Video Consent


INFORMED CONSENT and AGREEMENT to VIDEOTAPE SESSIONS 

                          

I. INFORMATION FOR YOUR INFORMED CONSENT  

A. THE PROCESS of PACT Sessions. The Psychobiologic Approach to Couples Therapy [PACT]  is the main therapeutic processes I use in my work with you. It focuses on how our emotions and  thoughts interact with our bodies: thus non-verbal communication is as important as the spoken word. In this  context, a picture really is “worth a thousand words”, as the saying goes. Hence the importance and use of  videotaping our sessions to convey information, interactions, and emotional context that cannot be described  verbally. NB: During Covid, videotape has been replaced with Zoom recording on a HIPAA compliant platform. 

B. CONFIDENTIALITY.  

  1. LOCATION. I will not use your recording[s] in your city of origin, i.e. where you live or work.  
  2. NO IDENTITY. You will not be identified by name or location. Only your initials, the date, & zoom or my  office location will be recorded.  
  3. STORAGE. The digital record will be stored on a password protected or encrypted computer hard drive.  This in turn will be stored in a locked cabinet as soon as possible.  
  4. DISPOSAL. Recordings are erased (or recorded over) after serving (or not) one or some purposes noted  above.

C. PURPOSES of VIDEOTAPING.  
By checking the boxes below, you agree to the following:

By checking the boxes below, you agree to the following:

II. YOUR AGREEMENT 

  1. You can request to view, and/or to turn off video recorder, or Zoom recording, at any time and may request that the tape or any portion thereof be erased. You may terminate in writing this permission to videotape at any time.
  2. I may use your tape for purposes described above.
  3. Your consent is voluntary, and there is no financial compensation involved for the use of these recordings
  4. Your questions pertaining to this consent have been answered to your satisfaction.

Your signature below indicates that you give me, Joy A. Dryer, Ph.D,. permission to videotape, or Zoom record, our sessions.  

Name of 1st Partner
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Name of 2nd Partner
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