Support and Therapy Groups

If you run psychotherapy or processing groups for people who have experienced psychological trauma, childhood abuse, or dissociation, the Sidran Institute would like to list them in our Trauma Resources Database. To be included, please complete the questionnaire below. There is not charge for inclusion, and we thank you for the work that you do.

*Name:

*Street Address:

*City: *State: *Zip:

*Country:

*Phone: Ext:

*Fax:

*Email: Website:

Intake / Contact Person:

*Populations Served: ChildrenAdolescentsAdultsMales OnlyFemales Only

*Specializations: Post Traumatic Stress DisorderDissociative DisordersEating DisordersMales onlySelf-InjuryBorderline Personality DisorderSleep DisordersDepressive DisordersAnxiety DisordersSubstance Abuse/Dual DiagnosisSexual Orientation/Identity Issues

Other Relevant Specialties:

Philosophical Orientation (e.g. Spiritual/Religious):

Do you run therapy groups?: YesNo

If yes, please describe the groups you sponsor:

What is your experience, including your credentials, for running these groups?:

Do you sponsor peer-run support groups?: YesNo

If yes, please describe:

Briefly state your treatment philosophy. What issues does your program focus on and how do you treat them?:

Institutional Information

Is your program affiliated with a hospital or medical center?: YesNo

If yes, please name the institution and describe the relationship:

*What types of insurance do you accept?:

Does Your Center / Program Provide:

Financial assistance?: YesNo
Sliding Fee Scale?: YesNo
Payment Plans?: YesNo