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Consent Form

I understand that I am about to experience a technique known as “Holographic Memory Resolution®.” It is my understanding that HMR is an educational process and therapeutic approach that is currently in its research and developmental stages, and, as such, has not completed formal empirical testing. I agree to undergo this practice by my own choice, recognizing that HMR does not constitute “medical” diagnosis, a medical practice or procedure. I understand that the stress/trauma resolution techniques employed do not supplant the need for proper psychiatric or therapeutic treatment of personality disorders, physiologically-based conditions and disorders, or primary illnesses such as chemical dependency; I recognize that the efficacy of this method may be influenced by the aforementioned conditions, particularly the use of or dependency upon benzodiazepines – limiting my capacity to effectively apply or benefit from the effects of HMR. I also consent to receive from the facilitator limited physical contact along my upper spine for purposes of providing safety and grounding in order to facilitate the “emotional reframing” of memory. I understand that, as a “body-centered, client-centered” therapy, HMR may enhance my access to previously forgotten or repressed memory encoded during moments of acute stress. I understand that there is a very limited risk of accessing subconscious memory data that will require more intensive therapeutic intervention or follow-up beyond the capacity of the facilitator, at which time I will be directed or referred to the appropriate therapeutic resources for resolution. I accept my own responsibility for the follow-up to these therapeutic recommendations. It is my understanding that HMR functions by providing enhanced access to the data of memory, whether this data is historical, imagined, dreamed, or otherwise acquired. Accepting this “non-intrusive” verbal and tactile procedure, I understand that what I experience with HMR is the product of my own perceptual processes and that the therapeutic data recorded is not a medical or legal record of historical events. Furthermore, I acknowledge that it is not the role, expertise, or authority of the HMR facilitator to verify, interpret, or explain the authenticity of these images, but merely to provide safety, support, and feedback for my own stress reduction and empowerment process.

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HMR® Client Disclaimer

Holographic Memory Resolution® Client Disclaimer: I understand that Holographic Memory Resolution® is a body-centered, client-centered process designed to help me access and, when possible, emotionally reframe memories fostering stress, anxiety and trauma imprinted my body-mind from the past. HMR employs a “clean language” technique to enable me to dialogue and establish safe rapport with somatic and emotional memory to transmit “proof of safety” from the conscious to the subconscious mind. I understand that I will be referred to an appropriate therapist should the level of trauma exceed the session limitations, temporal constraints or skills level of the HMR practitioner. It is my understanding that the following confidential information obtained during therapy and the application of Holographic Memory Resolution® is confidential and that the interpretation, disclosure, distribution, and security of this information are my sole responsibility upon delivery. I understand that the data contained herein is recorded from the clientcentered, body-centered application of verbal interventions and visual imagery employed to educate the body-mind and to reduce somatic stress and tension related to both historical and non-historical sources of imprinting. I understand that it is not the responsibility of the therapist to determine the historical validity of imagery generated during this process and that Rachel Maurice MD and The Maurice Self Help Association are not legally liable for any legal claims generated from the therapist’s or client’s interpretation of the data contained in these reports. The Maurice Self Help Association is not responsible for the subjective interpretations of the data provided whether this is the interpretation of the individual facilitator or the client. The standardization of the recording process may also result in reduction of the reported experience as it was originally articulated or delivered, though accurate reporting and objectivity are always sought. These recording methods were designed to provide an overview of behavioural patterns and somatic imprints that can be used to help reduce the impact of stress and trauma in my daily life. HMR functions with the understanding that, while memory can be historical in origin, it can also be both more and less than “historical” and be somatically encoded in ways that “transcend” a single moment-encoding (archetypal or “Level 2” imprinting), leading to creative subconscious associations and somatic relationships that are broader than the original historical or creative context; such data is often historically unverifiable and is a creative context frequently generated to address multiple instances of stress-encoding at once. Memory can also be less than historical by being only fragmentary and incomplete, whereupon creative processes can be employed to offer a context of resolution, as in the case of “reported” trauma. I fully understand that it is not within the purview or capacity of the therapist-facilitator to determine the veracity of my memories or imagery, but that the creative resources employed in HMR can be used to help educate the body-mind and reduce the impact of such stress and trauma-imprinting. I fully comprehend that HMR “Memory Mapping” is a resource for permitting the mapping of stress and trauma imprinting in the body-mind, whether these sources are of a historical or non-historical nature. I understand that hallucinations and delusional experiences can imprint vividly and traumatically and must often be “reframed” in spite of their bio-chemical or non-historical origins. I agree to keep this document attached to any reports printed in order to offer clarification as to the creative nature of these stress reduction techniques which are designed, not to impact historical memory, but to assist in reducing the “emotional charge” of stored or imprinted memory or imagery. HMR offers a very restricted range of access to the emotional charge of stored imprints, thereby reducing the somatic response to sensory triggers and improving overall health. I understand that the data offered by HMR is the result of a body-centered focusing technique which permits enhanced access to the data of somatic and sensory imprints without affecting historical memory or causing abreaction or relive. It does not involve any formal “induction” as with hypnosis, and its effectiveness can be impaired as a result of the ingestion of memory-impacting medications, particularly “anti-anxiety” medications such as the benzodiazepines. I do not hold the practitioner responsible for the inability of my body and its biochemistry to benefit from the reframing process employed with HMR; “apparent” reframing can occur and be recorded while the biochemistry prevents assimilation of the benefits of HMR. I fully understand the limits of the data being provided and will utilize them only for my own stress-reduction and health care. I grant permission for the placement of one hand on or near Cervical Vertebra 7 (while fully clothed, during in-person sessions) for purposes of “grounding me” in present time and reducing the potential for disassociation during memory access.

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