Carolina Integrative Psychotherapy, Inc.
Carolina Integrative Psychotherapy DBT Family Skills
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Dialectical Behavior Therapy
What is Dialectical Behavior Therapy?
Dialectical Behavior Therapy for Families
Dialectical Behavior Therapy for Couples
Resources for Families, Couples & Friends
Client Forms & Worksheets
Online Training Information
Upcoming Classes
Blogs
Blog: Head, Heart & Hands
Blog for Fellow Therapists
Recent Resources via Twitter
About John Mader
Contact & Request Information
Maps
Mindfulness in Clinical Practice and Daily Life
Coping with Covid Resources
DBT Family Skills Registration
CIP Good Faith Estimate Notice
Home
Dialectical Behavior Therapy
What is Dialectical Behavior Therapy?
Dialectical Behavior Therapy for Families
Dialectical Behavior Therapy for Couples
Resources for Families, Couples & Friends
Client Forms & Worksheets
Online Training Information
Upcoming Classes
Blogs
Blog: Head, Heart & Hands
Blog for Fellow Therapists
Recent Resources via Twitter
About John Mader
Contact & Request Information
Maps
Mindfulness in Clinical Practice and Daily Life
Coping with Covid Resources
DBT Family Skills Registration
CIP Good Faith Estimate Notice
* Registration *
DBT Skills for Couples
*
Indicates required field
Name
*
First
Last
[object Object]
Email for Class Materials and Resources
*
Name of Partner
*
First
Last
Partner Email for Class Materials and Resources
*
Home City or Town
*
Chapel Hill-Carrboro
Durham
Raleigh
Hillsborough
Pittsboro/Chatham County
Cary
Greensboro/Guilford County
Apex
Mebane/Alamance County
Other: See next field -->
Preferred Phone Number
*
If Other, please specify City, State:
*
Years in this Couple Relationship
*
Less than 2
3-5
6-10
11-20
21-30
Over 30
Prefer not to say
Experience with Therapy
*
Currently in Couple Therapy
Past participation in Couple Therapy
Have done Couple/Relationship/Marriage Workshop
Individual Therapy
None
Experience with DBT (Dialectical Behavior Therapy)
*
DBT Couple or Family Therapy
DBT Individual Therapy
DBT Family Skills Training
DBT Skills Group Member
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 Skills for Couples class? If you were referred by a health professional, please specify by name if possible.
*
Class Agreement -- Please initial that both of you consent. ________________________________ -- 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 partner 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 (1-2 hrs/wk) to practice the week’s skills and read the handout/chapter from The High Conflict Couple: A Dialectical Behavior Therapy Guide to Finding Peace, Intimacy, and Validation by Alan Fruzzetti. -- 6. While not a requirement, I understand that couples may find it helpful to have a couple therapist to consult while participating in this class. I understand that members of previous classes found it a more effective, shared experience when couples participated with their webcams on.
*
I am sending payment for the standard fee of $750 per couple, early registration fee of $650 (by August 17th) or reduced fee of $375.
*
using PayPal to jmaderlmft@gmail.com
mailing check to CIP/Mader, 110 Circadian Way, Chapel Hill NC 27516
respond by email (to discuss the option of an additional reduction)
Please use the button below to complete your registration. Thank you!
Registration Completed!