PSYCH-K® with Angela Anderson
Release and Personal Data Record
Please read and sign the following. When you are done signing, please prepare for your first session by providing me with some personal information. Email your responses to questions 1-6 (below) to firstname.lastname@example.org.
I understand that PSYCH-K® facilitation offered by Angela Anderson will include the number of sessions I have chosen and/or the number of sessions that are in my package and that there could still be an undetermined number of sessions needed depending on my individual needs and wishes.
I understand and agree that the major purpose of this program is for vocational and/or avocational self-improvement in the area of subconscious belief change and that problems of psychogenic or functional origin are treated by psychological or medical referrals only (Business and Professional Code 2908). I understand that I am responsible for my own physical, mental and emotional well-being.
I also understand that there are no guarantees as to the results or progress to be made, only that Angela Anderson will, to the best of her ability, endeavor to help me accomplish the objectives of my session(s).
I understand that I am responsible for the results I achieve in my life.
Additional Conditions: I have also read the ground rules below. Please…
ASK QUESTIONS. There’s an old saying that the only stupid question is the one you don’t ask. This is your session, and it will be more effective if you are clear about what is going on. If you have issues or fears about asking or whether PSYCH-K® works - or will work for you, let’s work on that…
BE HONEST. I am not a mind reader, so I will need you to give me the information we need to reach your goals. And if something isn’t working, let me know – do not ever say anything just to please me. I don’t want you to tell me what you think I want to hear – I want you to achieve your goals.
KEEP AN OPEN MIND. The work we do may be new to you, and may seem “unconventional.” I use PSYCH-K® and the tools presented to you in each session because they work. Rest assured, though, that while I may challenge your beliefs, I will never compromise your ethics. Remember, I cannot make you say or do anything against your wishes. And, the PSYCH-K® permission protocols that we follow in each of your sessions (no exceptions!) cannot make you say or do anything against your wishes either!
FOLLOW DIRECTIONS. I work for you, and I will do the best I can, but I need your help. If I ask you to do something, there is a reason for it. And if I interrupt you while you are talking, don’t be offended. I want to accomplish as much as possible in our time together, and that may require cutting a story short.
VALUE MY TIME. If for some reason we have not discussed my fees, please be sure that we have done so before we begin the session. Payment is due prior to the session – thank you. There are no refunds if you cancel a session without 24-hour prior notification or do not appear for your session – full payment will be expected for less than 1 hour notification. And, value your time – the time we schedule is the time we have – please be here when it begins so we can use all of it.
BE COMMITTED. I am committed to your success – but I need you to be committed as well. I do not cure you – I help you access your wisdom and natural ability to heal yourself and achieve your goals. We will accomplish as much in each session as we can. How quickly and effectively they work depends on the scope of your issue and your willingness to work on it. No prescribed drug will help if it just sits in the medicine cabinet – same goes for this work. Ultimately, you are responsible for what you accomplish in life. (Now that’s freedom!) So – play full out!
E-MAIL. Between sessions you may feel compelled to write down things that come up, and that can be great for your process. Any insights you feel are important to share with me or issues that are coming up for our next session are great to get on paper if you desire. My preference is that you use our Google document to record these things. If you are enrolled in Into the Wild or True Wealth Mastery, unlimited email support is part of your package. However, I will not attempt to help you change your beliefs outside of sessions. I can answer questions and provide clarity, but belief change happens in sessions. If you have signed up for a la carte sessions and have something brief that feels important, such as a personal victory or a specific question that can be easily answered by e-mail, then you are welcome to e-mail me, however unlimited email support does not come with a la carte sessions.
Please do not call, text, or message me via social media. Email email@example.com.
DISCLAIMER: I am not licensed as either a psychotherapist, counselor or a physician. I am trained in PSYCH-K® Facilitation and am listed as a Preferred Affiliate on the PSYCH-K® Centre International website. I am not a certified PSYCH-K® Instructor. The difference between a certified instructor and a facilitator is that certified instructors teach the PSYCH-K® processes via in-person workshops with groups. Facilitators offer 1:1, individual PSYCH-K sessions where we facilitate the processes so you can change your limiting beliefs. In essence, we do not teach the PSYCH-K® processes to you, we facilitate them WITH you. It’s similar to going to learn how to give a massage from a certifying agent versus being a massage therapist and working with clients. I will refer you to a licensed professional should I feel it is appropriate, but, again, you must ultimately take responsibility for your own well being.
Please use the following information to prepare for our session. Email your responses before your first session to: firstname.lastname@example.org.
1. Ideal Life
Please write out a statement of what you would like your life to look like. Give some consideration to what your life’s purpose might be, and how that would show up in your ideal life. Write this in first person present tense.
Take note of any thoughts or feelings that come up about why you believe it can’t be that way (i.e. – “I’m not good enough,” “I don’t deserve it,” etc.).
Please also write out three specific goals for your life. They can be short-term or long-term.
Feel free to add as much detail as you like (what will you see? what will people be saying about you or to you? what will you be saying to yourself? how will you feel?) Again, take note of any thoughts or feelings that come up about why you believe it can't, won't shouldn't happen.
3. Blocks & Traumas
Please also make a list of between 3 and 10 events in your life that you would prefer had not happened. Try to narrow them down to two-minute events, and give them titles: "My Biggest Humiliation" or "The Time in Third Grade When They Laughed at Me." With out going into them or dwelling on them, think of how you would like to feel about these events or traumas instead (ex: peace and non-attachment).
Please write a list of your values, using single words or short phrases (i.e. – Commitment, Sharing My Gifts, Safety, etc…). Then put them in order of importance based on how you are living right now. Please be honest – state the values that you are currently operating from. Then make a separate list in the order you’d like them to be – you may also add or delete values.
5. Cast of Characters
Please let me know the names of your parents, siblings, former partners, anyone else you feel is significant in your past – whether they are living, married, etc. – anything you feel might be beneficial to our work together and feel comfortable sharing. Anything you share with me - here and in our sessions – will be kept strictly confidential.
If you are willing, please also share your religious/spiritual beliefs. This is of course optional, but often useful. Are you comfortable with the word God, or do you prefer another term? Please know that I will respect whatever your beliefs are, and I ask this question so that our work will be compatible with those beliefs.
Thank you for your efforts on this. This will provide us with a jumping off place - though we never know where the work will take us. I greatly appreciate you for putting your trust in me – I will do all I can to support you in living the most joyful and abundant life possible.