PDI (B) – Substance Abuse & Addiction | Reigning Grace Counseling Center

PDI (B) – Substance Abuse & Addiction

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General Contact Information

Name(Required)

First Last

Please list any names you have previously held.

Today's Date(Required)

MM slash DD slash YYYY

Birthdate(Required)

MM slash DD slash YYYY

Current Age(Required)

Gender(Required)

Phone(Required)

Email(Required)

Enter Email Confirm Email

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please select what time zone you are located in.

Name of Emergency Contact(Required)

Relationship to Emergency Contact

Emergency Contact Phone

Emergency Contact Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Referred Here By?(Required)

Education, Employment, & Religion

Highest Level of Education

Please list any other degrees, certificates, or trainings completed.

Employer (Current or Last)(Required)

What was your position at current or last employer?(Required)

Number of Years Employed Here(Required)

Past Occupations (Employers & Positions)(Required)

Does your present work satisfy you? If not, please explain.

What religion do you associate with?

Denomination/Sect preference, if any?

Church Presently Attending (N/A, if not applicable.)(Required)

How often do you attend church?

Are you a member?(Required)

Please describe your current involvement at this church.

How long have you attended?

Pastor's Name(Required)

Pastor's Phone(Required)

Reigning Grace will be reaching out to your pastor. We understand that there are rare situations in which contacting your pastor would not be helpful. If this is one of those situations, please explain the situation and why you would prefer we not reach out below. Please put N/A if this does not apply.(Required)

Does your pastor know of your decision to seek biblical counseling?

Have you been/are you under church discipline?

If yes to the above question, what church?

Names of previous churches and reasons for leaving.

Have you been baptized?

If you were baptized after infancy, what was your age?

Describe your own understanding of God.

What is your level of confidence in God?

Do you pray to God?

Never

Occasionally

Not Sure

Always

Other

Are you forgiven by God? Would you go to heaven if you died?

How frequently do you read the Bible?

Do you read your Bible with your spouse and children?

Do you have a relationship with Jesus Christ? If so, briefly explain how this came about.

What are God's expectations of you currently?

What is your greatest spiritual need at this point?

Have you participated in.. (Check all that apply).

Masonic Lodge

Scientology

Jehovah Witness

Mormonism

Out-of-Body Experiences/Trances

Meditation

Occult

Cult

Witchcraft/Wicca

Sorcery

Health & Lifestyle

My health is..(Required)

Very Good

Good

Average

Less Than Average

Poor

I consider myself…(Required)

Heterosexual

Bisexual

Homosexual

Unsure

Have you had gender re-assignment surgery?(Required)

Yes

I’m considering

Are you currently taking hormones or undergoing treatment to transition to another sex/gender?(Required)

Yes

I’m considering

If yes to either of the above questions, please explain. If no to both, please put N/A.(Required)

Please list any current health issues.

Name & Facility of Primary Physician

Please list all current medications. Include prescriptions, over the counter, diet pills, laxatives, birth control pills, cold & allergy medicine, supplements, and pain relievers. List name and purpose of each.

Have you had any of the following problems?

Heart Problems

Liver Problems

Visual Problems

Sensory Distortion

Weakness

Problems Walking

Unusual Hair Loss

Parkinsons Disease

Blackouts

Amnesia

Constant Hunger

Headaches

Dizziness

Speech Problems

Lung Problems

Bulimia

Anorexia

Hallucinations

Change in Sex Drive

Seizures

Brain Tumor

Multiple Sclerosis

Nausea/Vomiting

Weight Change

Personality Change

Food Cravings

Allergies

Cancer

High Blood Pressure

Head Injury/Concussion

Kidney Problems

Stroke

Fatigue

Memory Problems

Tremors

Thyroid Disfunction

Diabetes

Hypoglycemia

Incoordination

Other

If you selected yes to any of the above, please explain.

What is your daily caffeine consumption?

Average Hours of Sleep per Night.(Required)

Do you have problems sleeping?(Required)

Yes

Average Sleep Quality.(Required)

Good

Fair

Poor

Recent Weight Changes

Gained

Lost

If applicable, please explain your weight change.

Please list any previous surgeries (those which required anesthesia).(Required)

(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 in favor of you coming to counseling? If no, please explain.

