Important  

ACT Study Group for Professionals 

Informed Consent and Agreement 

Effective date: Dates of the group you are attending.  

Informed Consent for Each Professional Attending the Group  

While this study group may implement psychological concepts, it is intended as a forum for study, not therapy. If you have a mental health condition you are struggling with, please seek professional care. If you are already in therapy, what you learn here may be a nice complement to the work you are currently doing with your therapist. Please consult with your clinician. My hope is that anyone engaging in this group will benefit both professionally and personally.   It is impossible to predict what your internal experiences will be as you delve into the personal reflection process that is encouraged in this group setting.  Everyone's personal history is unique; and therefore, your response to looking within will also be unique. Most people benefit from this process. Should you feel overwhelmed, please take care of yourself.  Reach out to Doris for guidance on what to do next.  

Agreement with Each Professional Attending the Group  

I understand I am ethically bound to protect the privacy of any individual in this group who divulges private information.  I further understand that to receive CE credit for this group, my video must remain on for the duration of each meeting, and I must remain in a fixed location (not driving or walking around).   

Informed Consent for Real-play or Role-play Participation

Acceptance and Commitment Therapy (ACT) is not easily described in general statements. Responses to this modality can depend on the personalities of the therapist and the client, and particular problems brought forward by the individual. Remembering unpleasant events and becoming aware of feelings attached to those events may evoke strong emotions. The ACT experience can also depend on willingness to engage in the process, which may, at times, result in considerable discomfort. Even so, individuals also often have pronounced, positive powerful experiences. ACT can have both benefits and risks. Since the real/role-play experience can involve addressing unpleasant aspects of life, you may (or may not) experience uncomfortable thoughts and/or emotions. If your personal reactions are difficult for you to handle, we should discuss these concerns whenever they arise. If challenges and/or questions arise and persist after such an ACT experience, please communicate those challenges/questions during the session or reach out for a phone consultation or for an additional appointment with Doris Curry, LCSW.

Agreement with Group Participants

By voluntarily participating in this Study Group, I hereby authorize Doris Curry, LCSW of Sage-Heart Counseling PLLC and attendees to discuss details of my case during this professional study group setting for educational purposes. I also understand that professionals who will view this interaction are bound by professional ethics not to disclose any information about me or my circumstances outside this study group situation.  I further understand that Doris Curry and other professionals who will view or discuss particulars of my case will hold this interaction with respect and care. I have the right to deny participation at any time, and I am free to choose my level of participation. I have the right to change my mind at any time without pressure to participate.  BY ENROLLING AND PARTICIPATING IN THIS STUDY GROUP, I AM INDICATING I UNDERSTAND, ACCEPT AND PLEDGE TO UPHOLD ALL OF THE AGREEMENTS SET FORTH IN THIS DOCUMENT.

Contact Me 

If you have any questions or concerns about this document, please contact me: 
By email: doris@sage-heart.com 
By phone: 910.491.4277