Relationship Recovery Process (RRP) Individual Work
Disclaimer: Due to high interest and the importance of fit, you may not receive a reply. If you do not hear back within two weeks, it likely means we don’t have an opening. You’re welcome to apply again in future.


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Name *
Which country to do you reside in? *
If there are multiple time-zones in your country, which time zone are you in?
Email *
What brings you here today? *
I have difficulty connecting emotionally with self or  others:
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Most days I struggle with daily functioning (lateness, organisation, follow through):
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Therapy has not been beneficial for me in the past:
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I struggle with dissociation (feeling out of my body and not connected).
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I am overwhelmed by stress most days:
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I'm seeking short-term, expedited change:
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My problems are more situational vs. emotionally internal:
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I do not know how childhood has impacted me:
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I currently have legal problems:
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I currently have problems of safety (domestic violence):
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I'm currently in a contentious separation or divorce:
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What is the most troublesome symptom or feeling you are experiencing now and why?
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I question my relationship with sex (shut down or compulsive):
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I did not seek this out on my own, it was suggested to me to do childhood trauma work:
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I've experienced suicidality in the last year:
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I've needed partial or inpatient hospitalisation in the last year:
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Required
What has helped specifically for you in the past?  (Self-help books, therapy, holistic health care, 12-step)
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What is the number one concern in your life right now?

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What do you do now currently when you feel overwhelmed?
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Do you have one or more persons in your life that you can turn to in times of trouble?
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Is there anything else you would like me to know?
Thank you for completing this form. You will be contacted for an intake appointment if it is determined that you are a good fit for individual work at this time. Thank you for your patience.
Gabriel
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