Consent for Participation in Corda Groups

We want to welcome you to Corda. It is important that you first review the following information and policies. In order to start the next module, you will need to sign and date these forms and bring them with you to the first group meeting. You may not begin group without these forms in place. Please feel free to ask any questions you may have.

Important Notice: Corda Groups are not group therapy. Instead of therapy, we bring in approaches from life coaching, education, pastoral work, support groups, and from other fields and disciplines. In Corda, we have a training ground for the real hands-on work of loving and being loved. We work on being attuned to each other, really understanding each other and being with each other. And it works. Members are healing. Members are growing.

• Your confidentiality is very important to us. Your facilitator will not acknowledge you as a participant, or share any information with anyone about you without your prior written consent. Should you request that your facilitator speak with another professional or person (i.e. doctors, current or former counselors, spouses, teachers, family, friends or anyone else outside of the group room), your facilitator will first ask for your written consent. It will be at your facilitator's discretion to agree to discuss, consult, or meet with your requested party even with this written release in place as it may not support your growth process to do so.

• A pre-screen phone meeting may be required for all participants before admittance into group.

• What you disclose in Corda groups is confidential. However, there are limits to confidentiality. The facilitators and staff at Corda take confidentiality very seriously. Your information is confidential, with the exception of information relating to child abuse, or suspected child abuse, child pornography, elder abuse, dependent adult abuse, or intent to harm self or others, or unless mandated by a court of law. Legally, facilitators are mandated reporters of abuse or intent to harm another. If you are suicidal or homicidal, your facilitator with Corda will take all reasonable steps to prevent harm to you or another.

  
  

Legal exceptions to confidentiality are in place to protect your safety and the safety of others. This includes: when there is a reasonable suspicion of child abuse (physical, sexual, emotional, neglect), or adult dependent care abuse, elder abuse/neglect; and where a participant threatens to harm or kill other(s) (homicide), or threatens to damage another person's property.

If you are homicidal and make a serious threat to hurt another person(s), your facilitator will contact 911 and make every attempt to warn the intended victim or victims. Additionally, if court ordered to release records (for example a divorce hearing or custody hearing), your facilitator must abide by the court order and may be compelled by court order to testify under oath and thus must answer all questions honestly.

Mandated Reporting of Incidents Involving Minors

A minor is defined as any person who is legally under the age of 18.

Your facilitator is obliged under California law to report to the appropriate authorities any instance where a participant discloses that they have accessed, streamed, or downloaded material through any electronic or digital media depictions where a child is engaged in an obscene sexual act.

Should you choose to disclose that you have accessed child pornography of any kind (currently, recently, or in the past) during any of the following:

• a session with any facilitator employed at Corda

• via your participant consent forms

• an assessment tool that is administered as part of your program, such as the SDI (Sexual Dependency Inventory), or via other assessment tools (such as the SAST or Sex Addiction Assessment Tool) that are administered by facilitators with Corda

• during an individual, group, or couples session in the office

• via email, text, phone, regular mail

• or by any other means in or out of session

The facilitators at Corda do not work with minors as participants.

However please understand that we are mandated reporters of any sexual acts involving minors. This means that if any of the facilitators or staff at Corda learns of any incident involving minors and illegal sexual activity or abuse, we are legally required to report this to the proper authorities.

If you are a parent seeking support at Corda, and discuss with your facilitator your concern over your minor teenager sexting OR exchanging nude or sexual pictures of herself/himself to her teenaged minor boyfriend/girlfriend, your Corda facilitator is mandated by law to report both minors to authorities under AB1775 for "knowingly accessing, streaming, or downloading material where a child is engaged in an obscene sexual act."

Additionally, if you share with your facilitator that your adult child or any identifiable adult (18 years or older) that you are in relationship with is sexting or texting sexual or nude images to a minor (for example an 18 year old son texting sexual images to his 16 year old girlfriend) your facilitator is mandated by law to report this to the authorities.

If you are a spouse or partner seeking support in our women's group and you disclose that your spouse or partner has accessed child pornography, or your minor child or minor teen has texted nude photos with other minors please know that anything disclosed around offending behaviors with minors (a person under the age of 18 years old) is a reportable offense and your facilitator is mandated to report you, your spouse or partner, or your minor child to the proper authorities.

·       Confidentiality when working with others you know: There are occasions where your facilitator from [Corda]{.mark} may provide support for someone you know (a spouse, family member, co-worker or friend) in the [Corda practice]{.mark} -- either for individual, couples, or group support. If your significant other is seen in some capacity within the [Corda practice]{.mark}, boundaries of confidentiality will be upheld on both sides. Thus, what you share in group stays in group and is not discussed with your significant other or acquaintance. If you ask for information regarding a person you know that is also a participant of [Corda]{.mark}, this will not be discussed with any participant unless there is a signed release of information in place from that person.

