Research Participant Information and Consent Form

 You are being asked to participate in a PILOT STUDY research project.  Researchers are required to provide a consent form to inform you about the study, to convey that participation is voluntary, to explain risks and benefits of participation, and to empower you to make an informed decision.  You should feel free to ask the researcher any questions you may have. 

 Study Title: EMOTIONAL TERRORISM Informal Survey Questionnaire

Researcher and Title: Karen E. Engebretsen-Stopczynski, PsyD.

                                   Florida Licensed Psychologist, PY 5409

Department and Institution: Karen E. Engebretsen, PsyD, LLC, Private Practice

Address and Contact Information: Karen E. Engebretsen-Stopczynski, PsyD.

                                                Office Address: 1876 N. University Drive, Ste, 200F, Plantation, FL 33323

                                                Mailing Address: P. O. Box 450158,

                                                                    3225 N. HIATUS ROAD. Fort Lauderdale, FL 33345

                                    Email:                 drkaren@drkaren.com

 

 PURPOSE OF RESEARCH:              

 You are being asked to participate in an INDEPENDENT research study of Emotional Terrorism (E.T.) Victimization (operational definition described below) by Dr. Karen E Engebretsen-Stopczynski (AKA Dr. Karen) along with Anew Focus Training Institute (AFTI - owned by Karen E. Engebretsen, PsyD, LLC), a privately held corporation). This opportunity is open to ADULT WOMEN ONLY (ages 18 and above).

 The Pilot study is designed to gather information to publish articles and/or a book about FEMALE VICTIMIZATION of emotional terrorism and will also be used to create an AFTER CARE Workbook. The Book will be a hands-on, pen and paper edition which is anticipated to assist victims of extreme emotional abuse (Emotional Terrorism) to re-discover the SELF who was damaged by the E. T. and become victorious in life once again.

 Dr. Karen and Company are recruiting the sample from community-wide Internet Connections via LinkedIn and Social Media, world-wide.  We are specifically looking for women (who can understand and communicate in ENGLISH) who were successful and accomplished BEFORE succumbing to her E. T. predator.

 This project is independently funded Dr. Karen E Engebretsen-Stopczynski and Karen E. Engebretsen, PsyD, LLC and ARE NOT offering money to participate in this study. She and her corporation are not affiliated with any commercial entities, or universities, and are not receiving donations from same either.

 Compensation for participation to all participants who complete the questionnaire will receive a FREE (down-loadable) COPY of the TATTERED AND TORN BY AN EMOTIONAL TERRORIST: THE JOURNEY BACK TO SELF book and accompanying WORKBOOK once they are completed.   

 You have been selected as a subject for this study because you answered the call for participants via the Internet search and invitation.

 From this study, the researcher (Dr. Karen) hopes to learn about the seduction process of the emotional terrorist MALE predator, how they groom their FEMALE victims, and the resilience factors that are associated with this type of trauma and how the information gleaned from other victims can help future targets of E. T. move from victimization to victorious and healthy living.

 Your participation in this study will take as long as necessary for you to answer the one-time series of questions on the questionnaire that you will be given.

 If you are under 18, you cannot be in this study.

 Your participation is completely voluntary and your answers will remain confidential UNLESS you agree to have your name disclosed at the completion of this study.

 

  1. WHAT YOU WILL DO:                          

 As a participant, you will be asked to complete a questionnaire ONLINE. You will be asked to read the following Operational Definition of Emotional Terrorism:

“An Emotional Terrorist (ET) targets the victim’s emotional well-being and psychological state of mind, with the intent of inflicting adverse, usually devastating consequences, mentally, emotionally, spiritually, physically, socially, sexually, professionally and economically. The ET is likely to possess Narcissistic Sociopathic characteristics and appear quite charming, so their initial tactics may seem fairly benign and thereby easily discounted or minimized. However, once in the clutches of an ET, the underhanded devious maneuvers, become more severe and pervasive over time. ET’s use acts of humiliation, intimidation, confinement, isolation, verbal assault, devaluation or other means of abuse to diminish the victim’s sensing of identity, dignity, and self-worth. The ET’s adept ability to manipulate - with the express goal of causing fear and terror - is purposeful and deliberate. When the ET has gained sufficient influence, executed ongoing threats, achieved power and control, and perpetrated unrelenting cruelty and torture, the ET’s merciless antics render their victim helpless and hopeless, which will likely cause permanent damage and continue to impact their lives, long after the relationship has terminated. The looming dread of imminent doom leaves a lasting fear of reprisal (for attempting to break free of their reign of terror) and leaves the victim with life-long painful, crippling memories. Because of the massive destruction to psyche and soul, most victims NEVER recover from the effects of emotional terrorism.” (Engebretsen-Stopczynski, K. E. 06 June 2014, delivered at the 46th Annual AASECT Conference in Monterey, CA). Copyright 2013-2015 ©. All rights reserved.

