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2024/25 POE Free Therapy Program

Please complete this survey if you are in need of mental health support -- having emotional concerns that are causing distress and negatively impacting your daily life -- and would like to see a therapist. All answers you share on the form will be kept confidential.

Our program connects POE students with local licensed therapists who donate their time to offer FREE short-term individual virtual therapy for 8-12 sessions.  We will do our best to find therapists for all students who sign up (based upon availability). We'll contact students who complete this survey within 5 days to set up a brief virtual call to learn more about your needs, explain more about the program and next steps.

The program starts in October 2024 and ends June 2025.   Preference will be given to students who are participating for the first time.  

Warmly,
Elizabeth Dumanian, LCSW
& Lissa Dutton, LMFT

P.S.  Due to state licensing requirements, this program is limited to students who attend schools in California.

If you have any questions, please contact Lissa Dutton at lissaduttonmft@gmail.com

Email *
POE Mentor name *
Let us know how you prefer to communicate with you below *
Full name *
Phone/text *
What are the reasons you want to see a therapist? Please be as detailed as you can.  *
What do you think you need the MOST help with right now?
*
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