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1 .

Informed Consent – Psychotherapist Competencies & Related Factors



Principal Investigator: Kristy M. Keefe, Psy.D., H.S.P.

School/Department: Western Illinois University, Psychology Department

Telephone: (309) 298-3162



Co-Investigator(s): Phillip C. Berg, B.S.

Telephone: (763) 412-6874



Co-Investigator(s): Ashley Griffith, B.S.

Telephone: (319) 759-8471



INFORMED CONSENT FOR PARTICIPATION IN RESEARCH ACTIVITIES

Psychotherapist Competencies & Related Factors



I have been asked to participate in this research study because I am 18 years of age or older, read English, and am currently either enrolled in an undergraduate program or graduate training program or am a current practicing psychotherapist. Additionally, if I am not currently a practicing psychotherapist, I aspire to become a psychotherapist in the future. The purpose of this study is to explore factors that could be related to competencies that psychotherapists have or strive to have.



I understand that my participation in this study is expected to last 40 minutes and that I will be asked to fill out questionnaires designed to asses my personality, emotional intelligence, metacognitive ability, self-care behaviors, and ability to problem solve.



By participating in this study I know that I risk slight mental fatigue from completing the aforementioned tasks and uncomfortable feelings about answering some questions asked about myself.



By participating in this study, I know that I may benefit from said participation by gaining insight into how research is conducted and help improve the current understanding of what may be related to a psychotherapists competencies. If I have been recruited through Western Illinois University’s SONA system, I am aware that I will receive two (2) SONA credits.



I am aware that I may withdraw from the study without risk.



I am aware that all information that I submit will be kept confidential in that no answers that I give on the questionnaires, the problem solving essay, or any assessment made about these responses will be able to be tied back to me to the best of the researchers’ ability. I understand that my name will not be attached to any of the responses I give. Additionally, I understand that the responses and evaluations of said responses will only be observable by the researchers and lab assistants.



I understand that if I have any further questions I can contact Dr. Keefe, Psy.D., at (309) 298-3162.



This study has been reviewed and approved by the Western Illinois Institutional Review Board (IRB). A representative of that Board, from the IRB Office, is available to discuss the review process or my rights as a research subject. The telephone number of the Western Illinois University IRB Office is (309) 298-1191 or email at: IRB@WIU.edu



I have read the previous document and agree to participate in the study.