 

 You will then be asked to complete the Engebretsen-Stopczynski Emotional Terrorism Questionnaire (E-SETQ). You will also be asked to answer a series of questions related to your abuse. The topics will include: 1) Briefly describe how you met your E.T; 2) Describe the early stages of the victimization; 3) Explain what happened when you reached out for help; 4) Explain family/friend reactions to your disclosure of victimization; 5 If you sought formal psychological help, please describe the relationship with your therapist and the “process” of psychotherapy; 6) Explain how it affected your JOB of working with patients/co-workers and how it affected your ability to focus on the tasks at hand; 7) Explain how it affected your relationship with your husband/partner (if he/she was not the abuser) and children; 8) Explain your sense of blame/shame and whether or not you gave yourself a mental health “diagnosis;” 9) Describe why and finally how you broke free of your E. T.; 10) Please describe your "coping" skills (healthy and unhealthy) while attempting to still manage your life; 11) Please describe what would you say is the single most helpful “tool” for you to stay grounded and FOCUSED TODAY when you are “triggered” by someone or something that reminds you of the torment you endured?

 Since it is not easy to “capture” the scope of abuse if a few words, I will leave it up to you to keep your submission short, sweet, and to the point. When editing, I will let you know if I need more or less content.

 The data gathered from your answers will be used for educational purposes as well as for identifying the resilience factors that play a role in the re-discovery process following the aftermath of E.T. victimization. These findings will be published in the TATTERED AND TORN BY AN EMOTIONAL TERRORIST: THE JOURNEY BACK TO SELF Book and accompanying WORKBOOK.

  

  1. POTENTIAL BENEFITS:                       

 The potential benefits to you for taking part in this study include the opportunity for "catharsis" (which means a purging of emotions, especially pity and fear, and/or any extreme change in emotion that results in renewal and restoration following victimization).

 Although painful, it may also give you a chance to revisit some of the factors that played a role in your victimization.

 As such, identifying these factors MAY help you from being re-victimized by another predator.

 Although you may not directly benefit from your participation in this study, your willingness to candidly answer the questions may contribute to the understanding of FEMALE victims of E.T. and offer hope for re-discovery of self, following the aftermath of E. T. victimization.

 

  1. POTENTIAL RISKS:    

                 The potential risks of participating in this study are that you may be TRIGGERED by painful memories of your abuse.

 You may experience flashbacks, nightmares, and/or psychological "numbness," anxiety and/or depression. Please understand, THESE ARE NORMAL REACTIONS TO RE-LIVING YOUR TRAUMA and you will not die or go "crazy" as a result of recalling these memories. You may also experience somatic complaints including headaches, stomach aches, nausea, unexplained sweating, or aches and pains, or other forms of physical distress and discomfort as a result of answering painful questions from your past.

 Psychological treatment of any kind CANNOT and WILL NOT be offered to you as a result of your participation in this study. However, you will be referred to a clinician in your local area if necessary.

 YOU WILL NOT BE REIMBURSED FOR THE COST OF PSYCHOLOGICAL TREATMENT if you are referred to and decide to particiate in therapy with a qualified trauma therapist or any other Allied Health Professional.

  

  1. PRIVACY AND CONFIDENTIALITY:            

 The data for this project IS NOT being collected anonymously. Since understanding cultural differences and the nature of the abuses you endured, it will be necessary to parse out this information via Dr. Karen's research team (statisticians). Intake data will not be disguised. However, your name will NOT be disclosed under any circumstances unless you agree to same IN WRITING.

 THIS Privacy Policy Statement of Dr. Karen E. Engebretsen-Stopczynski, Karen E. Engebretsen, PsyD, LLC, and www.drkaren.com  is written in accordance with Florida Law. Individual agency websites in the State of Florida are required to contain a Privacy Policy Statement that describes what information is being obtained online, how that information will be used, and what steps are being taken to ensure the security of customer/ research participant data. Your rights to privacy are of utmost importance to us in building trust and confidence when seeking information and conducting business through the Internet.

 

Limits of Use and Online Customer Service

 All data collected from this RESEARCH STUDY via www.drkaren.com has been done so with PERMISSION by the submitters of the information. Unless otherwise noted, all identifying information has been changed to protect the identity of the submitter. Therefore, Karen E. Engebretsen, PsyD, LLC,  Dr. Karen E. Engebretsen-Stopczynski, and www.drkaren.com are not liable for any defamatory, offensive, or illegal conduct by you or any other user.

  While Karen E. Engebretsen, PsyD, LLC, Dr. Karen E. Engebretsen-Stopczynski, and www.drkaren.com take all reasonable steps to ensure the privacy of the users and subscribers of this site, she reserves the right to disclose, according to the Mandatory Reporting Laws in the State of Florida, any personally identifiable information as it violates this law and/or there is clear evidence of harm to self or others.

 The Administrators of this site reserve the right to ban and block anyone from this page for any reason determined by said Administrator. Abuse in any form will not be tolerated and an Administrator has the authority to ban/block without consult with other Administrators and does not require majority opinion. Furthermore, no explanation is required.

