Informed Consent for "Maintaining Balance" Group Therapy Sessions

Welcome to Group Therapy!

Please read through the information below and feel free to ask your questions about our sessions and/or anything about us. Once you are ready to participate, please sign this informed consent form below so we will have on our records that you have read the information and that you have been properly informed about the therapy.

WHAT IS GROUP THERAPY 

Group Therapy is a unique kind of therapy where a group of people who are likely experiencing similar challenges in the period of their lives gets together to share their difficulties which as a result give and at the same time, receive help from each other. We make sure to maintain a safe environment that is conducive both for sharing and accepting each other where each can grow and trust one another and where each and everyone will feel respected and valued. Group counseling can be a powerful and valuable environment for healing and growth. It is the desire of your group therapists that you reap all the benefits the group has to offer. To help this occur, groups are structured to include the following elements: A safe environment in which you are able to feel respected and valued as you work, an understanding of group goals and group norms and an investment by both your therapist and members to produce a consistent group experience.

Permission to Video Record and Share Recording 

We are requesting your permission to record the group therapy session and post the recording on the Lartey Wellness Group social media accounts. The purpose of the recording is to provide educational resources for people in need of mental health services. Be be advised that by law we will need to share the with appropriate authorities the following occurrences: Threatening one's self or another that may result in physical harm; An act of physical or emotional abuse against a child or any person; Sexual abuse against a child where the child is living with the abuser; Whenever we are summoned by court order to disclose information against a participant. However, we shall notify you and let you exercise your privilege in the right to deny the disclosure of your records with us. Your prior written consent to release records.

ATTENDANCE

Your presence in the group is highly important. A group dynamic is formed that helps create an environment for growth and change. If you are absent from the group this dynamic suffers and affects the experience of you and other members of the group. Therefore, your therapist (s) would ask that you make this commitment a top priority for the duration of the group. It is understood that occasionally an emergency may occur that will prevent you from attending group. If you are faced with an emergency or sudden illness, please contact your group therapist (s) before group begins let them know you will not be present. Because it usually takes several group sessions for clients to "settle in" and receive the full benefits a therapy group provides, we ask incoming members to make an 8 week commitment. If for any reason you will not be able to complete group, we are asking for a week notice so that you and other group members may have some closure with this group. If the group member can not make the start date of the group series date, the member may start on the 2nd date. 

FEES 

Group sessions are free of charge, however, a brief individual intake session is required for group participation.  

AFTER-HOURS EMERGENCIES 

In the event of a psychiatric emergency, please CALL 911 or go to the nearest Emergency Room of your nearest hospital and ask to be evaluated by the psychologist or psychiatrist on call. Mental Health Hotline numbers include 211 (Maryland’s State-wide Information and Referral) and 1(800)-422-0009 (Maryland Crisis Hotline). For less urgent matters or scheduling  issues, please contact Lartey Wellness Group by phone at 1 (800) 994-5403. 

INFORMED CONSENT TO TREATMENT

I have read, understood, and had the opportunity to ask questions, and I agree to the above conditions and  policies. I agree and consent to participate in behavioral health care services offered and provided by the Lartey  Wellness Group. If the patient is under the age of eighteen or unable to consent to treatment, I attest that I have  legal custody of this individual and am authorized to initiate and consent for treatment and/or legally authorized  to initiate and consent to treatment on behalf of this individual. I also permit the use of a copy of this signed  authorization in place of the original. Please return the following form to ensure your placement in the group.