"Listed below is an explanation of the program and its requirements"
L.I.G.H.T. APPLICATION-„Living in God‟s Holiness Today‟ Listed below is an explanation of the program and its requirements for enrollees: 1. The LIGHT program is designed to disciple women who find themselves trapped in the bondage of habitual sexual-based sin. The class will explore the cycle of addiction/attachment, root causes, triggers, and changing behaviors. Participants will learn spiritual principles regarding surrendering their control and will to God through the cross in order to reclaim their freedom from sin and its strongholds. 2. This is a high accountability program whose leaders have themselves been through the program or similar programs. The leaders have a level of compassion that enables them to provide a safe place for those willing to seek the road to health and wholeness that only Jesus Christ can give. 3. This packet includes a questionnaire about your personal history and addiction. Please fill it out as honestly as you can. Only leaders of the LIGHT program will look at your information. 4. This year‟s program begins in June 2008. You will be asked to commit to the entire 16 weeks of the program. Two excused absences are permitted. Participants accruing unexcused absences meet with small group leaders to establish motivation to remain in group. 5. Resources and referrals are available for on-going support during or after completing the program. You also have the opportunity to go through the program again when a new session begins. 6. The enrollment fee is $160.00 which includes all resources needed for the group. Please enclose a $25.00 application fee along with your completed application. Make checks payable to Sought Out, Inc. Applications are not considered without the application fee. 7. After a successful interview/acceptance, an activation deposit of $100.00 is due by check or cash which holds your place in the group. The remaining balance of $60 is payable anytime, but unless other arrangements are made minimum weekly payments of $15 are due at each meeting. Our office gladly provides letters or phone call support to the pastors of applicants needing financial assistance from their home church. 8. The group begins at 6:30 p.m. and includes worship, a short teaching, small-group discussion of the material, emotional processing, accountability, and prayer ministry. Meetings are from 6:30 to 8:30 p.m. and begin and end on time. If you have any further questions, please call Sought Out at 631-0099. LIGHT Application Date _____________________ Name__________________________________________ Birthdate____________ Address____________________________________________________________ City______________________________State______Zip______________ (Unless otherwise requested, we will add this address to the Sought Out mailing list.) Phone: Day:________________________ Evening:__________________________ Cell:___________________ which #‟s are safe for messages?__________________ Email:__________________________ Email #2:__________________________ (Group announcements are sent to e-mail accounts unless otherwise specified.) Marital Status Single ____ Married____ (date)___________ Separated____ (how long)________ Divorced____ (how long)_____________ Widowed____ (how long)___________ Children? ____________________________________ In case of emergency contact:_______________________ Phone #‟s____________________ Relationship to you______________________________ Office Use Only Group___________________________ Application Received_________________ Deposit Received_________________ Activation deposit fee Received________________ Small Group Leader__________________ Additional Contracts?___________ Comments:_________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ Highest grade completed_______ Degrees_________________________________ Have you ever been in counseling? ______ When? ______________________________ Where? _________________________ With Whom? _________________________ Why? _______________________________________________________________ Have you ever been diagnosed by a therapist? _________________________________ What was the diagnosis? _________________________________________________ Have you ever been hospitalized in a psychiatric facility? _________________________ When? ______________________________ Why? ___________________________ ___________________________________________________________________ ___________________________________________________________________ Have you ever been through a sexual addiction program before? ___________________ When? ___________________ Where? ____________________________________ Do you experience any type of hallucinations or spiritual experiences (visual, Physical)? _______ If yes, describe:_______________________________________ ___________________________________________________________________ Do you ever hear audible voices? _______ If yes, describe (inside or outside of the head) _______________________________________________________________ ___________________________________________________________________ Are you/have you ever been suicidal? _______ When? ____________ What happened? ___________________________________________________________________ ___________________________________________________________________ Have you or anyone in your family been involved with Satanic Ritual Abuse? _______ Do you recall any significant, traumatic incidents in your life, (i.e. verbal, physical, sexual or emotional abuse?) Please explain:_________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ Are you currently on any medication(s)? _______ If so, what? ____________________ Have you been examined and/or treated for S.T.D.