Therapeutic Groups - Initial Questions

If you have signed up for our therapeutic group sessions, we require you to fill in this form to the best our your ability. This will help our facilitator to make you feel comfortable within the group and understand your needs within it. If you have any questions about the form please contact Becca at b.bland@standalone.org.uk.

Therapeutic Initial Questions

Name*
Email*
Address*
Street Address Address Line 2 City ZIP / Postal Code
Which of the following describes how comfortable you feel in a group situation?
How would you describe your emotional state at the moment?
Have you visited or are you currently visiting a therapist?
Can you try your best to summarise your family situation, and who you are estranged from?
Can you tell us how you feel it impacts on your life?
Can you describe how long you have been estranged?
Can you describe your attitude towards reconciliation?
Can you best describe your relationships with other people in your life?
Have you ever been clinically diagnosed with an illness such as depression, GAD or BPD?
- Yes
- No
- I'm not sure
If yes, please could you tell us if you still experience symptoms and if you are still in a course of treatment?
Do you feel nervous about sharing your thoughts with the group?
Please could you share your objectives with reference to signing up for this group. What do you want to gain from the work?
Is there anything else you'd like to share? If so, please use this box to comment...
Phone Number
This work is part of our National Lottery funded pilot project. Please read and tick to show you understand/agree to the following....
- I am aware that this group is part of a pilot project
- I agree to take part in the pilot project and provide feedback to help shape future services
- If I notice a negative change in my wellbeing after starting these groups, I will notify the group leader or Stand Alone