Pastoral Care Agreement
You may view this entire agreement without the scroll bar at https://www.icebergmodel.com/pages/spiritual-direction-agreement
The following agreement applies to all services provided by Rev. Rob Jackson, MS, LPC, BC-TMH, including:
- pastoral care by telephone
- pastoral care over the Internet with Zoom Video Conferencing
- in office appointments by the hour or multi-day intensives
- on-location services
- seminars, workshops, and retreats
Location and Time Length. Because you and your needs are unique, I have a flexible approach that can fit the most demanding schedules. You can mix and match one or more of these approaches to the amount of time you want to allocate to your program. The typical length for pastoral care is four to six months.
Procedure. Appointments are typically booked online, unless you need to work out a flex schedule with my help. Complete the automated ‘Prep Form’ in advance of your session. This information helps me to serve you better. I will either call the number you provide, or initiate the Zoom Video Meeting.
Rescheduling and Cancellations. If you need to cancel a session, please provide 24 hours notice. I can work around valid emergencies. Missed calls are not made up or refunded.
Extra Time. I encourage contact between sessions, and have built this retainer service into my client agreement. ‘Spot calls” (five minutes or so in length), emails, faxes, and texts are all acceptable. Clients who take advantage of this extra time often make better progress.
Fees. Payment is made by most major credit or debit cards. Insurance will not reimburse for pastoral care, and no claims will be submitted for reimbursement by either party. Brief pastoral care intensives are scheduled with a 50% deposit that is non-refundable in the event of late cancellation. However, if clients are willing to reschedule, the deposit is applied to future service without penalty.
Problems or Conflicts. Transparency and honesty are foundational to pastoral care. If you become dissatisfied with something, please bring it to my attention. I will work with you to find a good and reasonable resolution.
Flow. Recovery is a 24/7 process that includes not only your sessions, but the in-between times also. There will be times where you have some obvious, even tangible action steps and systems to implement, and other times when you’ll be emerged in ‘softer’ exercises like prayer, meditation, and journaling. Whatever the case, check your commitment to the process, and make the most of it!
There are limits to privacy and confidentiality, that require us to make various reports appropriate authorities as outlined below:
- If you pose a serious physical danger to yourself or another person.
- If you disclose that a child, an elderly person, an incompetent person, or a disabled person has been physically or sexually abused or molested.
- If you disclose that a child, an elderly person, an incompetent person, or a disabled person is suffering from neglect.
- A disclosure of your information can be ordered by a judge or court for the purpose of criminal or delinquency hearings, or when there is a legal or disciplinary proceeding regarding quality of care, or when services are being reviewed by a professional or legal entity.
- You disclose a threat to national security.
Addendum to Pastoral Care Agreement
1. As a client, I understand and agree that I am fully responsible for my pastoral care calls, including my choices and decisions. I am aware that I can choose to discontinue this service at any time. I recognize that pastoral care is not psychotherapy and that professional referrals will be given if necessary.
2. I understand that pastoral care is a voluntary relationship I have with my spiritual director that is designed to facilitate my wellness. To that end I may also receive mentoring that facilitates the creation/development of personal, professional, or business goals, and develops an incremental plan that targets those goals.
3. I understand that pastoral care is a comprehensive process that may involve all areas of my life, including work, finances, health, relationships, education, and recreation. I acknowledge that deciding how to handle these issues and implement my choices is exclusively my responsibility.
4. I understand that pastoral care does not treat mental disorders as defined by the American Psychiatric Association. I understand that pastoral care is not a substitute for counseling, psychotherapy, psychoanalysis, mental health care, or substance abuse treatment and I will not use mentoring in place of any form of therapy.
5. I promise that if I am currently in therapy or other wise under the care of a mental health professional, that I have consulted with this person regarding the advisability of working with a spiritual director and that this person is aware of my decision to proceed with a pastoral care.
6. I understand that information will be held as confidential unless I state otherwise, in writing, except as required by law.
7. I understand that pastoral care is not to be used in lieu of professional advice. I will seek professional guidance for legal, medical, financial, business, spiritual, or other matters. I understand that all decisions in these areas are exclusively mine and I acknowledge that my decisions and my actions regarding them are my responsibility.
8. The parties to this agreement are Christians and believe that the Bible commands them to make every effort to live at peace and to resolve disputes with each other in private or within the Chris=an church (see Matthew 18:15-20; 1 Corinthians 6:1-8). Therefore, the parties agree that any claim or dispute arising from or related to this agreement shall be settled by biblically-based mediation and, if necessary, legally binding arbitration in accordance with the Rules of Procedure for Christiaan Conciliation of the Institute for Christian Conciliation, a division of Peacemakers Ministries (complete text of the Rules is available here). Judgment upon an arbitration decision maybe entered in any court otherwise having jurisdiction. The parties understand that these methods shall be the sole remedy for any controversy or claim arising out of this agreement and expressly waive their right to file a lawsuit in any civil court against one another for such disputes, except to enforce an arbitration decision.
My purchase of pastoral care indicates that I have I read this document in its entirety, and agree to abide by its content. I affirm that I am responsible for my wellbeing, choices, and decisions while receiving services from Rob Jackson. I understand that this mentoring service has not promised or guaranteed any expected outcome. I also realize that mentoring is not psychotherapy, and that professional referrals may be offered when deemed appropriate. Finally, I acknowledge that I am free to discontinue pastoral care at any time.
Last Updated: January 9, 2019