Grief and Loss: Connection and Post-Traumatic Growth Therapy Group Interest Form

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Please complete the following inquiry form regarding the Grief & Loss: Connection and Post-Traumatic Growth Group and the group facilitators Maria Jose Sotomayor-Giacomucci and Lincoln Blackwell, will contact you via email to set up an intake session to assess for group readiness and appropriateness.

-A Spring 2024 group is forming:

Leb by Lincoln Blackwell, MA, NCC, CCTP

Date & Time: Friday’s starting April 19, 2024, from 6:30 PM- 8:00 PM. Group will meet every Friday for 12 weeks. A commitment of 12 weeks is required to join.

-A Fall 2024 group is forming on Monday nights with an intended start date on Monday, September 30, 2024 ending on Monday, Dec 9, 2024 from 5:30-7:00 pm. The group will take place in-person at Phoenix Center for Experiential Trauma Therapy, in Media PA. A commitment of 10 weeks is required to join.

About our group: 

This group is designed to help participants deal with feelings and experiences involved with grief and loss. There are no exact ‘rights or wrongs’ in dealing with loss, nor any specific timeframe where we expect to move beyond it. The death of someone significant in our lives affects each person uniquely and personally. We often find ourselves in the ripple effects of the loss, and other losses that come after. We want you to know that you are not alone!
It is through interacting with our emotions, as well as expressing them in a safe, supportive place that we encounter new beginnings and hope beyond our experienced loss.  Throughout the length of our group, we will learn about grief and loss, explore and understand our grief and loss, connect with others, and find ways to make sense and personally grow from our losses. 

Email *

Full Name *

Email Address *

Phone Number *

Date of Birth

YYYY

Preferred Pronouns and Preferred Name. Learn more about pronouns at Pronouns.org *

Have you been a client of Phoenix Center before?*
*

Yes

Which group are you interested in joining?

Spring 2024- starts April 19, 2024

Fall 2024- starts September 30, 2024

Are you currently working with a therapist, either at our center or outside? Please share how long you have been working with your current therapist, how often to do you see your therapist. Please list other therapeutic or support groups that you are part of at this moment (ex. AA, NA, ACA, specific support groups, community groups, religious groups, etc not limited to this list) *

What brings you to group at this time? What are your hopes for group? What questions do you have about this group?
*

By submitting this form I affirm the following: *
*

I understand that this form is an inquiry for this group, not group registration

I agree to abide by the group rules and norms

I agree to participate with respect to all present

I understand that the group therapist and myself will determine my fit for the group together

Required

Please share your relationship to the deceased? *

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