Lean On Me Support Group - Registration & Intake
Welcome to Lean On Me Summer 2022!  I am so excited you have decided to join us! Group work is incredibly powerful and can be transformational.  Starting is the hardest part. It takes vulnerability and courage. And it's worth it. Please reach out with any questions or to explore further if this group is a good fit for you.  milja@tccmaine.com.
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This group is a small, intimate group of 4-10 people between 19-29 years of age led by Psychotherapist, Milja Brecher-DeMuro, LCSW.  Meetings will mostly be held every week on Thursdays 1-2:30pm, June 2 - August 25, 2022.  There are some Thursdays I will not be here and so exact dates are listed below.  At this point, I am considering a blend of on-line and in-person meetings - you get to choose what works best for you and determine that week to week.  The online platform we will us is Google Meets.  In person gathering will take place at The Counseling Collaborative at 1489 State Highway 102, Bar Harbor, ME.   COVID-19 Vaccination and masks are required for in-person participation.  Masks may be required (and area always optional) if meeting inside, in person, depending on the current state of COVID in Hancock County, Maine.

10 Sessions: Thursdays 1-2:30pm.  6/2, 6/9, 6/16, 6/23, 7/14, 7/21, 8/4, 8/11, 8/18, 8/25

** It is possible that it may take us longer to get 4 participants by June 2 since I announced the group just recently. It that is the case, the first session will be 6/9 and the fee for the group will be adjusted.
Last Name *
First Name/Preferred Name: *
Pronouns (She/Her, They/Them, He/Him, etc) *
Date of Birth *
Phone Number *
Mailing Address (Street/PO Box, City, State, Zip) *
Permission to text and/or email (I will use these ways to communicate any changes in meetings, updates etc...) *
How did you hear about this group? *
In this group we will explore many topics, examples are: Sexual Identity, Gender Identity, Racial Justice, Equanimity, Anxiety, Depression, Fear, Life Transitions, Schooling, Body Image, Sex, Substance Use, Cutting/Self-Harm, Suicide, Relationships, Understanding Emotions, Sexual Assault/Rape, Stress, Career, Negative Thinking, Self-Care, Self-Compassion, EFT (Tapping), Meditation, Mindfulness, Breath work,  Vulnerability, Courage, Values, Perfectionism, Shame (and more!). Please share any areas of particular interest for exploration in this group - sharing what sounds most appealing to you and what we may have missed!   *
Supplies for participation: Please "bring" with you to each session a writing implement, a journal or notebook, maybe some coloring markers/pens/pencils (not required).  Doodling & note-taking is encouraged! This is an experiential group that may include writing, practice of mediation, breathing, tapping and mindfulness techniques and maybe some art?! (and before you balk, everyone is an artist! No specific skill required!)
Confidentiality is VITAL to the success of this group.  I will discuss what this means at our first session and remind everyone of this pledge during each session.  By participating in this group, you understand, acknowledge and promise that what is shared in the group regarding individual stories and experiences, stays in the group. You can share about your own personal experience and learning but not what others share.   *
Will you be joining this group Virtually or In-Person or some combination of the two?  
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Fee for this group is $400 for 10 sessions - $40/session.  You may pay the fee in total upfront or break up the payment into 3 payments of $133.34.  A sliding scale or a different payment plan is available if you need it.  Please reach out to me, Milja, to discuss. Remember, this is a conscious investment in your well-being.  This is a powerful group, professionally led and well worth the investment in you!  Refunds are not available once payment has been made, unless there is an emergency that prevents continued regular participation or Milja and you determines the group is not a good fit. Refund will be prorated depending on number of sessions attended. Otherwise, the expectation is once you have signed up, you have committed to the full group segment (June-August).  In the event that I would have to unexpectedly cancel (only due to emergency or illness), I will schedule a "make up" session.  

*If the fee scale is still beyond your means, please reach out to me and we can discuss what fee would be manageable to you.
Payment Commitment *
Payment Options *
Do you have any questions or concerns or something that would be important for me to know about you? Perhaps something that may have an impact on your participation in this group and how you may show up? I am always open to a phone conversation if there is something that feels best to share directly rather than written.  If nothing comes to mind, feel free to leave this blank. You can email me anytime throughout the duration of the group to set up a time to talk, if desired: milja@tccmaine.com 
Please share a brief history of your relationship with your own mental health. Perhaps experiences of depression, anxiety, other diagnosis (official or unofficial), counseling experience,  mental health medication (past or present), any major medical conditions, history of counseling, history of hospitalization, Neuro-divergence (Known or suspected - ADHD, Autism Spectrum, Learning style, etc...), Substance Use.  Again, I would be more than happy to have a phone conversation with you about this if you would rather. And if you have a significant history with any of the above, it may be best for us to talk. So, please just say, "Let's Talk" here if that is easier. *
Emergency Contact: First & Last Name, Phone number, Relationship to you *
THANK YOU!  By clicking SUBMIT, your registration is complete.  An email will be sent to you confirming your participation within a few days.  A day or two of prior to our first group I will send an email with instructions on the telehealth platform we will use and how to connect virtually.   Please reach out with any questions at any time. milja@tccmaine.com.  I am so honored you have chosen to join us.  
A copy of your responses will be emailed to the address you provided.
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