“The best part about being with a group is that you don’t have to do everything alone.” —Anonymous Please complete the questions below to submit your application for the Alliance Teen Therapy Group. Name of Group Attendee * First Name Last Name Contact Email * Contact Phone Number * (###) ### #### What would you like to get out of this group? * What would you like to learn from this group? * How would you like to feel differently at the end of this group? * What do you need to learn about the mental health challenges experienced by adolescents? * What have you tried to do that has worked? What have you tried to do that hasn't worked? * How has your family and relationship history influenced your goals and problems? * How do you see yourself working on this goal in group? * How would the group help with this goal? * What things could you do in this group to help you with this goal? * What activities and interventions do you think would be helpful? * Do you experience depression, anxiety, ADHD, or other mental health challenges? * Do you have thoughts of wanting to hurt yourself or end your life? * Do you have thoughts of wanting to hurt someone else or end their life? * Have you ever been removed from a group setting? * How do you typically participate in groups? * How you ever been in a psychoeducational or counseling group before? What was helpful? Why or why not? * Do you perceive the problem as something that can be changed, or over which you have no control? * How comfortable are you with talking about your feelings? * How comfortable are you with talking about this problem or issue? * Are you willing to try and help others and also be helped by others? * What strengths would you bring to this group? * What unique contribution would you make to the group? * How could you help others with similar concerns? * Where do you see yourself having the most trouble as we begin to talk about some of the issues? * Are you willing to attend all group sessions on time? * Are you willing to keep things that are discussed within the group confidential? * Are you willing to share honestly about yourself in the group? * Do you have reliable transportation to and from 195 S. Main St., Cheshire, CT? * Are you willing to receive therapeutic feedback and try new behaviors? * Have you used substances within the past 30 days? If so, what substances, and how often? * Thank you! Your registration has been submitted. An Alliance Group Administrator will reach out to you with more information soon.
