Experiential Workshop Informed Consent

Informed Consent for Experiential Training

Overview: This Agreement outlines the expectations for participants in experiential therapy workshops hosted by Personal Odyssey Counseling Services, LLC in Pennsylvania. Participants are expected to read and agree to this document before registering for workshops. If you have any uncertainties or concerns with information in this document, please contact the facilitator. Please note that experiential workshops will include both didactic and experiential learning components. The learning structures of this workshop include experiential processes which often include (optional) personal disclosures from participants. While personal growth is often a byproduct of experiential learning, the primary purpose of our training workshop is learning. If you are seeking a workshop for personal growth, or seeking a professional training event that is entirely didactic (lecture/PowerPoint), these are probably not the best workshops for you. These workshops will include didactic teaching segments, experiential demonstrations and role-playing components, didactic teaching segments, personal sharing, and a processing of the training elements.

Voluntary Participation: At any time, you have the right to discontinue your participation.

Agreement to Group Guidelines: Participants agree to abide by expectations and group guidelines of this workshop, which include:

Preserving the privacy and confidentiality of other workshop group members’ disclosures

Respecting time boundaries by arriving on time and attending the full session (unless coordinated with trainer previously or due to emergency)

Maintaining respect for all participants of the training, regardless of identity

Participating in a manner consistent with ACA code of ethics (in addition to the code of ethics of your profession) while maintaining an atmosphere of professionalism

Confidentiality:

I agree to maintain confidentiality for any personal disclosures of other participants, as well as any information shared about their clients, students, or organizations.

I understand that the facilitator and participants have committed to preserve the privacy and confidentiality of participants’ disclosures but that there may be risks to confidentiality in group settings.

I understand that I can choose how much to disclose, what to disclose, and how I make disclosures about myself and/or my clients.

I understand that the trainer, as well as many participants, are required by law to take protective action, even if it means breaking confidentiality, in certain circumstances related to court orders or subpoenas, suspected child abuse, elder abuse, suicidality, or threats of harm to others.

Ethical Practice and Scope of Competency: Participants are expected to adhere to ethical guidelines applicable to their field of practice, certification, and licensure. Furthermore, students are expected to recognize that the experiential methods taught and demonstrated in these workshops are powerful tools which can support healing but also cause great harm when used outside the scope of one’s competency, training, or practice. Participants agree to use methods at their level of training under supervision and with ongoing communication with their trainer(s) and/or supervisor(s).

Informed Consent Agreement

I understand that I am choosing to participate in an experiential workshop event that may include physical and emotional exercises where some/minimal risk is involved

I understand that I can choose how much to participate (or to observe) any experiential process included in the training workshop.

I affirm that I do not have any physical, emotional, or psychological condition that may prevent me from participating in experiential therapy training.

I understand that experiential methods may elicit personal and emotional issues and that this is a training group, not a therapy group. I agree to seek outside psychological support/treatment if necessary.

I understand that while the trainer will do their best to monitor the physical/emotional state of participants, it is ultimately my responsibility to take care of myself.

I agree to refrain or decline any activities that could be overwhelming emotionally or risky physically for me based on my physical, emotional, and psychological state.

I understand this training agreement and I assume the risk and responsibility for any injuries arising out of my participation in this experiential training workshop.

Waiver: I recognize that experiential therapies may provoke intense emotions and may involve physical movement. I hereby waive any responsibility of the workshop trainer/organizers, Ana Lukaszczyk, and Personal Odyssey Counseling Services, LLC for any possible emotional or physical injury I might sustain due to my participation in the workshop.

Informed Consent for Participation:

I agree to participate in this experiential therapy training event. I fully understand my rights, expectations, and the scope of the workshop outlined above.

By registering for a workshop, you are assuring that you understand the terms and conditions of this Agreement, and that you provide your consent to participate.