‟s (sexually transmitted diseases)?___ Have you ever been tested for A.I.D.S or the A.I.D.S. antibodies? _________________ Do you have any nutritional problems? _______ Please explain ____________________ ___________________________________________________________________ ___________________________________________________________________ Briefly describe your relationship with your parents. Father______________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ Mother_____________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ Have you or your parents ever been chemically dependent? Me___Mother___Father____ If so, please elaborate: _________________________________________________ ___________________________________________________________________ ___________________________________________________________________ What specific areas of support and/or instruction do you desire? _______Sexual Abuse _______Homosexual brokenness _______Emotional dependency _______Co-dependency _______Compulsive masturbation _______Compulsive sexual behavior _______Pornography _______Dealing with heterosexual relationships _______Internet Chat Rooms _______Preoccupation fantasies/fantasy material Other_______________________________________________________________ ___________________________________________________________________ At what point in your life did you consider yourself a Christian? Describe your experience. ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ List your past church affiliations or religious instruction beginning in childhood. Name of church group From To ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ How does your church facilitate relationship outside of services? ___________________________________________________________________ Describe your current participation in relational groups at your church: ___________________________________________________________________ AGREEMENT AND RELEASE FROM LIABLITY I (Printed name) ______________________________________, acknowledge that I have voluntarily applied to Sought Out, Inc. to participate in the LIGHT program, a Christian, nontherapist, worship, teaching, discipleship, and mutual support program. I am aware that my participation in the LIGHT program is not a substitute for psychiatric treatment, psychotherapy, therapeutic counseling or any other form of professional therapy. I am also aware that my participation in the LIGHT program is not a substitute for my active involvement in a local Christian church body of my choice. I am voluntarily participating in the LIGHT program with full knowledge of these facts and I accept complete responsibility for my own psychological, mental, emotional, and spiritual well-being. I acknowledge that my participation in the LIGHT program does not create any special relationship of custody or control between myself and Sought Out, Inc., (including employee, officers, or directors of Sought Out, Inc.), or between myself and any other person. As consideration for being accepted by Sought Out, Inc. to voluntarily participate in the LIGHT program, I acknowledge that my emotional vulnerability may increase along with the desire to act out in new or old compulsive behaviors. I acknowledge that, if accepted, my continued participation in the LIGHT program may be contingent upon complying with the program director‟s request to maintain involvement in appropriate extracurricular support such as therapy, additional support groups, or home fellowship. If needed, these conditions will be established at the review of this application. I acknowledge that I am committing to miss no more than two of the sixteen group sessions in this program as a standard for my personal accountability and as a condition of acceptance. I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AGREE THAT FAILURE TO COMPLY WITH ANY PREAGREED CONDITIONS OF ACCEPTANCE TO THE LIGHT PROGRAM MAY RENDER MY ACCEPTANCE TO THE PROGRAM NULL AND VOID. _________________________________________ Signature _______________ Date CONFIDENTIALITY POLICY OF LIGHT LIGHT leadership will hold as confidential all disclosure made in the context of the LIGHT program with these three exceptions: 1. All small group leaders reserve the right to discuss matters disclosed by group members for the purpose of receiving supervision and oversight. This oversight will occur in group supervision meetings held by the group leaders and their supervisors and will be confidential. 2. Any LIGHT group member who discloses intentions to take harmful, dangerous, or criminal action against another human being or against herself will necessitate LIGHT leadership to warn appropriate individuals of such intentions. Suspected acts of child abuse or neglect will be reported. Those warned may include a variety of such persons as: a. the person or family of the person who is likely to suffer the results of harmful behavior b. the family of the group member who intends to harm herself or someone else; c. associates or friends of those threatened or making threats, and; d. law enforcement officials or child protection services. 