·       Secret Keeping: If any facilitator at Corda works with you and also works with your spouse/partner/family member/friend in Corda your Corda facilitator will not be placed in the role of a secret keeper.

For example: If you are both in group support, or one person is seen in individual support and one in group, and you reveal a secret that impacts the relationship in a significant way (i.e. an ongoing affair, continued acting out behaviors, risky sexual behavior, etc.) while this information is confidential and cannot be shared without your written permission, we will not be placed in the role of a secret keeper as it impacts the trust in the supportive relationship.

In this case, your facilitator will meet with you after group and discuss ways in which you can share this information with your significant other/family member/friend within a couple's or conjoint session with a signed release. It is also important to understand that if your significant other reveals something in group that he/she/they chooses not to share with you, even with encouragement to do so, a facilitator cannot force a participant to share secrets, no matter how serious, and must uphold confidentiality (unless it falls under the limits of confidentiality as described above). Thus we will not be able to discuss this with you if we work together in individual or group support and also work with your significant other in some other capacity within the practice.

It is important to consider how this could potentially impact your trust in your facilitator at Corda if your spouse or significant other refuses to share with you. If your significant other is not seen at the Corda practice this does not apply to you.

Group Guidelines:

• You agree to be free of drugs or alcohol during group sessions.

• You agree to make arrangements for childcare as this is an adult setting.

• Recording (visually or audibly) in group is not permitted.

• You agree to miss no more than two group meetings per module. Should you miss more than this you will be asked to leave group, and you will be required to pay for the remaining sessions as your space is reserved for you.

If you are unable to abide by the group guidelines, are not able to respect boundaries, or the facilitator's direction and feedback, the facilitator will speak with you to review the group guidelines and policies. If after discussing this with you, you continue to disrupt the group with absences or other disruptive behaviors, you will be asked to leave. A facilitator is under no obligation to keep a participant in group if they do not feel it is in the best interest of the participant or the group process.

• Cell Phones: Due to the sensitive nature of group work, we ask that you turn all electronic devises, cell phones and pagers (this includes ringers, camera or video phones, music tones, and the vibrate, 'buzz' or silent mode, or flashing light mode), in order to respect the process and other group members during the 90 minutes we meet each week.

Some participants use their smart phones for particular group exercises (i.e. to play a song, or read part of the homework, or follow along in the book). However, unless we are reading from the book, or it is your turn to present your exercise, phones are to be turned off and put away. The only exception to this is if you are expecting an emergency call, are a physician on call, or need to be in touch via phone with a family member for medical care, for childcare, or for some other emergency.

• Group sessions are weekly, and are scheduled in advance. Each group session is 90-minutes and begins and ends on time. Please arrive on time to respect the other group members. The group is closed at 8 members held for participants in need. This means that you are agreeing to honor your commitment to the group process for at least 8 sessions. We ask that you miss no more than 2 meetings in a module as this impacts the flow and bonding of group. Typically, we meet for 4 weeks in a row, then take the 5th week off, 4 weeks on, the 5th week off, etc

• Payment: Payment is due at the start of each week for all group meetings within that week, and the number of group meeting within that week will be charged at the start of the week. All payments are non-refundable whether or not you attend group.

• Group Fees: On occasion, Corda may offer a participant a reduced fee. Please respect the privacy of others and use discretion if you choose to discuss your group fee. The group fee is $80 per group member per group.

• Contact: Please respect the privacy of your group members in contacting one another via phone or email. Some group members prefer to maintain their privacy outside of group, while others welcome the contact. The best rule is to ask the group member what they prefer. If you should run into each other in public, please understand that not every group member may welcome contact outside of group depending on their individual circumstances. Please respect confidentiality boundaries. Please respect boundaries around frequent contacting of the group facilitator outside of group.

  
  

• Meeting outside of group: It is up to you if you choose to meet with one another outside of group. While you may bond with some members over others, please consider reducing cliques and exclusivity as part of your group experience. Please keep contact to a non-sexual nature. Please do not gossip or make suggestive statements or negative comments about your fellow group mates or group facilitator. When in doubt, don't.

• Professional Conduct: Each member is welcome to discuss their work in group as it applies to their growth process. However, networking for business or soliciting other group members for business ventures, sales, etc. is not a part of our group work. Please refrain from doing this within group.

• Group Homework: On occasion exercises will be assigned in group. Homework is sent via email and you are responsible for printing and keeping track of your homework. The group facilitator is not responsible for printing services. Some of the exercises may stir up feelings that are difficult for you. You are asked to participate to your comfort level and keep the group facilitator abreast of any difficult or challenging feelings that arise.

If you are triggered by a particular reading assignment or exercise, please set the homework aside until you speak to the group facilitator and/or your own support professional. Each person will have his or her own experience with group assignments. Some members may enjoy a particular exercise, book, article and such, while others may not.