Have you recently experienced a severe upset, nervous breakdown, or life-changing crisis?

Have you recently experienced a panic attack?

Did the crisis or panic attack require hospitalization?

Have you experienced hallucinations?

Yes

Do you experience the feeling that people are watching you?

Yes

Suicidal Thoughts? (Check all that apply.)(Required)

Yes, recent.

Yes, current.

Suicidal Plans? (Check all that apply.)(Required)

Yes, recent.

Yes, current.

No.

Suicidal Attempts? (Check all that apply.)(Required)

Yes, recent.

Yes, current.

No.

Have you had any close family/friend/coworker commit suicide? If yes, please explain the relation to you and when.

Homicidal Thoughts? (Check all that apply.)(Required)

Yes, recent.

Yes, current.

No.

Homicidal Plans? (Check all that apply.)(Required)

Yes, recent.

Yes, current.

No.

Homicidal Attempts? (Check all that apply.)(Required)

Yes, recent.

Yes, current.

No.

Have you ever experienced physical abuse?

Have you ever experienced mental abuse?

Have you ever experienced emotional abuse?

Have you ever experienced rape or inappropriate touch?

Have you ever been involved in the abuse of another person?

Have you ever been involved in the molestation of another person?

In the past year, have you experienced the loss of someone who was close to you? If yes, please explain.

What was your age at your first exposure to pornography?

Use of Pornography

Daily

Weekly

Monthly

Rarely

None

What is your total number of sexual partners?

Have you had concerns about your drinking or other substance abuse?

Yes, I do now.

Yes, I have in the past.

N/A

Have you had legal problems associated with your drinking or other substance abuse?

Yes, I do now.

Yes, I have in the past.

N/A

Has drinking or other substance abuse affected you financially?

Yes, it does currently.

Yes, it has in the past.

N/A

Have you ever been seen by a substance abuse counselor or other mental health professional?

Yes, I am presently.

Yes, I have in the past.

N/A

Has drinking or other substance abuse caused problems in your relationships?

Yes, it does now.

Yes, it has in the past.

N/A

Has your drinking or other substance abuse affected your work?

Yes, it does now.

Yes, it has in the past.

N/A

Have you experienced "fuzzy" recall or "blank periods" as a result of your drinking or other substance abuse?

Yes, I do presently

Yes, I have in the past.

N/A

Has your behaviors while drinking and/or using other substances resulted in you doing something embarrassing or stupid?

Yes, it has recently.

Yes, it has in the past.

N/A

Have you been in the hospital or institution on account of your drinking or other substance abuse?

Yes, I have recently.

Yes, I have in the past.

N/A

Have you been in the hospital or institution on account of your drinking or other substance abuse?

Yes, I have recently.

Yes, I have in the past.

N/A

Have you ever been arrested and held in jail, even if only for a couple of hours?

Yes, I have recently.

Yes, I have in the past.

N/A

Do you drink or use substance in the morning?

Yes, I have recently.

Yes, I have in the past.

N/A

Do you drink alone?

Yes, I have recently.

Yes, I have in the past.

N/A

Do you have arguments while drinking?

Yes, I have recently.

Yes, I have in the past.

N/A

Have you been in a physical fight while drinking or using other substances?

Yes, I have recently.

Yes, I have in the past.

N/A

Do you drink or use other substances to escape from worries or other troubles?

Yes, I have recently.

Yes, I have in the past.

N/A

Do you drink or use other substances to decrease tension?

Yes, I have recently.

Yes, I have in the past.

N/A

Do you drink or use other substances to reduce anxiety/fear or self-consciousness?

Yes, I have recently.

Yes, I have in the past.

N/A

Have you hidden alcohol or other substances?

Yes, I have recently.

Yes, I have in the past.

N/A

Do you want to quit drinking?

Yes.

No.

N/A

Do you want to quit other substance abuse?

Yes.

No.

N/A

Do you want to reduce your drinking?

Yes.

No.

N/A

Do you want to reduce your other substance abuse?

Yes.

No.

N/A

Have there been periods of time that you drank or used substances daily?

Yes, I have recently.

Yes, I have in the past.

N/A

Have you ever been diagnosed with.. (Check all that apply.)

