ministry.

This release contains the entire agreement between the parties hereto, and the terms of this waiver and release are contractual and not mere recital. The undersigned further states they have carefully read the foregoing release, know the contents thereof, and sign the same of their own free act and deed.

Signed: _______________________________ Date: _________________
Signature of Client indicating informed consent and acceptance of above.

PLEASE PRINT CLEARLY
Name ________________________________________________________
Address _______________________________________________________
City ___________________________________________________________
Province/St ate__________________________________________________
Postal/Zip Code _________________________________________________
Phone _____________________________Cell _________________________
Email___________________________________________________________
Signature of Witness _______________________________________________
Printed Name & Address of Witness: __________________________________
________________________________________________________________

MINOR RELEASE (LEGAL PARENT(s) / LEGAL GUARDIAN(s) PLEASE SIGN)

Signed: __________________________________ Date: ___________________
Signature of Parent/Guardian indicating informed consent and acceptance of above.
Date _____________________________
Minor client, 12-17 years inclusive _____________________________________
Date _______________________________
Witness _______________________________________ DATE ______________

INFORMED CONSENT FOR PARTICIPATING IN THEOPHOSTIC PRAYER MINISTRY(a form of Inner Healing)

FOR THE PROPOSES OF THIS INFORMED CONSENT “CHRIST-LED INNER HEALING” SHALL BE CONSIDERED TO BE THE SAME AS, AND INTERCHANGEABLE WITH, “THEOPHOSTIC PRAYER MINISTRY”. Wherever you find reference to Theophostic or Theophostic Prayer Ministry or Theophostic process (TPM) it shall be taken also be interchangeable with Christ-Led Inner Healing (CLIH).

DIAGNOSIS/ASSESSMENT AND REASONS FOR USING THEOPHOSTIC PRAYER MINISTRY: It is important for you to understand that The International Christian Counselling Association & Immanuel Restoration Ministries, dba The ICCA/IRM Group of Charities and ICCA-IRM Group's Counselling director R.H. (Ray) Gaglardi (hereinafter known as Counsellor) diagnosis/assessment regarding your symptoms/problems, and for you to understand why, Counsellor may think Theophostic Ministry will be helpful. The best way for us to accomplish this is to discuss these two issues prior to your first session.

WHAT TO EXPECT: It is important for you to know the basic details of what to expect as you participate in Theophostic Prayer Ministry. The best way to do this is to read Genuine Recovery or Healing Life’s Deepest Hurts” which can be ordered from the Theophostic Web Site at: www.Theophostic.com and review the "Frequently Asked Question Section" also found on the site before your first Theophostic session, and then take time at or prior to your first session to ask any questions you have about the Theophostic process.

Click here for Theophostic Prayer Ministry Session Guidelines.

NOT YET RESEARCH-PROVEN AS EFFECTIVE: There is not yet significant empirical research proving that Theophostic ministry is effective (several research projects are in process, but we do not yet have statistically significant research results proving that Theophostic Prayer Ministry is effective). However, Theophostic Prayer Ministry does include many of the core principles of cognitive-behavioral therapy, forms of psychotherapy that are strongly supported by empirical research. Furthermore, Counsellor personal experience is that Theophostic Prayer Ministry is as effective, or even more effective, than each of these research supported forms of psychotherapy.

Click here to find additional information regarding research finding.

Click here TPM continually improves with the help of redemptive criticism 

DIFFERENCES IN INDIVIDUAL EXPERIENCE AND TIME FRAMES: It is important to realize that there is a wide range of experiences with Theophostic Prayer Ministry. Some receive healing very quickly, and are free of their presenting symptoms in one or two sessions. For others the process goes much more slowly. Sometimes, even when the process is working correctly, the presenting symptoms can still be present after many months of hard work. The time frames are also dependent on the number and severity of lie-based memories that are currently impacting your life.

NO GUARANTEE: It is also important to realize that there is no way to guarantee results with any form of psychotherapy or ministry, including Theophostic Prayer Ministry. Some people receive important healing with Theophostic Prayer Ministry, and others may not be able to use Theophostic Prayer Ministry effectively (for reasons we sometimes do not understand).

OPTIONS OTHER THAN THEOPHOSTIC PRAYER MINISTRY: Counsellor uses Theophostic Prayer Ministry in much of the work that Counsellor does because Counsellor believes it to be an effective and cost and time efficient tool. However, it is important that you realize there are other options. If you do not wish to participate in Theophostic Prayer Ministry, and would rather use other healing tools, such as cognitive therapy, behavioral therapy, relaxation techniques, psychiatric medications, or other forms of prayer for emotional healing, this is your choice. It is also important for you to be aware of the option to use psychiatric medication (s) and/or nutrient solutions in combination with Theophostic Prayer Ministry.

