Relationship Recovery Process (RRP) Groups 
Disclaimer: Due to high interest and the importance of fit, you may not receive a reply. If you do not hear back within one week, it likely means we don’t have an opening or this group isn’t the best clinical fit right now. You’re welcome to apply again for future cohorts.

Based on the work of Amanda Curtin, RRP groups are a holistic approach that will give you practical tools to support you in your growth and learning. This form is the starting point to working with me. Please answer all the questions to the best of your ability. There are no right or wrong responses, this informs me on how to best support you. I am glad you are here.

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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 a group at this time. Thank you for your patience.
Gabriel
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