Registration for DBT Family Skills Training

Name *

First

Last

Email for Class Materials and Resources *

Name of Family Member, Partner or Friend *

First

Last

Partner Email for Class Materials and Resources *

Experience with DBT (Dialectical Behavior Therapy) *

DBT Couple or Family Therapy DBT Individual Therapy DBT Family Skills Training Standard DBT Skills Group or Teen-Parent Skills Group Read Marsha Linehan's text, manual, or memoir. Read books by Fruzzetti, Hoffman, Koerner, Swenson, Manning or Rathus & Miller This will be my first experience with DBT!

How did you learn about the DBT Family Skills Training? *

Class Agreement. Please initial that you (and participating family members) consent to the following. -- 1. I will maintain confidentiality of any personal information of members from this class or discussion group. I agree to not share information about my family member/partner/friend without their consent in the Tuesday sessions or in the discussion groups. -- 2. I understand this class is not providing psychotherapy or clinical treatment and agree that I will not record, photograph, or otherwise capture or distribute class content or materials. -- 3. I will inform John if I will be missing a session, as well as if I have any concerns about the class. -- 4. I understand this skills class is to be recorded as an additional learning resource. The recordings will be available until the end of the class. -- 5. I intend to make time (~60 min.) to practice the week’s skills and read the handouts for the upcoming class. -- 6. While not a requirement, I understand that we may find it helpful to have a therapist to consult while participating in this class. *

I am sending payment for standard fee of $400 or reduced fee of $200: *

using PayPal to jmaderlmft@gmail.com mailing check to CIP/Mader, 110 Circadian Way, Chapel Hill NC 27516 another option that I will now confirm by email

* Registration *

2021 DBT Family Skills Training

Please use the button below to complete your registration. Thank you!

* Registration *​​2021 DBT Family Skills Training​​

Please use the button below to complete your registration. Thank you!

* Registration *

2021 DBT Family Skills Training