3. LIGHT recognizes the importance of church authority. LIGHT leadership reserves the right to disclose confidential information to pastoral leadership regarding any individuals who are putting others in the congregation at risk by their behavior. This is for the purpose of pastoral oversight and disclosure will be done with the foreknowledge of the group participant. I have read and understand this confidentiality policy, including its exceptions. _________________________________________ Printed Name _________________________________________ _______________ Signature Date POLICY FOR INTERACTION WITH OTHER LIGHT PARTICIPANTS Over the course of our experience, we have found that certain things enhance healthy group dynamics and certain activities detract from LIGHT being a healthy, healing experience. One of the important goals of LIGHT is to create a holy, safe, and intimate contact where the deep wounds of each group member‟s heart can rise to the surface and begin to be healed through the care and prayers of the group. Because by definition LIGHT participants suffer from emotional and/or sexual addictions, we have learned that certain boundaries must be erected to safeguard the intimacy and sanctity of the group. We have seen the effectiveness of LIGHT greatly undermined when people intertwine the unique intimacy forged in LIGHT with socializing outside of the group. In order to maintain our goals of providing the best healing opportunity possible, we ask that you observe the following guidelines for social contact outside of the parameters of LIGHT with other group members for the course of the 16-week program: 1. Group Leaders will supervise the exchange of phone numbers within the small group. This is encouraged for accountability purposes, unless there is the possibility of a sexual pull between two group members. 2. While bona fide church activities may be shared when two group members attend the same church, we ask that you refrain from initiating new social relationships with group members. If a small group wishes to do an activity together outside of LIGHT, the small group leader will be present and the entire small group is invited. Over the course of LIGHT the group coordinator or small group leader may make exceptions to this policy as seem appropriate to individual or small group situations. LIGHT does value the importance of healthy friendships. We believe that the primary place for those heart investments to be made is in the contact of one‟s local church. We believe that it is important to develop relationships with people who do not have the potential to accommodate our sexual vulnerability in the context of the church. LIGHT is a unique context where we can discuss and receive healing from the fears which inhibit our greater integration into the church and into healthy friendships. I understand and will abide by the policy of refraining from outside social contact with other LIGHT participants. I agree to discuss any complications with this policy with my small group leader. I understand that any willful dishonesty or disregard of this policy may lead to my forfeiting my place in the LIGHT group. _________________________________________ Name _________________________________________ _______________ Signature Date RULES FOR SHARING in LIGHT 1. We must assure confidentiality. What you see here, what you hear here, when you leave here, let it stay here. 2. Group members must avoid cross talk. Cross talk is commenting on what someone else has shared, rather than about my own life. Please avoid criticism, advice giving, questioning, or denial of another person‟s pain. Some group members will want to spend their time and energy in the group focusing on how to fix others. This is a defense, even though it may seem helpful. Each group member should be encouraged to focus on her own defects. To habitually focus on others will detract from her own recovery. If a group member wants input from the group she may ask for it without violating the rules of the group. In so doing she has canceled the no advice rule for that sharing time only. If it seems that a group member is asking for input but there is room for doubt, the group leader should clarify verbally whether or not the speaker wants advice. 3. In your sharing use “I” statements. This is a time to share about you, not your spouse, family or friends. Some group members will talk about their own experience using “you” in the place of “I.” This is confusing for the group and also keeps them at a distance from their own emotions. Help them to switch from” you” to “I.” This rule also help keep the group dynamic safe for those who want to give advice to others. They can do so by sharing about their own lives, using “I” statements. In so doing it becomes a sharing of her own strength, experience and hope. The words, “share about yourself, not your spouse, family or friends,” are not meant to restrict such sharing if it is relevant to the group member describing a problem that she is facing and wants to work on within themselves. They are meant to keep a group member‟s focus away from blame shifting and justifying self-pity. 4. Keep your sharing to 3 to 5 minutes. This will give all group members time to share in the group. Group members can share again once all have shared. 