Consent Form Mindfulness Group Therapy
  • Consent Form for Group Therapy

    CREATIVE EXPRESSION MINDFULNESS GROUP
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  • Welcome to Group Therapy!

    Please read through the information below and let us know if you want clarification on any of the topics discussed or if you have any questions that are not addressed here. Once you are ready to participate, please sign this informed consent form below so we will have on our records that you understand and will adhere to the information in this document.

  • WHAT IS GROUP THERAPY

    Group Therapy is a unique kind of therapy where a group of people who are likely experiencing similar challenges in the period of their lives gets together to share their difficulties which as a result give and at the same time, receive help from each other.

    We make sure to maintain a safe environment that is conducive both for sharing and accepting each other where each can grow and trust one another and where each and everyone will feel respected and valued.

  • CONFIDENTIALITY

    You have the right to confidentiality and privacy by the group facilitator and other group members. Confidentiality within the group setting is a shared responsibility of all members and facilitators. While group facilitators may not disclose any client communications or information except as provided by law, group members’ communications are not protected. As such, confidentiality within the group setting is often based on mutual trust and respect. Alder Grove adheres to professional, legal, and ethical guidelines of confidentiality established by professional organizations and state law. Legal and ethical exceptions to confidentiality include:

    • a clear or present danger to harm yourself or another
    • knowledge of the abuse or neglect of a minor child or incapacitated adult
    • responses to a court subpoena or as otherwise required by law

    As a member of this group, it is your responsibility to not disclose to anyone outside the group, including on social networking websites, any information that may help to identify another group member. This includes, but is not limited to, names, physical descriptions, biological information, and specifics to the content of interactions with other group members.  

  • GROUP GUIDELINES

    • Group sessions last about an hour. An Alder Grove therapist or intern will facilitate the group.
    • There are benefits and risks to groups. Potential benefits include increased healthy habits, improved communication and stability in relationships, and lessening of distress. Some potential risks include increased uncomfortable emotions as you self-explore, and changes in dynamics or communication with significant people in your life. Although there are many benefits to groups, there is no guarantee of positive or intended results.
    • We may at times seek consultation with other therapists to ensure we are helping you in the most effective manner. We will give information only to the extent necessary, and we make every effort to avoid revealing the identity of clients. The consultant is also under a legal and ethical duty to keep the information confidential.
    • We reserve the right to end group services for a participant in certain situations, including but not limited to violence, threats, or harassment towards us or other members of the group or not protecting the confidentiality of other participants.
    • This group is not a replacement for individual treatment. If in crisis, group members need to reach out to their individual therapist, dial 911, or go to their nearest emergency room.
    • We ask that if you are not feeling well that you not attend the group. The group facilitator can send you a brief summary of the group session over email.
  • SOCIAL MEDIA POLICY

    • In order to maintain your confidentiality and our respective privacy, we do not interact with current or former clients and group members on social networking websites. We do not accept friend or contact requests from current or former clients and group members on any social networking sites including Twitter, Facebook, LinkedIn, etc. We will not respond to friend requests or messages through these sites.

     

    • We will not solicit testimonials, ratings, or grades from clients on websites or through any means. We will not respond to testimonials, ratings, or grades on websites, whether positive or negative, in order to maintain your confidentiality. Our hope is that you will bring concerns about our work together to the therapy session so we can address concerns directly.

     

    • Please do not send the group facilitator emails with significant clinical issues. These are not secure communications, and there is a possibility that we will not get the message in a timely manner, or that communication will be interpreted in an unclear manner.
  • WHAT TO EXPECT

    Exploring different techniques to reduce anxiety through art and self-expression.


    *breathing techniques

    *visualization

    *painting with watercolors

    *creating individual handmade journal

    *body movement exercises

    *meditation

     

  • CONSENT

    I agree to adhere to the norms and expectations for group therapy as indicated above. I acknowledge that I have had the opportunity to ask questions and such questions were answered clearly and to my satisfaction.

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