Group Therapy Confidentiality Form

I, the undersigned participant, understand and agree to the following terms and conditions regarding the confidentiality of information shared within the group therapy sessions:

Purpose of Group Therapy:

• I understand that the purpose of the group therapy sessions is to provide a supportive and confidential environment for individuals to explore and discuss personal and sensitive issues.

Confidentiality Commitment:

• I agree to maintain the confidentiality of all information shared by other group members during the sessions.
• I will not disclose any personally identifiable information about fellow group members outside of the group setting.

Limits to Confidentiality:

• I acknowledge that there are legal and ethical limits to confidentiality. Group facilitators may be obligated to break confidentiality under certain circumstances, including:
  • Threats of harm to oneself or others.
  • Suspected child or elder abuse.
  • Court orders requiring the disclosure of information.

Exceptions to Confidentiality:

• I understand that while facilitators will make every effort to maintain confidentiality, absolute confidentiality cannot be guaranteed due to the interactive nature of group therapy.

Group Facilitator Access:

• I acknowledge that group facilitators may have access to information shared during group sessions and will use that information to provide support and guidance within the group context.

Commitment to Privacy:

• I agree to respect the privacy and confidentiality of other group members outside of the group setting. This includes refraining from discussing specific group members or their disclosures with individuals not participating in the group.

Document Storage:

• I understand that any written records or notes related to group therapy will be securely stored by the group facilitator and will not be shared without my explicit consent, except as required by law.

Termination of Group Participation:

• If I choose to discontinue participation in the group, I understand that the confidentiality agreement will continue to apply to the information shared during my participation.

I have read and understood the terms of this confidentiality agreement, and I voluntarily agree to abide by these terms during my participation in the group therapy sessions.