Download - The Safran Lab

If you decide to participate in this study you will be asked to do the following:
1. Not to participate in other psychotherapy or take psychoactive
medication while receiving treatment in this program.
2. Be available for 30 sessions.
3. Take two evaluation interviews and complete a package of
questionnaires to evaluate how you are doing in treatment:
a. Before beginning treatment
b. Midway during treatment
c. At termination of treatment
d. Six months after treatment is completed
4. Complete a post-session questionnaire after each session.
5. Agree to have evaluation and treatment sessions videotaped.
6. Consent to have information obtained from videotaped recordings of
sessions used for scientific purposes, such as research study,
professional publication, educational presentations in transcribed,
audiotaped, or videotaped format by the program staff.
Appendix I Page 107
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Possible Risks
We know of no inherent risks associated with these treatments. Each type of treatment may cause some emotional discomfort
at times, but this is generally considered a natural part of the therapeutic process.
Confidentiality
Information that is obtained in connection with this study that can be identified with you, including evaluation materials and
videotaped recordings, will be held in the strictest confidence and would be voluntarily disclosed only with your explicit
permission. We will share such information only with other members of our research and treatment team at Beth Israel.
The only exception is the post-session questionnaire, which will not be available to your therapist and which will be identified
solely by your identification number that will be provided at the onset. This exception is made because some of the material
in this questionnaire pertains to your relationship with your therapist. While it is possible that at some point in the future
selected excerpts from your sessions will be either presented or published for scientific purposes, adequate precautions will
be taken to maintain complete confidentiality, according to the customary professional ethics of Beth Israel Medical Center.
Possible Benefits
All treatment groups offer possible benefits to you because they follow principles that have been tested and proven effective
for some time. We are attempting to study what aspects of the different treatments contribute to or detract from their
efficacy, particularly in terms of specific types of people and specific types of problems. Thus, your participation may be
beneficial to you and others in the future.
Withdrawal
You may withdraw or cancel your participation at any time and you are under no obligation to participate. If you choose
not to participate or withdraw at a later date, you will not jeopardize your future care by doing so. In this event you will
be provided with standard Beth Israel care on the usual basis.
Questions
If you have any questions, you may contact J. Chris Muran, Ph.D., Program Director at 420-3819. If you have any
unsatisfied complaints you may contact Jo Ann Tancer, Patient Representative at 420-3818. You may request a copy of this
consent form at any time. You may also request feedback regarding aspects of the study upon your termination of treatment.