Intent to Join
I honor you as you take this step towards your healing. Please complete this form to indicate your interest in participating in a 8-week closed support group for those impacted by Betrayal Trauma. 

Facilitator: This support group is led by Tara Beall-Gomes, NCC, LPC APSATS Trainee and Psychotherapist at Main Street Counseling, LLC & Betrayal Trauma Specialist with Grit & Recovery, LLC.  

Group Purpose: The Betrayal Trauma Support Group is those who are in the aftermath of betrayal due to Sex Addiction, Infedility and Interpersonal Betrayal Trauma. Expect to be seen, heard, supported and learn skills necessary for your own recovery using the APSATS The Multidimensional Partner Trauma Model. You do not need to cope with the symptoms of trauma such as depression, hypervigilance, anxiety, and lack of trust alone. 

Group size is limited to five women. 

Once your Intent Form is received, we will reach out to you VIA EMAIL with next steps.  Please check your SPAM folder periodically.
 
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First Name *
Last Name *
Gender *
 Phone Number *
Which form of communication do you prefer? *
Required
Email *
Date of Birth *
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How long has it been since you first discovered your partner's sexually problematic and/or deceptive behaviors? *I recognize there could be multiple discoveries over a period of time. 
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The total cost of the program is $320, which is $40 per session. Are you able to commit to 8 consecutive weeks of group support for a total fee of $320?  Please note that although this is a group is led by a liscensed therapist, support groups are not covered by insurance.

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Group sessions are in person in our Monroe office.  If travel is a barrier, you are able to join via Zoom although in person provides added benefit for connection and support. Please indicate which time will work for you?
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Please choose how you will join us: *
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If you have any additional comments or questions, please let us know!  We are here to support YOU!
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By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Grit and Grace, LLC harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.
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