2025 Workshop Participant Informed Consent to Group Treatment

Focus:  Relationships throughout life can cause some degree of stress or trauma. This researched protocol for adults uses the Comprehensive Relationship Approach, a therapy protocol which combines group integrative Bowen and EMDR (iBE) Therapy focused on all of the following 5 topics: “To Thine Own Self Be True,” conflict, distance, triangling, and overfunctioning/underfunctioning reciprocity (codependency). It will assist the participant to clear the distress of past and present memories of interactional boundary-setting, conflict, distance, triangling and overfunctioning/underfunctioning reciprocity (codependency) and to learn to replace old patterns with new strategies and skills for healthier attitudes and behaviors. Note: it may be necessary to request added time at the workshop to help you regain your peace, or to schedule added individual sessions if you believe you have remaining stress or trauma to process after the group workshop is completed.

Name and Credentials of the Researcher/Therapist:

Dana Elken Terrell, LCSW, EAC has been developing and researching the iBE therapy, and newer CRA therapy since 2000 and 2024 respectively. Currently she is the only therapist with this approach. Her goal is to complete the research and begin training other EMDR therapists so that many more people can benefit from this approach to emotional maturity and relationship health.

She has been practicing Bowen theory since 1979 and EMDR since 1997. She was Certified in EMDR in 2003 and became an Approved Consultant (EAC) in 2008. This means she can give Certification training and consultation to other EMDR therapists.

Agreement:

This document is to certify that I, _______________________________ hereby freely agree to participate in the Comprehensive Relationships Approach iBE Group Therapy under the guidance and supervision of Dana Elken Terrell, LCSW, EAC.

History:  EMDR is a research-validated treatment for trauma. The World Health Organization lists it as one of two recommended treatments for PTSD, based on the research. Ignacio Jarero’s EMDR-IGTP (EMDR Integrative Group Treatment Protocol) and the expansion of it, called the Ongoing Traumatic Stress (OTS) protocol has many published research studies demonstrating its value. Dana Terrell has practiced her method of integrating Bowen family systems theory for emotional maturity with EMDR-IGTP therapy since 2015. In 2022 she has adapted iBE to include the OTS protocol because it addresses the truth that we face disturbing relationship patterns throughout our life, and thus we need a little more opportunity to process experiences on this theme than her previous approach offered.

• The purpose of this group therapy has been fully explained to me and I understand that I will be asked to complete the following:

1. an Intro Survey to be sure this group experience is appropriate for me at this time. If I have no red flags making group treatment inadvisable at this time, I will be invited to join the group I have requested, if there is still space available.

2. I will answer all surveys/questionnaires frankly to the best of my ability. I will complete a “Pre” Set of 4 forms, a post set of 4 forms within 2 days of the workshop, and a 30 day post set within 30-32 days of the workshop.

3. I will let the therapist know if I am needing more individual attention.

• I understand I may have uncomfortable feelings related to experiences in my past, present, or my concerns for the future connected to the topic of conflict in relationships. Previous participants have shared that they were sometimes surprised and even scared of the intensity of the feelings that came up in EMDR therapy. However, by staying with the process they could observe that the distress tended to decrease with the EMDR processing methods. Thus, they began to trust that they could handle intense distress for 1-2 minutes at a time.

• I have been given the opportunity to ask questions, and all such questions and inquiries have been answered to my satisfaction by Dana Elken Terrell, LCSW, EAC.

• I understand that, in the unlikely event of any physical or mental injury resulting from this investigation, I will not hold Dana Terrell, LCSW and Comprehensive Therapy Approach, Inc. responsible. I understand that if my distress is above a 5 out of 10 at the close of a research day, I should inform Dana Terrell, LCSW, who will spend individual time with me to help me reduce the distress level.

• I certify that to the best of my knowledge, I have no physical or mental illness beyond anxiety or depression, or other weakness that would increase risk during participation in this workshop.

• I UNDERSTAND THAT I AM FREE TO DISCONTINUE MY PARTICIPATION AT ANY TIME.

• I understand that if I have any questions concerning the purpose or the procedures associated with this workshop, at any time along the way I may contact:

Dana Elken Terrell, LCSW at (619) 322-3666 or danaterrell.lcsw@gmail.com.

I have read all of the above and agree to all of the above terms of participation. I agree that my typed signature on the four signature lines below shall be as valid as a hand-written signature demonstrating my agreement to the terms herein.