 Although we have made all attempts to protect your privacy, we know abusers may follow victims here. If you know your abuser has done so, a private message can be sent to the Administrators and said abuser will be removed.

 The privacy settings of each individual member is the responsibility of said member and Karen E. Engebretsen, PsyD, LLC,  Dr. Karen E. Engebretsen-Stopczynski, and www.drkaren.com is not liable for the indiscretion of a member who shares /posts without adjusting their privacy settings to protect him/herself properly.

 

 Collection and Use of Information

This website does not use “cookies” to gather information during your visit. However, the web server that hosts the www.drkaren.com  does gather certain information about the visit automatically in a standard log file. This information never identifies you personally and consists of only the following items:

  1. The Internet domain (for example, "xcompany.com" if you use a private Internet access account, or "yourschool.edu" if you connect from a university's domain) from which you access the website;
  2. The IP address (an IP address is a number that is automatically assigned to your computer whenever you are surfing the Web) from which you access the website; and
  3. The date and time of your access.

We use this information to gather statistics about the amount of use the site receives. Again, we do not automatically record information about you as an individual. This information is not shared, sold, or otherwise disseminated by Karen E. Engebretsen, PsyD, LLC,  Dr. Karen E. Engebretsen-Stopczynski, and www.drkaren.com

 

Information You Provide

Application forms for the RESEARCH PROJECT downloaded online will be treated in the same manner as an application form obtained directly from Karen E. Engebretsen, PsyD, LLC practice guidelines. They will remain private unless this agency is required to divulge certain information in response to a warrant, subpoena, or other court order.

 To reiterate, information about you will be kept confidential to the maximum extent allowable by law.

 No one will have access to this data aside from Dr. Karen E. Engebretsen-Stopczynski and Karen E. Engebretsen, PsyD, LLC and the research team associated with this PILOT PROJECT.

 The results of this study may be published or presented at professional meetings or conferences, but the identities of all research participants will remain anonymous.

 o I agree to allow my identity to be disclosed in reports and presentations. Please circle:

 Yes              No          Initials____________

  

  1. YOUR RIGHTS TO PARTICIPATE, SAY NO, OR WITHDRAW  

 Participation in this research project is completely voluntary.  You have the right to say no.

 You may change your mind at any time and withdraw. 

 You may choose not to answer specific questions or to stop participating at any time.  

 Choosing not to participate or withdrawing from this study is your right. If you do not complete the questionnaire (questions that are unique to you specifically), you will only forfeit copies of the downloadable books (mentioned above) when they are completed.

 You will be told of any significant findings that develop during the course of the study that may influence your willingness to continue to participate in the research.

 

  1. COSTS AND COMPENSATION FOR BEING IN THE STUDY:

 Procedures (questionnaire) being performed for research purposes will be provided free of charge by Dr. Karen E. Engebretsen-Stopczynski and Karen E. Engebretsen, PsyD, LLC.

 You will not receive money for participating in this study.  However, you will be entitled to a FREE (down-loadable) COPY of the TATTERED AND TORN BY AN EMOTIONAL TERRORIST: THE JOURNEY BACK TO SELF book and accompanying WORKBOOK once they are completed as long as you complete the study based on the guidelines outlined above.

 

  1. ALTERNATIVE OPTIONS                 

 There are no alternative options to participating in this research project aside from answering the questions in the questionnaire.

 

  1. THE RIGHT TO GET HELP IF INJURED:

 This research project is not involved in biomedical procedures and therefore does not offer the right to get help if injured.  

 

  1. CONFLICT OF INTEREST                 

 The developer of this research project stands to benefit from income from the published book TATTERED AND TORN BY AN EMOTIONAL TERRORIST: THE JOURNEY BACK TO SELF Book and accompanying WORKBOOK once they are published.

 

  1. CONTACT INFORMATION FOR QUESTIONS AND CONCERNS

 If you have any questions about this study, such as scientific issues or how to do any part of it, please contact the researcher (name and complete contact information: mailing address, e-mail address, phone number above).

 If you have any questions about your role and rights as a research participant, or would like to register a complaint about this study, you may contact, Dr. Karen E. Engebretsen-Stopczynski, PsyD/Karen E. Engebretsen, PsyD, LLC, at P. O. Box 450158, 3225 N. HIATUS ROAD. Fort Lauderdale, FL 33345 or via email @ drkaren@drkaren.com. All complaints will be taken seriously.

  

  1. DOCUMENTATION OF INFORMED CONSENT.

 Your signature below means that you voluntarily agree to participate in this research study.  

 

_____________________________________                              _____________________________

Signature                                                                                       Date _______________________________________                             _____________________________

Signature of Assenting Child (13-17; if appropriate)                            Date

 You may keep a copy of this form for your personal records. Be advised, if you elect to retain a copy for your records, whether storage of this INFORMED CONSENT FORM is done via hard copy or electronic format, it will be will be your responsibility to preserve your privacy of this document.