Additional Contract and Disclosure Statement Regarding Alternative Treatment Methods
Please read through the following and provide your electronic signature at the bottom. Each person must provide their own electronic signature for consent.
Client Centered Therapy
Clients will be encouraged to pursue personal growth in a non-judgmental environment with an emphasis on client-centered therapy. A combination of a systems therapy, existential therapy, and alternative therapy approaches will be used. The determination of which method is to be favored is based on the individual client’s need and presenting issue.
The state of Colorado adopts the following definition for client-centered therapy. "In Client-Centered therapy, the central hypothesis is that the full growth potential of any patient will tend to be released in a relationship in which the therapist communicates the realness, caring, and a deeply sensitive, nonjudgmental understanding. Thus, the therapist practices participative and empathetic listening, while allowing the client to freely vent his/her feelings."
Systems therapy examines how one functions within and is impacted by various entities such as family, employment, and other support mechanisms.
Existential therapy focuses on freedom of choice in shaping one's own life. It teaches that one is responsible to shape his / her own life and that there is a need for self-determination and self-awareness. Existential therapy focuses on the present and on the future. The therapist will challenge the client to recognize that they were responsible for making choices that have affected their life. This type of therapy is well suited in helping the client to make good choices.
Alternative therapies include models that have demonstrated efficacy through a minimum of anecdotal evidence but may still be in the process of collecting research data to publish efficacy rates. Splankna therapy falls under this category.
Splankna therapy was based on a biblically based protocol for energy psychology. “Energy Psychology” utilizes the same system in the body that acupuncture and chiropractic are based on to resolve unbalanced emotions that are stored in the body. “Energy Techniques” is a collective term used to refer to a variety of methods based on the use, modification, and manipulation of energy fields that look at imbalances within the person’s energy system as well as the energetic influence of thoughts, beliefs, and emotions on the body. The prevailing premise of Energy Techniques is that the flow and balance of the body’s electromagnetic and more subtle energies are important for optimal physical, spiritual, and emotional functioning.
Splankna Therapy was designed to help get to the origin of an emotional issue with the goal of rapidly desensitizing the emotional stress connected to a past event. Splankna therapy incorporates elements from several newly-emerging energy-based psychotherapies, coaching, and self-help techniques, specifically Neuro-Emotional Technique, Thought Field Therapy, and Eye Movement Desensitization and Reprocessing. Prayer is intertwined throughout the protocol with a deep emphasis on trusting the lead of the Holy Spirit. Basic biblical principles are also incorporated such as confession, repentance and forgiveness.
Although Energy Techniques like Splankna therapy appear to have promising emotional, spiritual, and physical health benefits, they have yet to be fully researched by the Western academic, medical, and psychological communities, and therefore, may be considered experimental. The Energy Techniques are self-regulated and they are considered alternative or complementary to the healing arts that are licensed in the State of Colorado. Because Energy Techniques are relatively new healing approaches, the extent of their effectiveness, as well as their risks and benefits, are not fully known. Splankna and deliverance work share some commonalities. While deliverance work is not officially recognized by the State of Colorado as a mode of psychotherapy, we feel it is appropriate to consider this type of work with clients on a case by case basis in an effort to provide a holistic approach that includes spiritual concerns.
Please note that it is impossible to guarantee any specific results regarding your goals using any of the approaches offered in our sessions, and we cannot be expected to know how you will personally respond to any of the approaches. However, we will work together to achieve the best possible results for you. Our work together requires your very active involvement, honesty, and openness in order to impact the reported change you desire regarding thoughts, feelings and/or behavior. You will have to work both in and out of our sessions. We will ask for your feedback and views on our work and its progress, and will expect you to respond openly and honestly. As with any intervention, there are risks associated with Energy Psychology. Risks might include remembering, talking about, or experiencing unpleasant events which results in uncomfortable levels of feelings like sadness, guilt, anxiety, anger, frustration, worry, etc., or experiencing anxiety, depression, or insomnia, etc., or having difficulties with other people. Being confronted with your difficulties can be very challenging. Some changes may lead to what seems to be worsening circumstances or even losses.
Please be advised that the approaches offered are not intended to be a substitute for medical diagnosis and they do not replace the services of a licensed physician. You agree and understand it is your responsibility to consult with your physician/psychiatrist for any specific medical problems including but not limited to mental health issues requiring pharmaceutical intervention. Further, you understand we may suggest you contact your physician or psychiatrist if we believe it is advisable. In addition, you understand that any information shared during our sessions is not to be considered a recommendation that you stop seeing your physician or using prescribed medication, if any, without consulting with your physician/psychologist, even if after a session it appears and indicates that such medication or treatment is unnecessary.
In addition, if you choose to engage in Splankna therapy, emotional or physical sensations or additional unresolved memories may surface which could be perceived as negative side effects. You may experience some temporary emotional distress and physical discomfort related to prior life experiences.
During the multiple day “intensive” session time, we will address as many of your concerns as time allows. We will discuss a plan that seems most appropriate to help you reach your goals. However, regardless of our work together, you agree to take full responsibility for your/your child’s self-care in the emotional, mental, physical, and spiritual dimensions of your life.
You understand the application of Splankna therapy includes light touch on the back of the wrist and on occasion a head point (i.e. temples, forehead, top of the head, or back of the head). Touch can be a potential problem in a support relationship if you feel it is inappropriate. If you have any misgivings, doubts, or any negative reactions to any physical contact, it is very important that you let me know as soon as possible so that we can discuss your concerns. You understand you have a choice about these techniques that involve touch.
By signing this document and any attachments hereto, you agree that we have disclosed to you sufficient information to enable you to decide to undergo or forgo any of the approaches and other services offered. You understand that your consent to the nature of our sessions is given voluntarily, without coercion, and may be withdrawn at any time in the future. Further, you understand that Splankna therapy is a relatively new healing approach and the extent of its risks and benefits are not fully known and you agree to assume and accept full responsibility for all risks associated with using Splankna therapy. You represent that you are competent and able to understand the nature and consequences of our proposed sessions. You have read and understand the above disclosure about the services offered by Dallas Henslee and Mark Henslee and our differing degrees of training and education and you have discussed with us the nature of the services to be provided, and except in the case of gross negligence or malpractice, agree to release, indemnify, hold harmless and defend Blue Fire Legacy, its stakeholders, board, employees, representatives, and consultants from and against any and all claims of liability, of whatsoever kind or nature, which you, or your representatives, may have for any loss, damage, or injury, including without limitation, physical, emotional, mental, financial, or personal, arising out of or in connection with your sessions.