Bipolar Disorder

Schizophrenia

Depression

Borderline Personality

Anxiety

Generalized Anxiety Disorder

Panic Attacks

Eating Disorder

Obsessive Compulsive Disorder (OCD)

Post-Traumatic Stress Disorder (PTSD)

Are you currently working with another counselor or therapist?

Please list all past & current counselors, therapists, psychologists, and psychiatrists you have had. Include any times you have been admitted to a mental health facility. (Include name, organization, location, beginning and end dates, initial reason for seeking help, and any diagnosis received along with medication prescribed.)

What was the outcome of the counseling/therapy? Was it helpful? If not, why?

Marriage & Family

Name of Father

First Last

Is your father living?

Father's Religion

Name of Mother

First Last

Is your mother living?

Mother's Religion

Describe your parent's involvement in your life.

Parents were.. (Check all that apply.)

Never Married

Married

Separated

Divorced

Remarried

Your age when parents separated.

Your age when parents divorced.

Were you raised by anyone other than your biological parents?

Please list your siblings from oldest to youngest, including yourself. Mark step-siblings with an asterick (*).

Marital Status (Check All That Apply)

Single

Dating

Engaged

Married

Separated

Divorced

Widowed

Remarried

Living Together & Unmarried

I consider myself..

Heterosexual

Bisexual

Homosexual

Unsure

Name of Spouse

First Last

Age of Spouse

Religion of Spouse

Highest Level of Education Completed by Spouse

Employer/Occupation of Spouse

Wedding Date & State

Age When Married (You/Spouse)

Length of Dating/Engagement

Length of Marriage

Have you ever been separated?

Yes

Date & Length of Separation

Have either of you filed for divorce?

Yes, I have.

No, neither have.

Yes, my spouse has.

Date Filed for Divorce

MM slash DD slash YYYY

Is your spouse currently filling out an application for counseling?

Your Total Number of Marriages

Please list your children. Include the following information: SC = stepchild/no biological relation to you, NM = biological child whose other parent you are not married to; Name, Age, Gender, Living (Y/N), Occupation, Marital Status.

Other pregnancies you fathered or carried (# of miscarriages, # of abortions).

(Men Only) I could have children that I haven't met..

Yes

Final Questions

Please choose any words that indicate your MAIN issues that bring you to counseling.(Required)

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

Deception

Spousal Abuse

Homosexuality

A Particular Vice

Please write a quick summary of your main concerns. Indicate how long you have had these concerns.(Required)

What have you already done about these concerns? What have been the results?(Required)

Please describe any significant events related to your concerns.(Required)

What, if anything, do you fear?(Required)

What would you like us to do? What are your expectations and goals in coming here?

From whom do you normally receive advice for problems? (Check all that apply.)

Friend

Pastor

Neighbor

Relative/Family

Counselor/Therapist

Other

Were you referred here by someone? (Name & Relationship)

Was your involvement in counseling placed on you as a requirement? If yes, please explain.

Is there any other information we should know?(Required)

Consent to Counsel(Required)

I agree to the Consent to Counsel clause.

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.

Read this form carefully. You will be signing at the end to confirm you understand and agree to it. If you want or need separate counsel (legal or otherwise), you may obtain it prior to signing this document and participating in counseling.

COMMITMENT TO BIBLICAL COUNSELING
Reigning Grace Counseling Center is a ministry of the Gospel of Jesus Christ and part and part of our practice of religion. You have indicated that you are voluntarily seeking religious guidance (biblical counseling) from one or more Christians. The goal of biblical counseling is to help Christians become more and more like Jesus Christ in attitude, thought, and action. With that in mind, biblical counseling is the same as discipleship. As Christians, we are called to make disciples teaching them to observe all that Jesus commanded (Matthew 28:16-20).

Our goal in providing Christian, biblical counseling is to help you live your entire life in a God honoring\God pleasing way. This includes, but is not limited to, providing biblical counsel to assist you in meeting the challenges of your life; shedding sin that so easily entangles; learning to develop, cultivate and live in relationships that please God; giving thanks to God in all circumstances; living in a community of other believers; as you participate in your local church, and learning to rely on the Holy Spirit, for direction as you seek to know God through his Word (the Bible).

Although the biblical advice we give is intended to be practical, it is entirely your decision how to (and whether to) implement that advice. We want to help you love God and love others as we walk with you in this process.

