Video Technicians' Statement of Confidentiality

As a camera/video technician for psychology 513/514 course in group psychotherapy & psychodrama, or /447/547 course in interpersonal relationships, it is understood that I will not divulge any confidential information which comes to me through the psychodramatic warm-ups, psychodramas, sharing sessions and sociometric intervention while operating the TV cameras or in the control room operating the switcher . Furthermore, this includes:

• not discussing any information learned 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 a group member's consent.

Finally, I understand that violation of these confidentiality principals could potentially result in my termination as a video/camera technician, group member, and/or potential graduate from West Chester University. Further, breaching of confidentiality may subject me to civil or criminal liability.

Signature of Video/Camera Technician____________________ Date__________

Signature of Instructor_________________________________Date__________