Group Members Statement of Confidentiality

As a member of psychology 447/547513/514 course in group psychotherapy & psychodrama, I will not divulge any confidential information which comes to me through the psychodramatic warm-ups, psychodramas, sharing sessions and sociometric intervention. This shall include:

• not discussing any information pertaining to any group member with anyone (including my own family), roommates, significant others or any other person(s) not a member of this group.
• not reviewing any video-tape recorded from this group (or any other psychodrama group) with one's own family, roommates, significant others, or any other person(s) not a member of this group.
• not discussing any information pertaining to any group member in any place where it can be overheard by anyone not directly involved with the group.
• I will not contact any individual or agency outside of West Chester University to get personal information about any group member.
• I will not release any information, in writing or orally, regarding any group member to any person(s) or agencies. I understand that in extreme circumstances, such as medical emergencies, it may be necessary to release information to a health care giver without the group member's consent.
• I understand that violation of these confidentiality principals could potentially result in my termination as a group member, potential graduate or graduate candidate for the Master of Art's degree in Clinical Psychology or any undergraduate student at West Chester University. Further, breaching of confidentiality may subject me to civil or criminal liability.

Signature of Student ____________________Date_________________

Signature of Instructor _T.Treadwell_________Date_________________