Seen and Heard Group Application

Please complete the form below. You do not have to write a lot to answer the numbered sections. We are simply looking for a general idea of why you are here and what your experiences have been to this point. Thanks again for your interest in this group.

Prospective group members must:

• Have a diagnosis of a dissociative condition from a licensed mental health professional (including provisional or unspecified/other specified diagnosis) and/or adequately describe their connection with clinically significant dissociative experiences—this include depersonalization and derealization. [This does not include results from screening or diagnostic tools administered by a non-mental health professional.]
• Be psychologically stable enough to participate in the group process, as evidenced by an ability to adhere to group guidelines and communicate positively with other members.
• It is not a requirement, but we recommend group members participate in individual therapy (presently or in the past) for their dissociative condition, as this group is not meant to be an introduction to dissociation, nor is it a substitute for therapy.