During the course of the counseling relationship, we may counsel you from the Bible that certain conduct is sinful and must be stopped in order to please God, and we may counsel you in how Scripture directs Christians to put off that sin and, instead, to live a life characterized by self-control and godliness.

By signing below, you are specifically agreeing to such counsel and are affirmatively asking that we provide it. As stated above, we will counsel you from our deeply held, Christian religious beliefs, and this counseling is part of our practice of religion.

Biblical counseling is a disciple-making ministry. Reigning Grace Counseling Ministry is a 501(3c) non-profit ministry. The fee structure represents the basic costs of providing the ministry.

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.)

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.

Biblical Basis

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, Reigning Grace Counseling Center encourages and enjoins people to seek counsel from and confess sins to each other first within the local church. Reigning Grace Counseling Center does not replace the local church but exists to assist the local church in the process of biblical counseling and discipleship.

We believe 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.

If you are unwilling to use the Bible as the final authority in counseling or unwilling to do the growth projects assigned, you should not proceed with this counseling. However, we do want to help, and we pray that you decide to look to God’s Word for guidance as we follow the loving example of Jesus Christ. Through the power of the Holy Spirit, we believe your life can be transformed.

PROFESSIONAL ADVICE
In the process of Biblical counseling, there are often times when there is a need for significant advice with regard to legal, medical, financial, or other technical areas. In those cases, you will be encouraged to seek independent professional counsel because we do not provide it; although we advise you to handle all matters in a Christlike and ethical way. Our pastoral and lay counselors will be happy to cooperate with such advisors and help you to consider their counsel in light of relevant scriptural principles.

Further, we are not responsible for nor shall we be liable for any physical, mental or medical condition of any counselee, whether or not such condition is affected in any way by the counseling process or counsel provided.

No professional-client or fiduciary is created between the counselee and counselor. The parties recognize that the counselor may have training in matters and/or employment beyond the scope of biblical counseling. However, the counselor is not acting in that other capacity on behalf of the counselee. Further, it is agreed that no church or school or any third party will incur any liability for counsel provided by us, even if such an institution is providing supervision, generally or specifically, over this counseling and/or this ministry.

Although we may take into consideration any applicable laws that you may bring to our attention, it is intended that the Holy Scriptures (the Bible) shall be the supreme authority governing every aspect of the counseling process and that God’s glory is the goal. However, failure of the counselor to interpret or apply the Bible in any way shall not subject the counselor to liability.

There shall be no legal or other liability that attaches to any counselor or institution for any advice, methods, conduct or act, or omission related in any way to the service that is provided, and you acknowledge that you are voluntarily seeking this counsel (free from coercion, duress, or pressure.

LEGAL PROCEEDINGS
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).
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 confidence 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, absolute confidentiality is not scriptural in all circumstances. In particular, when our leaders (as determined by us in our sole discretion) believe it is biblically necessary, they may disclose confidential information to appropriate people in the following circumstances:

1) When a counselor is uncertain of how to counsel a person about a particular problem and needs to seek advice from other counselors or leaders in our church or, if the person attends another church, from the leaders of that church (Proverbs 11:14);
2) 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.
3) 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,
4) When counselors are required by law to report suspected abuse and criminal activity (Romans 13:1), including abuse of children and the elderly.
5) When we believe there is a need for protective services or that a person of familial authority needs to be informed (e.g., wife\husband, or child\parent).

Local Church Participation
Attendance\Training\Education: Please make every effort to attend every scheduled session. Further, please encourage your pastor from your local church or one of those in leadership to accompany you in counseling sessions. In fact, depending on the situation, we may require such attendance as we recognize and respect the authority and the discipline of the local church in your spiritual life. In addition, this makes transfer back to the pastoral care of your church much easier to implement. If you are not attending a church, we expect you to attend a Bible-preaching and believing church weekly for your own benefit and for the benefit of the Body of Christ.

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. If this happens, care will be taken to protect your identity.

