Group Participation Agreement

Texas State University Counseling Center

Group Participation Agreement

 

Based on our experience with groups, the best way to create a safe environment for learning and personal growth is for you to understand and to agree to these guidelines.

 

  1.   Confidentiality

 

The Texas State Counseling Center adheres to professional, ethical, and legal guidelines of confidentiality.  Confidentiality within a group setting is the shared responsibility of all group members and the group facilitators.  Although a group leader will not disclose client communications or information except as provided by law or in other limited circumstances, group members’ communication and information shared within group are not legally protected.  This agreement is an attempt to provide you and your fellow group members with as much confidentiality protection as possible.

 

I agree not to disclose the identity or any identifying information of any other group members.  Nor will I discuss personal information that other group members have disclosed outside of group. I understand that I may tell others that I am attending this group, and that I may share my personal group experiences.  This includes my personal reactions (feelings and thoughts) to my group experience, feedback from other members concerning myself, and any personal information about myself such as new skills I have learned and changes I have made.  I am also aware that if I break confidentiality, I may be asked to leave the group.  Student’s initials _______

 

II. Risk to Self or Others

 

At times, members may experience a personal crisis that leads them to have suicidal or homicidal thoughts. If these thoughts, feelings or impulses are experienced it is important that you share them with the group or the group leaders to ensure you get the support and treatment you need.

 

I agree to share any suicidal and homicidal thoughts, feelings, and impulses with the group or group leaders.  Student’s initials ________

 

III. Telehealth requirements

 

  • You may only engage in sessions when you are physically in Texas. Your clinician will confirm your location at each session.
  • You must use a device that allows you to be seen and see multiple others on video (either a computer or other mobile device that allows Zoom to be viewed in gallery view).
  • You and your clinician will engage in sessions only from a private location where you will not be overheard or interrupted.
  • You will use a device and/or wi-fi connection that is secure (not accessible to the public) and ensure that the device has updated operating and anti-virus software.
  • You and your group clinician(s) will not record any sessions.

 

I agree to all of the above telehealth requirements. Student’s initials ________

IV. Respect for Others

 

I agree to be respectful of others in the group, inclusive of differences in ethnicity, race, nationality, gender identity and expression, sexual orientation, religious beliefs, political beliefs, age, etc.  If I unintentionally say something that hurts or offends another group member, I will be open to feedback.  Student’s initials _________

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  1. Attendance

 

Although we understand that making this commitment can be difficult, group members are expected to make a commitment to attend all group session.  Members also agree to arrive on time every week. If you are running late or have an emergency/illness that prohibits you from coming to group, we ask that you call the Counseling Center at (512) 245-2208 before group. 

 

Members often feel anxious about participating in groups and seeing the results can take time. If you are in a group that meets the entire semester and find that the group experience is not as you expected, we ask that you attend at least 3 sessions before making a decision to leave.  If you decide to end you participation, we ask that you let the group know you are leaving. Our experience is that members will begin to care about one another and will feel unresolved if you leave without any explanation.

 

V. Relationships with Other Members

 

Some group leaders may ask that you not form social relationships with group members during the duration of the group.  There is a reason for this group norm.  If some members are meeting socially outside of group it changes the dynamic of the group process and interferes with the personal growth members experience. If you do have contact with someone outside of group (i.e., spend time together beyond a casual greeting), we ask that you share that contact with the group at the next meeting.

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  1.   Active Participation

 

Members are not required to talk in group, but we know that the more you participate, the more benefits you will receive. The only time we ask that you do speak is when a new member is added to the group and introductions and goals for group are shared. Group members and/or other leaders may check in with you and ask you to share from time to time if you are quiet.

 

I agree to all of the above requirements. Student’s initials ________

 

Enter your TXST ID number (A0…):_______________________

 

 

 

_________________________________      __________________________________               

Printed Name of Participant                           Signature of Participant                      Date

 

 

__________________________________    __________________________________