Your honest experience with exercises, assignments, and reading is important and valuable, however, please refrain from making ongoing derogatory statements about the homework or exercises while reflecting in group as this may bring up shame for others, and may impact their willingness to share openly if they had a more positive experience with the homework. A group book will be assigned each module. This is your responsibility to purchase and to stay on top of the reading.

• Profanity or Slurs: Please express yourself appropriately and with limited profanity as profanity may be triggering to certain group members who have early trauma with respect to a parent's or significant others use of profanity. It is understandable that some profanity may occur and the group facilitator makes room for this, however, regular ongoing use of profanity will not be accepted, or language that is vulgar, triggering, hurtful or demeaning to others will not be tolerated.

• Catholic Spirituality: It is important to note that each Corda group is under the guidance of the teachings of the Catholic Church. Participants attending group may be of many different rite or different liturgical preference or stages of faith (cradle, recent convert, lapse). Additionally, some individuals may have spiritual and religious trauma.

• Group Focus: Please respect the boundaries of other group members and the facilitating leader. Corda groups are about growth, insight building, challenging self, and healing. Feedback from group members is to be framed with truth, respect and affirmations. Advice is not feedback. Redirecting back to you is not feedback.

Refrain from behavior that will impede the flow of group such as: complaining at length, sarcastic remarks, tardiness, multiple absences, going on at length, frequent interruptions, challenging other members or the leader in an aggressive manner, silence, passive aggressive comments, refusing to receive or give feedback, negative criticisms, and/or monopolizing time during your share.

• Group Process: This is up to the discretion of each facilitator. We typically start each group with highs and lows of the week. This means that you will be asked to share one high and one low from your week and to be open to feedback from the group. This is not the time to discuss at length all of your highs and lows of the weeks, please choose one of each to bring into group so that each person has a chance to share and to receive feedback and so that the group has time for the exercise processing. If you tend to run over, the group facilitator will ask you to wrap up your share time.

• Group Feedback: The group facilitator will give you feedback both within group and periodically outside of group in order to help support your process. This feedback is an important part of the group experience. When you are receiving feedback, please do not interrupt the group facilitator or another group member. If you are feeling highly triggered by this feedback, please discuss with the group facilitator.

• Completing Group: Because of the bonding aspect of group, if you are unable to finish a module due to an unforeseeable crisis or emergency, we will ask that you attend a final group in order for the other members to have closure. Your fee will stand for the remainder of the group meetings, unless the reason for your early departure is due to a life-threatening emergency or health crisis.

Please note that the group experience is different for each member. Some members may attend 8 weeks and receive the support and growth they need, while others may find that they will attend group much longer than this, some for years. Moving forward into the next module is at the discretion and direction of the group facilitator. If you are not asked to move forward, it is not a negative statement about you as an individual.

There are many reasons why a group facilitator may refer a participant out of the group including: The participant has received what he/she/they needs from the group, the participant is breaking group guidelines, the participant is no longer participating in group in a way that supports the participant's growth or the group, the participant is missing groups, the participant has met their group goals, the group no longer serves the needs of the participant.

·       I recognize that any information I hear within the group revealed to me by other participants is strictly confidential. I agree not to disclose the name of or any information related to any member of the group to anyone outside the group. Such a violation of this trust will result in immediate termination from the group.

·       I agree to follow the guidelines of group as outlined on the intake form. I understand the limits of confidentiality as outlined in the Group Policy Form. I understand that a facilitator is a mandated reporter of abuse.

·       I understand that my spot is held for me for the number of sessions within this group module and that the fee is due for each session even if I do not attend. I understand that each group is $80 and that the fees are due each week and will be charged at the start of each week for the number of groups within that week.

·       I understand that after my first session, if I choose to continue, I am committed to 7 more sessions for a total of 8 at which point I may go to week-by-week subscription service.  

·       I understand that if I am unable to respect the boundaries of the group, I will be asked to leave. I understand and agree to respect the facilitator's direction. I further understand that even if I abide by all the policies and group guidelines, I may be referred out of group after the module ends to another group or another form of support outside of Corda as determined by the group facilitator. I understand that this is not a personal statement about me; rather it is a decision by the group facilitator in what best supports my growth needs.

·       If my group facilitator sees a spouse, partner, friend or family member in another group or for individual support, I understand that the group facilitator will not discuss my group information or experience with my spouse, friend or significant other, nor will my group facilitator answer questions or discuss with me any information that my spouse, friend or significant other may share in their support or group.

·       I understand that my facilitator will not be placed in the position of a secret keeper. If my group facilitator works with my partner or spouse in some other capacity at Corda, and I reveal a secret in group that could impact my significant other, I agree to work with my Corda facilitator to reveal this information in a session.

Checking the box indicates you understand and agree to group policies, limits of confidentiality, group guidelines, fees, attendance, completion, and referral out of group.