5. Wait for the person speaking to finish before you speak. Silence is better than interrupting someone. This rule does not restrict the group leader from reminding the speaker of sharing guidelines, time limits, or any other group boundary. 6. Be honest. Appropriate openness is a key to a good group. Be who you really are, not who you think you should be. We encourage group members to speak honestly of who they are today, at this moment. Living in the past or future is a symptom of addiction. It is potentially a way to escape the reality of present day relationships. Sometimes it is important to connect a past event to how we operate in the present in order to change. The above statement is especially true if we can identify how a past event led to the sin of self-protection and then we encourage the group member repent of that strategy of self defense. Similarly it is important to confess past sin that has not been confessed. But great healing takes place as group members learn to develop the ability to be transparent and honest responses about who they are in each moment. 7. The words, “appropriate sharing,” mean that we want to avoid explicit sexual descriptions and sexual language that has the potential to offend others. We don‟t want the small group to become a place where material for sexual fantasy is offered, or where group participants get triggered into a sexual cycle. We encourage anyone who feels uncomfortable with what a specific speaker is sharing to raise her hand. The group leader then will help the speaker respect the boundaries of the group by being less specific in his/her descriptions. Some group members will use four letter words to express their anger. It is our opinion that we should help those members speak of their anger in words that are more accurate in describing the real and underlying emotions and fewer offensives to other group members. This will aid in bringing healing to the one who is hurting. Appropriate sharing means that the sharing is restricted from talking that might distract from the real goals of the group. 8. Be edifying. What is said should be aimed at building others up, and not tearing them down. Help those who share in the group share from their weakness, rather than a primary mode of displaying their knowledge or insights. Help group members stay out of their heads and share from their heart. Sharing from the heart is more risky because it is uncovering places that may still be under the cover of darkness and secrecy. But such sharing is also more healing. Other Thoughts 1. Research shows that relational-based wounding is best healed in the context of healthy relationships. This group will nurture the development of these healthy relationships and with the guidance of the Holy Spirit, the materials, and co-leaders/group members it is our goal to see this healing facilitated in each member‟s life. Each group member is expected to share within the group their personal experiences as related to the group process. Although this sharing is on a strictly voluntary basis, there is a positive correlation between willingness to „reveal‟ oneself openly and honestly with personal results from the group experience. Group leaders will monitor this sharing to protect the integrity and cohesion of the group. Group members are encouraged to interact within the group with each other and the group leaders. 2. Group members are encouraged to come to the group on time and regularly and to participate in all aspects of the group meeting. If you give of yourselves to the group you will get recovery back. Excessive religious talk should be avoided in the group. In some ways Christians are harder to work with than non-Christians because “relationship” with God can provide a way to escape personal responsibility. Some Christians use super-spirituality to avoid look at their own hearts. Still others avoid being as truthful as they might be because in their hearts they are afraid they are not performing in a “holy” way. Working in a religious way toward being good becomes a substitute for transformation through the cross. LIGHT Tuition Payment Contract I, __________________________________, have requested a Tuition Payment Plan based on genuine need. I have paid a deposit of $__________and agree to leave postdated checks (which will be tendered at the first business day of the designated month) with the Sought Out office administrator for the following payment schedule: (Month) $__________ (Month) $__________ (Month) $__________ (Month) $__________ Any changes to this payment plan must be agreed upon with the Sought Out office administrator. I agree that if I leave or am asked to leave LIGHT, I will pay the full tuition for the entire LIGHT program. I agree to pay LIGHT the full balance of any tuition that is outstanding at the time of my withdrawal/dismissal from the program. ______ Initial I acknowledge that I have read and full understand the terms of this contract. I will fully abide by its terms. ____________________________________ Signature ____________________________________ Print Name __________________ Date