Informed Consent & Release Form

Bay Area Moreno Institute

Sylvia Israel LMFT, RDT/BCT, TEP

Practicing Self-Compassion with Psychodrama

Informed Consent & Release Form

Consent to Participate in Psychodrama Workshop: This psychodrama workshop is designed for mental health professionals and students and those interested in human growth, to offer knowledge and experience in psychodrama and related action methods, and to develop and enhance competencies in the practice of psychotherapy and psychodrama

Because of the experiential nature of psychodrama, it is likely that personal issues may arise during the workshop. Participants will have the opportunity to do personal work in the workshop, but it will be primarily within the context of exploring concepts related to the roles of: psychodrama director, protagonist, auxiliary ego, and audience. The workshop uses the triadic system of psychodrama, sociometry and group psychotherapy.

Agreement Regarding Ethical Practice/Practice within Scope of Competence:

For practitioners: When implementing any of the methods I learn in this workshop, I agree to follow all ethical guidelines applicable to my field of practice. Moreover, whenever implementing psychodramatic methods, I agree to follow the ethical guidelines in the American Psychological Association’s (APA) Code of Ethics.  The APA Code of Ethics can be found at:  http://www.apa.org/ethics/code/

I further agree to use psychodrama, sociometry and related action methods only in the best interests of my clients, patients, students, or other service recipients, and to use the techniques within the scope of practice commensurate with my level of experience and proficiency.

Confidentiality Agreement:

• I understand that in the course of psychodrama training, I may be exposed to personal information about the trainer and participants. I agree to hold this information in confidence, as I would any private information shared in the context of a professional relationship.

• I understand that I am always in control of my own disclosures, including what I choose to share, under what circumstances and the way in which I choose to share it.

Informed Consent Agreement:

• I understand that I am enrolling in a workshop that will involve physical, emotional and psychological activities and that, in as in all such undertakings, there is always some risk involved.

• I understand that I am under no obligation to assume any role or participate in any psychodrama or other experiential activity that I choose not to.

• To the best of my knowledge, I have no physical, emotional or psychological condition that would preclude me from participating in training in psychodrama, sociometry, group psychotherapy and related action methods.

• I understand that I am under no obligation to provide personal information that I choose not to disclosure to the trainer or to the other group members.

• I understand that personal issues will inevitably come up during the course of this or any other intense, experiential training. I also understand that the workshop/training is educational in nature and will not adequately address personal issues.

• I understand that psychodrama and related experiential approaches sometimes involve physical contact and touch. I understand that I always have the right to refuse or decline to be touched during any workshop/training activities.

• I understand that the trainer cannot always monitor my physical, emotional or psychological state, and I am responsible for assessing the risk that any activity poses for me and for choosing a safe course of action for my self-care.

• I understand that I can always choose to refrain from or decline any activity that might become overly stressful or risky for me.

• I understand that psychodrama is a powerful method for change, growth, and learning, and that personal issues may emerge during the course of this workshop.  I hereby waive any responsibility on the part of Bay Area Moreno Institute, Sylvia Israel, or any of the student directors for any possible emotional injury I might sustain pursuant to my participation in the workshop/training.

CONSENT TO TRAINING AGREEMENT:

By my signature below, I affirm that I have read this Informed Consent & Release Form and I agree.  I voluntarily give my informed consent to participate:

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