RRP Group Screening Form
Lauren Topel's Relationship Recovery Process Group screening form
Email *
Name
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What services are you interested in?
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Required
I have difficulty connecting emotionally with self or others

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Most days I struggle with daily functioning (lateness, organization, follow through)
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Describe your experience with past therapy or write N/A if you have not had a therapist in the past.
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I am overwhelmed by stress most days.
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I’m seeking short-term expediated change.
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My problems are more situational vs. emotionally internal
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Required
I do not know how childhood has impacted me.
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I currently have legal problems.
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I currently have problems of safety (domestic violence).
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I’m currently in a contentious divorce.
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I question my relationship to sex (shut down or compulsive)
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I did not seek this out on my own, it was suggested to me to do childhood trauma work.
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I’ve experienced suicidality in the last year.
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I’ve needed partial or inpatient hospitalization in the last year.
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What has helped specifically? (Self help books, therapy, holistic, 12-step)
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What are some things you’d like to heal and or change?
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What led you to this moment in seeking change. (break up, saw a video, something keeps prompting you?)
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