Group Interest Form

🌸 Introducing Breaking Out/Being Free: A Safe Place for Women Navigating STD Stigma 🌸

In a world where open conversations are often overshadowed by shame and societal taboos, we warmly invite you to Breaking Out/Being Free – a forthcoming support group tailored to empower and uplift women grappling with the emotional complexities of managing sexually transmitted diseases (STDs).

🌟 Our Purpose: Breaking Out/Being Free is a haven crafted with care, where women can find solace, understanding, and camaraderie on their journey towards self-acceptance and healing. Our mission is to foster an environment of compassion, empathy, and growth, helping each participant embrace their worth beyond societal stigmas.

🌟 Why Join Us?

  1. Heal Together: Sharing your experiences and emotions with like-minded women offers a therapeutic outlet, easing the emotional burden that STD-related anxieties may bring.

  2. Empowerment: By openly discussing challenges and triumphs, you can regain your sense of agency, transforming shame into strength, and embracing your own narrative.

  3. Cultivate Resilience: Engage in group activities and discussions that focus on building emotional resilience, equipping you with valuable tools to face the world with confidence.

  4. Navigating Dating Dynamics: We'll explore the intricacies of dating, providing insights on when and how to have conversations about your STD status, fostering healthier connections based on honesty and trust.

  5. Breaking Taboos Together: Together, we challenge societal misconceptions surrounding STDs, shedding light on the reality and promoting understanding, both within ourselves and within society.

In the Breaking Out/Being Free support group, your worries, fears, and anxieties are met with unwavering support and respect. Our circle is a judgment-free space where you can learn, share, and thrive, embracing your full self beyond the weight of stigma. Join us on this path of self-discovery, empowerment, and connection. You are not alone, and together, we can rise above.

For more details and to reserve your spot, please complete this brief interest form.

Your journey towards resilience and renewed self-assurance begins here. 🌷

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Email *
Are you a black woman? *
Today's Date *
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Please share your biggest challenge(s) or struggles with living with an STD. *
WHAT YOU NEED TO KNOW

We extend our heartfelt welcome to the Breaking Out/Being Free group, where your well-being is our utmost priority. To create a safe, nurturing, and confidential online space, we kindly ask you to adhere to the following guidelines. These principles will ensure that every participant can share, learn, and connect with a sense of comfort and respect.

  1. Confidentiality is Paramount: We emphasize the sanctity of privacy. What is shared within our virtual circle must remain within our virtual circle. Respect the experiences and stories of your fellow members by refraining from discussing or sharing any identifying information outside the group.

  2. Compassion and Empathy: Our interactions are guided by kindness. Engage with fellow members in a supportive and empathetic manner. Your words have the power to uplift, so let's foster an atmosphere of understanding, free from judgment.

  3. Active Listening: Each voice deserves to be heard. Practice active listening, offering your full attention to those who are speaking. By validating one another's emotions, we create an environment of trust and validation.

  4. No Disparagement or Judgement: We are united against negativity. Refrain from making hurtful comments, offering unsolicited advice, or passing judgment. Let's build bridges of understanding and connection rather than walls of criticism.

  5. Stay on Topic: Our discussions are centered around our shared experiences. While tangents are natural, let's make an effort to keep our conversations aligned with the purpose of the group to ensure that everyone's needs are met.

  6. Respect Boundaries: It's important to recognize personal boundaries. If a fellow member chooses not to share certain details, please respect their decision and refrain from prying or pushing.

  7. Tech Etiquette: In our virtual meetings, maintain a respectful and distraction-free environment. Avoid interrupting others and ensure your background is conducive to a comfortable and confidential atmosphere.

  8. Participate Mindfully: While we encourage active engagement, remember that participation is always voluntary. Avoid giving unsolicited advice to fellow members of the group. If you ever feel uncomfortable, you're welcome to simply listen and absorb.

  9. Conflict Resolution: In case of disagreements, handle them with grace. Reach out to the facilitator privately if you require assistance in resolving any issues. Our aim is to uplift one another, even during moments of discord.

  10. Respect the Facilitator: Our facilitator is here to ensure a smooth and beneficial experience for all. Please follow their guidance and respect their role in maintaining the group's integrity.

  11. We ask that all members be mindful and respectful of the group rules which may also include: 

    a.  Showing up on time for the session. 
    b.  Staying the full duration of the session. 
    c.  Not smoke (marijuana), use alcohol or drugs during or just prior to the session. 
    d.  Never screenshot or record (including video or audio) group sessions.
    e.  Avoid group member interactions outside of group. 
    f.   Keep camera on during the session (some exceptions may apply)
    g. Make payment as agreed.
  12. h. Do not post what was said by anyone including the facilitator on social media 


Do you agree to adhere to the group rules? *
                            ~Memorandum of Understanding ~

I understand that this group is virtual. We will meet on a virutal platform for registered members only.

I understand that all members will be screened and interviewed to determine the appropriate fit, as certain groups are not for everyone.

The group will meet two times per month, up to 90 minutes per session.

I understand that I hold noone liable for my health and safety including any of the members, facilitators and afflialites of Inner Coach Counseling, LLC; however the facilitator will do what is humanely possible within the confines of a virtual community to create a safe and brave space for its attendees.

I understand that this group is not a substitute for medical treatment. I recognize that this group is not a replacement for professional medical care, therapy, or medication is essential. While member can offer emotional support and camaraderie, members cannot provide medical advice, diagnosis, or treatment. It is my personal duty to always consult a qualified healthcare provider for medical concerns.



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What is your legal Name (this information is confidential and will only be shared with the facilitator and admin assistant for scheduling and payment processing; however, if you chose to use a nickname or social media handle during the group sessions, for anonymity, that is okay too) *
I understand that the investment is $45 per session. I agree to put my credit card on file to process payments. *
Refund Policy:  I understand that we do not offer refunds for missed or cancelled sessions. 
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Do you have any additional information that you deem helpful to the facilitator to know? If so, please add it here. 
Thank you for embracing these guidelines, which are designed to create an atmosphere of trust and mutual growth. Together, we can forge a nurturing space where we rise above challenges, stigma, and fear, while fostering connections that lead to resilience and empowerment.

With gratitude,

Gena Golden Breaking Out/Being Free Group Facilitator

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