Support Groups & Workshops Informed Consent Form

Welcome to Support Groups & Workshops by The Divine Catalyst, LLC!

Please read through the information below and feel free to ask your questions about our sessions and/or anything about this group. Once you are ready to participate, please sign this informed consent form below so we will have on our records that you have read the information and that you have been properly informed about the support group.

WHAT ARE SUPPORT GROUPS & WORKSHOPS ABOUT?

Support Groups and Workshops are a unique kind of therapeutic environment  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. These groups and workshops are educational in nature and provide peer support, psychoeducation and skill-building.

We are to 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. Support groups should not be confused with clinical treatment or as a substitute for psychotherapy. 

 

CONFIDENTIALITY

The facilitator will make every reasonable effort to protect your confidentiality consistent with professional ethics and applicable law. However, confidentiality cannot be guaranteed because other group members are not legally bound by professional confidentiality standards.

All participants are expected to respect and maintain the privacy of other members by not disclosing information shared during group sessions.

Confidentiality may be broken when required by law or ethical obligations, including but not limited to:

• Imminent risk of serious harm to yourself or another person.
• Suspected abuse or neglect of a child, older adult, or vulnerable adult.
• Court orders or other legal requirements.
• Consultation with clinical supervisors as part of the counselor-in-training’s supervision process while protecting your privacy.

CONDUCT AND RELATIONSHIP

Participant Responsibilities
As a participant in this support group, you agree to actively contribute to maintaining a respectful, safe, and supportive environment. You are responsible for: 

• Treating all members with dignity and respect.
• Maintaining the confidentiality of information shared by other participants outside of the group.
• Refraining from harassment, discrimination, threats, intimidation, stalking, or abusive behavior toward any group member or facilitator.
• Respecting personal boundaries and avoiding unwanted contact with other participants during or outside of group sessions.
• Taking responsibility for your own decisions, behaviors, and actions occurring outside of scheduled group meetings.
• Informing the group facilitator if you experience concerns regarding safety, boundaries, or interactions with another member.

Failure to follow these expectations may result in removal from the group if continued participation could compromise the safety or therapeutic welfare of others.

COUNSELOR IN-TRAINING DISCLOSURE AND INFORMED CONSENT

Andrea Mathlin, BA Psy. also known as Michelle via social media is a Master's degree student pursuing licensure in Clinical Mental Health Counseling according to Florida State Law. She is NOT licensed as of yet and is scheduled to become licensed in July 2027. In her professional experience; she has worked as an activities therapist and a therapist/discharge planner on crisis units in a psychiatric hospital under clinical supervision for two years prior to starting her masters degree. For the last two years she has worked as a social worker/asst. director of social services within the geriatric population, and facilitating support group with psychologist Dr. Antonio Anglero, grief support groups, and in collaboration with the Alzheimer's Association; Caregiver Support group. 

WHAT TO EXPECT

Nature of the Support Group

Offered Virtually for 1 Hour via ZOOM SESSIONS ONLY: Check your email for the link! Sign in 15 mins prior to start time.

Please sign and pay to secure your place in group 2 hrs before the scheduled time in order to receive the link in time.

The Facilitator is not responsible for late check ins, you may have to attend the next scheduled session if you are late.

This group is intended to provide education, mutual support, skill development, and opportunities for personal growth. Although therapeutic benefits may occur, participation does not guarantee specific outcomes, symptom improvement, or resolution of personal concerns.

Participation is voluntary, and you may withdraw from the group at any time. The facilitator may also recommend withdrawal or termination from the group if continued participation is not clinically appropriate or presents a risk to yourself or others.

Risks of Participation
Participation in a support group may involve emotional discomfort, increased awareness of difficult experiences, interpersonal conflict, or emotional reactions following discussions. While every effort will be made to foster a respectful and supportive environment, interactions among participants cannot be completely controlled or predicted.

For Emergencies:

What is Crisis?

Crisis= SI/HI (suicidal ideations/homicidal ideations with or without a plan) +/- AVH (auditory/visual hallucinations).

If you are in need of immediate assistance or are in crisis, please contact:

988 Suicide & Crisis Lifeline: Dial/Text 988

Harbor House of Central Florida: 407-886-2856

Florida Abuse Hotline: 1-800-96ABUSE or 1-800-962-2873

*Call 911 or go to your nearest Emergency Department/Room*

 

CONSENT

Professional Supervision
The group is facilitated by a Counselor-in-Training under the supervision of a licensed clinical supervisor. Information discussed during group may be reviewed with the supervisor for educational, clinical, and ethical purposes. Reasonable efforts will be made to protect participant privacy during supervision.

Responsibility for Personal Decisions
Participation in this group does not replace emergency services, medical care, psychiatric treatment, or individual counseling when those services are clinically indicated.

Each participant remains solely responsible for personal decisions, behaviors, and relationships occurring outside of group meetings. The facilitator is not responsible for participants’ independent actions, communications, or interactions that occur outside scheduled sessions. Participants are encouraged to exercise sound judgment and seek appropriate professional or emergency assistance when needed.

By signing below, I acknowledge that:

• I have read and understand this informed consent.
• I have had the opportunity to ask questions (see note to facilitator below).
• I understand the potential benefits and risks of participation.
• I understand the limits of confidentiality.
• I understand that participation is voluntary.
• I agree to follow the expectations established for maintaining a respectful and safe group environment.