Termination/Records

At any time and for any reason, the counselor (as well as the counselee) may terminate counseling. However, termination of counseling will not preclude the counselor from making disclosures set forth above (Limited Confidentiality) if deemed appropriate by the counselor or if compelled by other legal means. It is agreed that counseling sessions, in whole or in part, may be recorded by the counselor by writing, video, audio, or other nonelectronic or electronic means, and consent is hereby given by the counselee for such recordings. Although it is understood that we may (but are not required to) keep records of sessions and their subject matter, any records are the sole property of Reigning Grace Counseling Center and it is expressly agreed that we may destroy any and all such records of any counseling sessions or issues at any time we deem appropriate, without incurring any liability.”

REIGNING GRACE COUNSELING CENTER’S STATEMENT ON MARRIAGE, GENDER, AND SEXUALITY.
We are committed to the belief that marriage was created and sanctioned by God to bring together biological men and biological women by joining them in a “one-flesh” covenantal relationship (Genesis 2:18-25). We believe God wonderfully and immutably creates each person as male or female. These two distinct, complimentary genders together reflect the image and nature of God (Genesis 1:26-27). We believe the term, “marriage” has only one meaning: the uniting of one man and one woman in a single, exclusive union as delineated in Scripture (Genesis 2:18-25). We believe marriage between one man and one woman for life uniquely reflects Christ’s relationship with the Church (Ephesians 5:21-33). Marriage also serves as the foundational unit of the family (1 Timothy 3:2) and provides the best chance that children will grow up in the same home with both their mom and their dad.

We believe God intends sexual intimacy to occur only between a biological man and a biological woman who are married to each other (1 Corinthians 6:18; 7:2-5; Hebrews 13:4). We believe that God has commanded that no intimate sexual activity be engaged in outside of a marriage between a man and a woman.

We believe that any form of sexual immorality as described in the Bible (including fornication, adultery, homosexual behavior, bisexual conduct, bestiality, incest, and use of pornography) is sinful and offensive to God (Matthew 15:18-20; 1 Corinthians 6:9-10).

We believe that in order to preserve the function and integrity of Reigning Grace Counseling Center as part of the Body of Christ, and to provide a biblical role model to the Church and the community, all persons employed by Reigning Grace Counseling Center in any capacity, or who serve as volunteers, abide by this Statement on Marriage, Gender, and Sexuality (Matthew 5:16; Philippians 2:14-16; 1 Thessalonians 5:22).

We believe God offers redemption and restoration to all who confess and forsake their sin, seeking His mercy and forgiveness through Jesus Christ (Acts 3:19-21; Romans 10:9-10; 1 Corinthians 6:9-11).

We believe that every person must be afforded compassion, love, kindness, respect, and dignity (Mark 12:28-31). Hateful and harassing behavior or attitudes directed toward any individual are to be repudiated and are not in accord with Scripture or the doctrines of the Reigning Grace Counseling Center.

By signing this document, you are irrevocably waiving any right that you might have to a trial by jury or judge in a judicial proceeding. If any provision of this agreement shall be held invalid, illegal, or unenforceable, only that provision shall be stricken, and the remainder of the agreement shall in no way be affected. concerning matters relating to Reigning Grace Counseling Center. All of the above is understood and agreed.

Facts About Biblical Counseling(Required)

I agree to the Facts About Biblical Counseling.

THE CONCEPT OF BIBLICAL COUNSELING: Biblical counseling is discipleship and 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 and discipleship. He or she does not base his or her counsel on man’s wisdom, opinions, experience, psychology, 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 (discipleship) uses the sufficient Word of God to address 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 and average of eight 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 and discuss it with you in order to help you to correct it. Phone: (816) 694-1677

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. Biblical counseling 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 that we shall 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 after receiving this packet. You will be called within 2-5 days to set up your initial appointment. If you are not called by then please call 816-694-1677 or email us through the counseling center’s email Reigninggracecounsel@rgcconline.org. 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 the MacArthur or the ESV 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 short clarifications about your counseling. Please call 911 for emergency issues. Thank you for your cooperation in this area!

RGCC Appointment Policy(Required)

I agree to the Appointment Policy.

I understand and agree to the Reigning Grace Counseling Center Appointment Policy which states that all appointments must be paid the day before the scheduled appointment, no later than 24 hours prior to the appointment. I understand that I must provide my credit card information, and that if I cancel my appointment with less than 24 hours notice, or if it is a no call/no show, I will be billed for that appointment.

PDI (B) – Substance Abuse & Addiction