Mindfulness-Based Stress Reduction (MBSR) Informed Consent Agreement

  1. I understand that in participating in the MBSR course, I am making a precious commitment to myself and classmates. Unless previous commitments or unexpected circumstances prevent me from doing so, I understand that I am committing to attend all eight classes, the retreat, and to dedicate approximately 30 minutes each day during the next eight weeks to practice mindfulness and complete homework assignments.
  1. I understand the concept of confidentiality and its importance in creating and maintaining safety and trust for myself and my classmates. I am committed to cherishing and maintaining the privacy of my classmates … both during the eight weeks and after the completion of the course.
  1. I understand that there are both potential risks and benefits involved in completing the course. The following considerations are important:
  • the practices and exercises are invitations to pay attention and notice so you may become aware of emotional, mental or physical patterns or qualities that have long been overlooked.
  • feelings of sadness, anxiety, anger or fear may seem stronger at the beginning of the course, especially given the uncertainty in the world in this time.
  • during the mindful movement (gentle yoga) practices, it is important to honour the limits of your body and to only move in ways that are physically safe for you. I also understand that if for any reason I am unable to, or believe it unwise to engage in these techniques and exercises, either during the weekly classes on Zoom or at home, I will inform the teacher and request modifications of the practices. As well, I will inform the teacher of any past or current injuries, surgeries or physical concerns prior to Class 3 so she can assist in maintaining my safety.
  • it may be challenging to find time each day to engage in the practices and explore the homework. Even if you find the time, you may not feel like doing them. All of these experiences are normal.
  • benefits of taking the course can include an increased sense of wellbeing, improved sleep, rediscovering beautiful qualities of yourself, and many others.
  1. I understand that although the course is taught by Joanne Frederick, a Registered Psychologist, MBSR is not group therapy and not intended to address or resolve specific personal issues. The course can be, however, therapeutic and beneficial to participants’ emotional and physical well-being.
  1. As discussed during the orientation session, I understand that Mike White, Registered Psychologist, is joining the group as a “participant-observer.” He will be participating in all the course activities and sharing as appropriate. His role as “observer” is directed at learning from Joanne the dynamics of facilitating group interactions as part of his continuing professional education. The privacy and confidentiality of all participants will be maintained as per the Canadian Code of Ethics for Psychologists, Third Edition.
  1. I understand that I am welcome to contact the teacher between classes for support or to ask questions that may arise from the practices and homework exercises.
  1. I understand that I am free to discontinue the course at any time. Should it become necessary to do so, I will inform the teacher of my decision.
Telephone and Email Communication Consent  As a participant in the MBSR course, you will receive emails containing links to guided audio recordings as well as information and reminders about aspects of the course. From time to time, it may also be necessary to communicate via telephone, including text message. In order to ensure your privacy, we request that you provide the email address and telephone number you wish the teacher to use.

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