William
Gaultiere, Ph.D.
Clinical Psychologist,
PSY12036, Christian Soul Care
4000 Barranca Pkwy., #250, Irvine, CA 92604, 949-262-3699
SPIRITUAL
DIRECTOION POLICIES
Please print this form out. After you have read carefully and
agreed to each of my policies below then sign the form at the bottom
and deliver to me. When we meet (or talk via phone/e-mail) we
will discuss these policies and I will answer any questions you may
have about them or the spiritual direction services I have to offer you.
Spiritual Direction is not Psychotherapy: As a licensed Psychologist I
offer Christian psychotherapy services, but that is not the help you
are requesting of me. Therefore, we will not be treating
psychological problems or emotional crises. And if
psychological issues arise for you then we will understand and respond
to them in the context of your relationship with God, or if necessary,
I’ll refer you for psychotherapy. By consulting me for
spiritual direction you are asking me to help you in your relationship
with God. We want our conversations to be prayerful and to
draw you closer to God and his will for your life. Jesus is
present with us in Spirit and he is the Spiritual Director that I will
help you to listen to and follow.
Appointments: Your standard appointment time, whether in the office or
by phone, is 45 minutes long. (You can schedule more
time). I have reserved that time for you. If you
are late I may not be able to give you your full session. If
you are unable to attend, please let me know at least 24 hours in
advance. You will be charged the regular rate for no shows
and last minute cancellations, except in the case of an emergency.
Contact between Sessions: For brief updates or questions you may call
me or e-mail me between sessions, but please realize that the deeper
processing of issues in your relationship with God is best done in
session.
Confidentiality: All the information you convey to me is kept
confidential, with the following rare exceptions:
* You report knowledge of sexual,
physical, or emotional abuse or physical neglect of a minor or elder
* You represent a life-threatening
danger to yourself or another
* The court requires disclosure of your
records
You may want for me to discuss your work with me with a pastor,
psychotherapist, doctor, other professional, or family
member. If so, indicate this and I will have you sign a
release of information.
Without disclosing your name or identifying information I may discuss
aspects of your spiritual direction with a peer or supervisor.
Homework: If you’re motivated to grow spiritually then you’ll
work with God between sessions by developing your own rhythm of
spiritual disciplines to practice. On my website,
ChristianSoulCare.com, you’ll find many helpful articles on Christian
psychology and spirituality, including “Spiritual Disciplines for your
Soul”, and referrals to a variety of Christian organizations.
Feedback: You can help me to help you in your relationship
with God by telling me what you want from spiritual direction and by
providing me with feedback along the way on how you feel it’s going.
The Effects of Spiritual Direction: As best I can I will tell
you if and how I think spiritual direction can help you
spiritually. You need to realize that changing spiritually
may be emotionally painful for you or your family.
Length and Frequency of Spiritual Direction: How long you
meet with me and how often we meet is up to you and is a good issue for
us to discuss. When you feel ready to end our work together
it would be helpful for us to discuss this. If I need to end
our work together I will give you notice so we can discuss this and how
you can best continue your spiritual journey. At any time I
can offer you referrals to other spiritual directors, pastors, or
psychotherapists who may be of assistance to you.
Payment: My fee for spiritual direction is negotiable and is
usually less than my standard fee for psychotherapy, which is $130 per
session. Please make your check out to “Christian Soul Care”
or provide your online payment in advance. Upon your request
I can give you a receipt, which you may be able to use as an income tax
deduction or for reimbursement from your employer, church, or other
entity. Spiritual direction is not reimbursed by medical
insurance. If financial problems arise for you then please
discuss these with me.
I have read and I understand the contents of the above material.
Directee Signature
_____________________________________
Date _______________
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