E. Formal Consent Document

Appendix E

Formal Consent Document

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Institute for Clinical Social Work

Research Information and Consent for Participation is Social Behavioral Research

The lived experiences of the animal rights activist

I, _____________________________________, acting for myself, agree to take part in the research entitled: The animal in the mirror: A psychoanalytic perspective of the farm animal rights activist.

This work will be carried out by Susan Geshay, LMFT, LMHC (Principal Researcher) under the supervision of Brenda Solomon, PhD (Dissertation Chair).

This work is being conducted under the auspices of the Institute for Clinical Social Work; At St. Augustine College, 1345 W. Argyle St., Chicago, IL 60640; (773)935-6500.

Purpose

The purpose of this study is to explore and discover experiences of the animal rights activist with specific inquiry into the life of the farm animal rights activist. To date the pathway of the animal rights activist is largely obscure and unknown. To advocate for a (non-human) animal is often seen as an unlikely pathway and often indecipherable to peers, family, and society in general. This research seeks to understand the lens of the animal rights activist and how did the activist come to know the animal is worth their advocacy, time, and concern.

Procedures used in the study and duration

You will receive two 60-minute, in person or zoom interviews at a private and convenient location of your choosing. A third 30-minute interview via phone may be added (if needed) to ask follow up questions. The interviews will be audiotaped and transcribed. A false name of your choosing will be used with your transcript. Transcripts of your interviews will be shared between my dissertation committee and myself.

Benefits

Your participation in this study will contribute to a better understanding of the experiences of the animal rights activist. The results of this research study aim to develop a clearer understanding of the individual who becomes an animal rights activist.

Costs

There are no costs associated with participation in this study.

Possible Risks and/or Side Effects

There are potential side effects as a result of participating in this study. The participant may experience emotional discomfort as a result of discussing personal information. The participant is encouraged to share what is comfortable to share and relevant to the research. The participant reserves the right to decline answering any question that is overly uncomfortable or upsetting. Following the interview, a list of resources will be made available to offer emotional support.

Privacy and Confidentiality

Participants in this study will be identified using a false name to identify themselves. Data from the interviews will be stored on a personal computer and transferred to the committee chairperson’s secured e-mail. Upon completion of the research study all audio files will be deleted.

Subject Assurances

By signing this consent form, you agree to take part in this study. You have not given up any of your rights or released this institution from responsibility for carelessness.

You may cancel my consent and refuse to continue in this study at any time without penalty or loss of benefits. Your relationship with the staff of ICSW will not be affected in any way, now or in the future, if you refuse to take part, or if you begin the study and then withdraw.

If you have any questions about the research methods, you can contact Susan Geshay at 317-514-1017; sgeshay@centerpointcounseling.org or Dr. Brenda Solomon at 312-7295179; bsolomon@icsw.edu

If you have any questions about your rights as a research subject, you may contact Dr. John Ridings, Chair of Institutional Review Board; the Institute for Clinical Social Work; At St. Augustine College, 1345 W. Argyle St., Chicago, IL 60640; (773)935-6500.; irbchair@icsw.edu.

Signatures

For the Participant

I have read this consent form and I agree to take part in this study as it is explained in this consent form:

Participant Name (please print): ___________________________________

Participant Signature:____________________________________ Date: _____________

1. Would you like a summary of the results of this study?

Yes: ____ For the Primary Researcher No: ____

I certify that I have explained the research to _________________________

and believe that they understand and that they have agreed to participate freely. I agree to answer any additional questions when they arise during the research or afterward.

Researcher Name (please print): ___________________________________

Researcher Signature:____________________________________ Date: _____________

Version 6.0: 7/18/2020