Group Session Confidentiality Agreement

Group Session Confidentiality Agreement

Counseling Department, Community College of Philadelphia

You have the right to confidentiality and privacy within a group session. Confidentiality within a group setting is a shared responsibility of all members and leaders. While group leaders may not disclose any student communications or information except as provided by law, group members’ communications are not protected. As such, confidentiality within a group setting is often based on mutual trust and respect.

The American Counseling Association Code of Ethics identifies the following legal and ethical exceptions to confidentialitya clear or present danger to harm yourself or another; knowledge of the abuse or neglect of a minor child or incapacitated adult; or responses to a court subpoena or as otherwise required by law.

As a member of this group, I agree to not disclose to anyone outside the group any information that may help to identify another group member. This includes, but is not limited to, names, physical descriptions, biological information, and specifics about what was discussed with other group members.

Additional group agreements:

  • I understand that group sessions may be discussed by the leader and co-leader outside of the session for training and supervision purposes.
  • I agree to participate in the group sober and not under the influence of controlled substances.
  • I understand that the work of any unlicensed staff is supervised by a licensed senior staff member.
  • I understand that any group outcome measures or satisfaction surveys are reported in summary form with no individual identifying information. This information can assist the CCP Counseling Department in improving services and in evaluating programs.
  • I agree NOT to record this session.
First Name
Last Name