Couples Therapy Application
If you're looking for couples therapy, and are open to sharing your story, we'd love to hear from you!

Fill out the form below, and we'll be in touch to discuss the opportunity.

You can receive 18 couples therapy sessions, at no cost. All sessions are filmed for possible use in the documentary series "Couples Therapy," which appears on Showtime.

Looking forward to talking with you!

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Email *
Phone Number  *
Your Name / Your Partner's Name & pronouns *
Your Ethnicity / Your Partner's Ethnicity
Your Age / Your Partner's Age
Your Sexual Orientation / Your Partner's Sexual Orientation
What is your occupation/ your partner's occupation?
How long have you been together?
Do you have children?
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If answered yes, how many do you have and what are their ages?
City and state of residence: *
Would you consider traveling to Chicago (free of cost!) for therapy one day a week?
Why are you seeking couples therapy?
How did you find us?
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