Confidentiality Agreement Template for Group Therapy

CONFIDENTIALITY AND NON-DISCLOSURE AGREEMENT (GROUP THERAPY)

THIS CONFIDENTIALITY AND NON-DISCLOSURE AGREEMENT (the "Agreement") is entered into on this ______ day of ________, 20 (the "Effective Date"), by and between:

FACILITATOR: ________________________________________, located at ________________________________________________________________ (the "Facilitator"),

AND

PARTICIPANT: ________________________________________, residing at ________________________________________________________________ (the "Participant").

1. PURPOSE

The Participant acknowledges that they are participating in a group therapy session facilitated by the Facilitator (the "Group"). The Participant understands that for the Group to be effective and for the safety and privacy of all members to be maintained, strict confidentiality regarding the identities and disclosures of other group members must be preserved.

2. DEFINITION OF CONFIDENTIAL INFORMATION

For the purposes of this Agreement, "Confidential Information" shall include, but is not limited to: a) The names, identities, and personal details of any other individuals participating in the Group; b) Any statements, disclosures, personal stories, emotional expressions, or sensitive information shared by any member of the Group during sessions; c) Any observations or assessments made regarding other group members.

3. OBLIGATIONS OF THE PARTICIPANT

The Participant hereby agrees to the following: a) Non-Disclosure: The Participant shall not, under any circumstances, disclose, publish, or share any Confidential Information with any third party, whether verbally, in writing, via social media, or through any other electronic means. b) Anonymity: The Participant shall not reveal the presence or identity of any other member outside of the group setting. c) Restricted Usage: The Participant shall use the Confidential Information solely for the purpose of personal growth within the context of the Group and shall not use such information for any commercial, competitive, or personal gain.

4. EXCEPTIONS

Confidentiality obligations under this Agreement shall not apply if: a) Disclosure is required by a valid court order or applicable law; b) The Participant reasonably believes that disclosure is necessary to prevent an imminent threat of serious physical harm to the Participant, another group member, or any other third party; c) The Facilitator is required by law to report suspected abuse or neglect of a minor, elderly person, or disabled person.

5. TERM

This Agreement shall commence on the Effective Date and shall survive the conclusion of the Group sessions indefinitely. The Participant’s obligation to maintain the confidentiality of information shared during their tenure in the Group shall remain in full force and effect regardless of their continued participation in the Group.

6. GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the State/Province of ____________________. Any disputes arising out of this Agreement shall be subject to the exclusive jurisdiction of the courts located in ____________________.

7. ACKNOWLEDGMENT

The Participant acknowledges that they have read this Agreement in its entirety, understand its terms, and agree that any breach of this confidentiality could result in irreparable harm to the Facilitator and other participants, for which the Participant may be held legally liable.

IN WITNESS WHEREOF, the parties have executed this Agreement as of the date first written above.

FACILITATOR:

Signature: _________________________________ Printed Name: ______________________________ Date: ______________________________________

PARTICIPANT:

Signature: _________________________________ Printed Name: ______________________________ Date: ______________________________________