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50% of survey complete.

* 1. What is your name?

* 2. What is your current Utah license to practice Mental Health Therapy?

* 3. Which populations are you highly skilled treating? (select up to 5 options)

* 4. Rate your skill level or familiarity with each therapeutic approach:

  I am not familiar with this style I have some knowledge of this style I am building skill in this style I use this style and am proficient in its use I am an expert in this therapeutic style
Cognitive Behavioral Therapy (CBT)
Couples Therapy (Pre-Marital)
Dialectical Behavior Therapy (DBT)
Eye Movement Desensitization and Reprocessing (EMDR)
Emotionally Focused Therapy (EFT)
Family Systems
Mindfulness Based Therapy
Narrative Therapy
Parent Child Interaction Therapy (PCIT)
Play Therapy
Rational Emotive Behavior Therapy (REBT)
Reality Therapy
Solution Focused Therapy
Trauma-Focused CBT

* 5. Mark all issues you feel confident treating (Yes or No):

  Yes No
Addiction (Gambling)
Addiction (Internet)
Addiction (Video Game)
Addiction (Substance)
Addiction (Sexual)
Adjustment Disorder
Adoption Issues
Affective Disorders
Anger Management
Asperger's Syndrome
Attachment Issues
Autism Spectrum Disorders
Behavior Disorders
Bereavement Issues
Blended Family Issues
Bullying Issues
Career Issues / Downsizing
Caregiver Burnout
Chemical Dependency
Child Abuse
Chronic Illness
Chronic Pain
Conduct Disorder
Crisis Intervention
Delusional Disorder
Depression (Major)
Depression (Postpartum)
Dissociative Disorder
Eating Disorders
Eliminating Disorders
Factitious Disorder
Family Violence (Victim)
Family Violence (Perpetrator)
Impulse Control Disorders
Learning Disabilities
Long/Short Term Disability
Medical Psychology
Men's Issues
Mental Retardation
Motivation Issues
Multiple Personality Disorder (MPD/DID)
Occupational Adjustment
Obsessive Compulsive Disorder (OCD)
Panic Disorders
Parenting Issues
Personality Disorder - Borderline
Personality Disorders - Narcissism
Personality Disorders (other)
Pervasive Developmental Disorder (PDD)
Pornography Addiction
Post Incest Disorder
Psychosomatic Disorder
Post Traumatic Stress Disorder (PTSD)
PTSD (Combat)
Reactive Attachment Disorder (RAD)
School/Academic Performance
Self-Worth Issues
Sensory Integration Disorder
Separation (Relationship)
Separation Anxiety
Sexual Abuse (Victim)
Sexual Abuse (Perpetrator)
Sexual Disorders
Sexual Dysfunction
Sexual Identity Issues
Sexual Reactivity in Children
Sleep Disorders
Smoking Cessation
Somatoform Disorder
Spiritual Issues
Step Families
Stress Management
Substance Abuse
Substance Related Disorder
Suicidal Ideation
Terminal Illness
Tic Disorders
Tourette's Syndrome
Transvestic Fetishism
Urgent Stress
Weight Loss
Women's Issues

* 6. What do you feel is a reasonable charge for a 53-60 minute session of therapy in a private practice setting? (Mark up to 2 options)

* 7. Describe any entrepreneurial experience you have had in the past.

* 8. How comfortable are you with collecting payment directly from a client in a private practice setting?

* 9. In your opinion how important is each of the following to the delivery of clinical care and customer service in a private practice setting?

  Not important Somewhat important Important Very important Extremely important
Low Pricing
High Pricing
Reasonable Pricing
Clinical skill in my area(s) of expertise
Well rounded skills over a broad spectrum of issues
Response time in returning calls or emails
Setting clear boundaries
Asking for help when you need it
Going the extra mile
Ability of clinician to say "No"
Willingness to refer out to others in the client's best interest
Personal financial management skills
Business financial management skills
Ability to include spirituality in therapy (even if different from my own)
Reading social cues
Coordinating client care with parents, doctors, clergy, etc
Personal moral & life decisions
Boldness in difficult interactions
Personable nature of therapist
Nice office and furnishings
Client focused customer service practices

* 10. Select the option that you feel is the most effective time to collect payment from a client in a private practice setting?

* 11. Scenario:

You realize you have two separate clients who have shown up to the same appointment time and are both in the waiting area.  Each is anticipating to be seen in this next session.  You check your schedule and see that one client has arrived at the right time (1:00 PM) but on the wrong day (Tuesday instead of Thursday).  How would you handle this situation?

Place approaches in the order that you agree with (most {1} to least {5}):

* 12. Please mark how others would describe you in each of the following areas:

  Weak Average Actively Building Strong Excellent
Clinical Skill
Customer Service
Personable Nature
Consideration of Others

* 13. What would you enjoy most about working in a private practice setting? (mark the top 3 reasons)

* 14. The following are all important aspects of private practice. Rank in order of how strongly you possess each of these qualities (from greatest {1} to least {5}):

* 15. The idea of being the one who is ultimately responsible for my income and for providing benefits for my family causes me to feel:

* 16. What sets you apart from other clinicians?

* 17. What are your thoughts about the involvement of spirituality in the process of therapy?

* 18. Which of the following challenges of working in a private practice setting would be difficult for you?  (mark top 3 challenging factors)

* 19. Do you have three former/present clients who would be willing to contact us and relate why they have confidence in you as a therapist?

* 20. Are you interested in accepting insurances?

* 21. Which insurances are you interested in taking? (select all that apply)

* 22. Would you feel comfortable working with LDS bishops to coordinate treatment for members of their ward?

* 23. Please describe what you believe are the major differences between practicing therapy in an agency vs a private practice setting.

Use this picture to answer the question below.

Use this picture to answer the question below.

* 24. Using the map of the parking lot (above) please indicate which colored section of parking spots you would prefer to park in when seeing clients at Aspire: