Group Confidentiality Agreement

When you join a psychotherapy group you will be required to accept and sign the below Psychotherapy Group Contract:


In deciding to become a member of Shari Baron’s psychotherapy group I agree to be responsible for the following contract:

Attendance

  • to initially attend for at least 12 sessions
  • to come on time and stay for the entire session; in the event of necessary absence or lateness, to tell or notify the group in advance

Confidentiality

  • to respect as confidential what goes on in the group. This means that in speaking of this group outside of the meeting room, I agree to do so in a way that protects the identity of other group members, as outlined on the “Working in Group Psychotherapy” description.

Payment

  • to pay for all sessions whether I attend or not

Outside Contact

  • to keep the relationships in the group therapeutic, not social. Interactions that occur between or among members outside of the group are group business and need to be brought back into the group

Termination

  • to let the group participate when I think the time has come to terminate
  • to leave enough time (at least four meetings) to say good-bye and allow for expression of my own and other group members' feelings regarding my leaving, as well as other issues that come up regarding termination, once the decision has been made

Group Process

  • to let other members affect me and be willing to talk openly and honestly about my reactions as I become aware of them
  • to use the group process to work actively on the problems that brought me into therapy and/or problems that are identified in the course of therapy
  • to use a fair share of the time
  • to put thoughts and feelings into words, not actions
  • to arrange for individual therapy sessions when an issue is not amenable to the group process

By my signature below, I indicate that I have read carefully and understand this agreement and that I agree to its terms and conditions. I have asked and had answered any questions I have concerning the agreement and am aware that signing of the agreement is required for my membership in the group. I am also aware that my refusal to sign this agreement will exclude my participation in the group, and that if I breach confidentiality I may be asked to leave the group. 


NAME (printed) ______________________________________DATE_______________


SIGNATURE_________________________________________________ 

image23