RISKS AND BENEFITS OF THEOPHOSTIC PRAYER MINISTRY AND OF OTHER OPTIONS: In any form of therapy and/or ministry that includes working with traumatic memories; there is a real risk that "things will feel worse before they feel better." You may experience intense negative emotions, and even painful physical sensations, as a part of going through traumatic memories. Theophostic Prayer Ministry may uncover unresolved issues, traumatic memories, and painful emotions that you have not anticipated. Sometimes the issues and/or memories brought forward during a session cannot be fully resolved by the end of the session. You may continue to process painful material between Theophostic sessions, and this processing between sessions may include uncovering additional painful material.
One often unanticipated "risk" is that you will change. If you receive significant healing, you will change, and this will affect many aspects of your life (for example, your satisfaction with your current career and how you relate to your family and friends). The biggest benefit – the biggest reason to use a treatment option that involves the risks of working with traumatic memories – is that these treatment options resolve the roots of the problem and thereby accomplish permanent healing. These risks and benefits pertain to any form of therapy or ministry that involves working with traumatic memories, including Theophostic Prayer Ministry, all other forms of prayer for emotional healing that I am aware of, as well as cognitive-behavioral therapy.

THEOPHOSTIC IS CONTROVERSIAL: Everyone contemplating Theophostic Prayer Ministry should understand that this form of ministry is controversial. See the following link for more details on critics and controversy . There are a number of reasons for the controversy including but not limited to: Repressed or Recovered Memory Therapy (RMT) is disputed by some mental health professional; certain theologians and apologetics dispute the necessity to deal with the past issues of a Christian’s life; certain theologians and apologetics go so far as to say Theophostic is false and perhaps even demonic; some apologetics say that this method is humanistic, it eliminates suffering from the Christian walk, is Freudian in nature, and on. Theophostic supporters and secular therapists are poles apart on mental health issues. Awareness of demonic possession, Satanic seduction, sensing or hearing the voice of Jesus, and/or seeing His image during therapy are all potential parts of Theophostic Prayer Ministry. The mental health movement abandoned the possibility of spirit possession many generations ago. Many therapies are controversial – it is up to each prospective participant to inform himself or herself of the potential benefits and the potential risks of any therapy before providing consent.

REGARDING COMPARATIVE RISKS AND BENEFITS: Counsellor personal assessment is that, for most people, Theophostic Prayer Ministry works more quickly and with less risk of symptom exacerbation than any other therapy or ministry that includes working with traumatic memories. Forms of treatment that focus primarily on symptom control, and that do not include working with old traumatic memories, include very little risk of temporarily increasing symptoms by "uncovering" painful memories and emotions. Relaxation techniques, some forms of cognitive therapy, and many psychiatric medications are examples of "symptom control" treatment options. Each psychiatric medication has its own risks and side effects, but the biggest risk of these symptom control treatment options is that they are temporary solutions and do not address the underlying issues. If they are not used in combination with a therapy or ministry that resolves the underlying roots, then various symptoms/problems will keep coming back, often at very inconvenient times and places. Another risk of "symptom control" treatment options is that they can make it more difficult to find and resolve the underlying roots of the symptoms.

Click here for more insight on seeking personal Theophostic Prayer Ministry

CONSENT TO PARTICIPATE IN THEOPHOSTIC PRAYER MINISTRY:
I have read the above and have discussed the diagnosis/assessment, and the reasons for using Theophostic Prayer Ministry with The International Christian Counselling Association & Immanuel Restoration Ministries, dba The ICCA/IRM Group of Charities and ICCA-IRM Group's Counselling director R.H. (Ray) Gaglardi. I have read about Theophostic ministry as recommended above, and/or discussed the basic details of Theophostic ministry with The International Christian Counselling Association & Immanuel Restoration Ministries, dba The ICCA/IRM Group of Charities and ICCA-IRM Group's Counselling director R.H. (Ray) Gaglardi, and I am comfortable with my understanding of what to expect as I participate in the Theophostic process. I understand that Theophostic Prayer Ministry has not yet been proven effective by empirical research. I understand that Theophostic Prayer Ministry can result in very rapid healing, but that it can also sometimes be a much slower process. I understand that I may receive important healing through Theophostic Prayer Ministry, but that there is no way to guarantee results. I understand that there are risks and the controversy with Theophostic Prayer Ministry, as described above. I understand that there are other treatment options, and that I can choose to not participate in Theophostic Prayer Ministry, now or at any time in the future. Being fully aware of these things, I agree to include Theophostic Prayer Ministry (a form of Christ-Led Inner Healing) in my care, and I request that Theophostic Prayer Ministry (a form of Christ-Led Inner Healing) be included in my care.

Signed:__________________________________ Date: _________________
Signature of Client indicating informed consent and acceptance of above.

PLEASE PRINT CLEARLY (printed client name and witness name and witness signature ONLY are required if the same as the above)
Name _________________________________________________________
Address _______________________________________________________
City __________________________________________________________
Province/State___________________________________________________
Postal/Zip Code _________________________________________________
Phone _____________________________Cell ________________________
Email__________________________________________________________
Signature of Witness ______________________________________________
Printed Name & Address of Witness: _________________________________
______________________________________________________________

MINOR RELEASE (LEGAL PARENT(s) / LEGAL GUARDIAN(s) PLEASE SIGN)

_______________________________________________________________
Signature of Parent/Guardian indicating informed consent and acceptance of above.
Date _____________________________
Minor client, 14-18 years inclusive ___________________________________

Witness ________________________________________________________
Date ________________________________