Body Brave Groups/Workshops Informed Consent Form (Mandatory for All Clients)


Terms of Acceptance

Online and in-person group therapy and educational workshops are a unique environment in which a group of people who are likely experiencing similar difficulties come together to both give and receive help from one another. Body Brave attempts to create an environment where honest, interpersonal exploration will occur that will benefit all members. In order to create this environment, there are certain guidelines that need to be agreed upon by each participant.

Confidentiality

Groups and workshops are effective because individuals feel safe to share private information in a confidential atmosphere. It is important that every member of the group agree to uphold the confidentiality of the therapeutic setting. Members agree to keep names and identities of other group members confidential. Facilitators will discuss a group or individuals in the group only with fellow professionals who are clearly concerned with the group, and then only for professional consultation. If a member of the group has a therapist from outside Body Brave and there is need for consultation, it is important to note that only the individual’s information that made the request will be identified; all other group members’ information will be de-identified and kept confidential.

All group/workshop materials and content are confidential. Please do not share, photocopy, record, screenshot, video tape or audio tape sessions unless agreed upon for therapeutic purposes.

Confidentially may be breached by the groups facilitators under the following situations:

1. It is disclosed that a minor, which is defined as a child who is 16 years of age or younger, has been or is at risk of being physically, sexually, or emotionally injured by another individual;
2. If it is disclosed that one of the group members intends to physically, sexually or emotionally injure another individual; or
3. If it is disclosed that a group member intends to inflict personal injury on himself or herself.

ATTENDANCE

Group therapy is successful (as is any form of therapy) when there is regular attendance on behalf of the participants. If you cannot attend a group meeting, please email us to let us know as soon as possible. In your message please also indicate whether or not it is permissible for us to share why you are absent. Please arrive on time. If you miss and do not call ahead of time 3 times, we reserve the right to remove you from the group.

ACTIVE PARTICIPATION

Members of effective groups actively share thoughts, reactions and feelings during group meetings as a way of increasing their self-understanding and contributing to the personal growth of other members. To support that goal, facilitators will strive to establish and maintain a climate of respect within the group. Each member will undoubtedly share in different ways and be comfortable with different levels of disclosure. It is requested that as a participant you share what is comfortable and actively listen and attend to other group members. Participation does not necessarily mean talking. It can also mean listening to what other members have to say. No one will ever be forced to share anything that they are not comfortable sharing.

RELATIONSHIPS

Members agree to primarily use relationships in the group therapeutically, not socially. Group provides an opportunity for learning about one's self in relation to others. If, by chance, members meet outside the group, then it is their responsibility to discuss any relevant aspects of that encounter at the next group session. Group members are asked to refrain from dating or engaging in close friendships with other members of the group while group is ongoing.

Withdrawal

Starting a new group can be difficult and even awkward at first, thus Body Brave requests that you please attend a minimum of three sessions before deciding to quit group therapy. Members will let the group know in advance if they are leaving the group. Group participation is on a voluntary basis. If you or the group leader(s) determines that group is not serving your needs, you will be referred to other options.

ONLINE SESSIONS

All of Body Brave’s online workshops and groups are conducted using the Ontario Telemedicine Network. OTN is also committed to protecting personal health information consistent with the requirements of the Personal Health Information Protection Act, 2004. To learn more about OTN’s commitment to privacy, visit: https://otn.ca/about-us/privacy/

Signing below means that you agree with the guidelines and will do all in your power to uphold them. Should it be discovered that you are in breach of any of the policies above, facilitator(s) and/or other group members may ask that you terminate your participation in group therapy.  

ELECTRONIC SIGNATURE *
ELECTRONIC SIGNATURE
Please type your first and last name
ACCEPTANCE CHECKBOX *
Date *
Date