Please Read and Sign Below
Hardwired For Security
Group Confidentiality and Informed Consent
Group work is a unique relationship in which a group of people come together to both give and receive help from one another, to see each other and be seen. Hardwired For Security Consultation Services Inc. attempts to create an environment where honest, interpersonal exploration will occur that will help each person grow in their life outside of the group: becoming more secure, more capacity for closeness in relationships, healthier self-esteem, higher capacity to handle the storms and challenges etc... In order to create this environment, there are certain guidelines that need to be agreed upon by each participant.
LOVING INTENTION AND SAFETY:
SAFE and SACRED
Sacred: In order to create a safe environment, everybody who joins this group is making a commitment to be a person who is deeply caring and respectful of all members in the group. This is a scared space where we are learning to find our true self and true other and get them to be more present!
Safe: No violence. Learning to express vulnerable emotions is encouraged, but obviously if anger flares to an extent that it feels unsafe, or if a person is overwhelmed with feedback, it is the responsibility of the person(s) feeling overwhelmed to ask for a pause for themself, the group, or the other person and members will remove themself as needed to calm themselves down or to support the feelings of safety within the group. This should not be seen as a failure, but in fact a win, because we are learning to do the hard work of vulnerability, of experiencing acceptance in the midst of our raw and messy self, of setting boundaries, of communicating our needs in the heat of a moment-no better place to learn. But, this loving intention and commitment to safety for all group members is essential. This group is guided by the quote by the mystic poet Rumi: “Out beyond ideas of wrongdoing and right doing, there is a field. I’ll meet you there.” To truly accept and respect the person wherever they’re at, and to recognize we are all on the journey of becoming more the person that we are meant to be in word and deed.
CONFIDENTIALITY
Group work is effective because individuals feel safe to share private information in a confidential atmosphere. It is important that every member of the group agree to uphold the confidentiality of the therapeutic setting. Members agree to keep names and identities of other group members confidential unless they have gotten their explicit permission and in the case of a facilitator, an authorization form will need to be filled out. On-Line sessions you are expected to have adequate privacy in order to respect confidentiality of members of the group.
LIMITS ON CONFIDENTIALITY/MANDATED REPORTER
The importance of confidentiality when sharing vulnerably about our lives is essential. As someone who has a clinical practice, I understand the importance of this and deeply respect the sacred responsibility of keeping confidential what people share with me under my consultation services. Although I utilize notes to track important themes and issues being worked on, the records I keep are limited to the most basic aspects such as name and date of appointments.
The limits to confidentiality include:
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If I have reasonable cause to believe that a child has suffered abuse or neglect, the law requires that I file a report with the appropriate government agency, usually the department of social and health services. Once such a report is filed, I may be required to provide additional information.
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If I have reasonable cause to believe that abandonment, abuse, financial exploitation or neglect of a vulnerable adult has occurred, the law requires that I have to file with the appropriate government agency, usually the department of social and health services. One such a report is filed I may be required to provide additional information.
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If I reasonably believe that there is an eminent danger to your health or safety or if any other individual I may be required to take protective actions. These actions may include notifying the potential victim, contacting the police, seeking hospitalization for you and or contacting family members or others who can help provide protection.
If such a situation arises, I will make every effort to fully discuss it with you before taking any action and I will limit my disclosure to what is necessary.
While this written summary of exceptions to confidentiality should provide help in informing you about potential problems, it is important that we discuss any questions or concerns that you may have now or in the future. The laws concerning confidentiality can be quite complex, and I am not an attorney. And situations where specific advice is required, formal legal advice may be needed.
Attention Health Care Providers:
As a result of state regulation adopted by the Washington state Department of health in 2008 I am required to report myself or another healthcare provider in the event of final determination of unprofessional conduct, a determination of risk to patient safety due to a mental or physical condition, or if I have actual knowledge of unprofessional conduct by another provider, regulated by the department of health, that constitutes a clear and present danger. Upon request, a copy of this law can be made available. If you have any questions or concerns about how this law might affect your consultation services, please let me know.
PAYMENT
Sliding scale; $155/month (minimum) $255/month (maximum) is due by the first meeting of each 4 week period and you are committing to three months participation. This helps in terms of the culture and values of the group which impacts each person’s experience.
ATTENDANCE
Group work is obviously more successful when there is regular attendance on behalf of the participants. If you cannot attend a group meeting, please communicate to let your group know as soon as possible. Please arrive on time-the flow of group is significantly impacted by people coming in late! Please be there before 4:15pm. Obviously things can come up, just do your best to be on time and let your group know if you are having difficulty. Members are agreeing to a 3 month commitment in order to avoid to much coming and going.
ACTIVE PARTICIPATION
Members of effective groups actively share thoughts, reactions and feelings during group meetings as a way of increasing their self-understanding and contributing to the personal growth of other members. To support that goal, facilitators will strive to establish and maintain a climate of respect within the group. Each member will undoubtedly share in different ways and be comfortable with different levels of disclosure. It is requested that as a participant you share what is comfortable and actively listen and attend to other group members. Participation does not necessarily mean talking. It can also mean listening to what other members have to say. No one will ever be forced to share anything that they are not comfortable sharing. Though you may be challenged, group members should know that it is imperative that they know they are free in the group and not obligated to be a certain way.
RELATIONSHIPS
Members agree to use relationships in the group therapeutically. Group provides an opportunity for learning about one's self in relation to others. If, by chance, members meet outside the group, then it is their responsibility to discuss any relevant aspects of that encounter at the next group session. Group members are asked to refrain from dating other members of the group, therefore if romantic interests are developing, it would be important for one of the pair to step-back from the group.
WITHDRAWAL
Starting a new group can be difficult and even awkward at first, therefore we request that you please attend a minimum of four meetings before deciding to stop participating in the group. You are making a commitment of three months but even if you have extended beyond that please let the group know in advance if you are leaving the group. Preferably one month notice. At the end of the day though, group participation is on a voluntary basis. If you or the group leader(s) determines that group is not serving your needs, you will be referred to other options.
Signing below/or on website and checking box, means that you agree with the guidelines and will do all in your power to uphold them. Should it be discovered that you are in breach of any of the policies above, co-leader(s) and/or other group members may ask that you terminate your participation in Hardwired for Security Group Work.
ON-LINE SESSIONS
Some groups meet on-line and over the summer all groups go on-line for some of the weeks to provide for continuity. On-line sessions utilize Zoom and it is important that you have a good signal for these sessions, so do your best to assess your signal in advance to make sure you are in a location that will function properly in order to avoid frustration on your own part and group members.
Not Mental Health Therapy
Signing below means that you agree with the guidelines and will do all in your power to uphold them. Also, that you understand that this is not mental health counseling: I do not medically diagnose or prescribe treatments in this part of my work. If you have a medical condition I ask that you be in the care of a licensed medical professional. I do not advise the discontinuation of any medical treatment/therapy that you are receiving at present. This work can be used as an adjunct to any medical treatments and therapy that you require.