Course Description:
Relationship issues, interpersonal injuries/trauma and emotional regulation continue to be hot topics with many clients in individual therapy. In this training, you will have the chance to explore Emotionally Focused Interpersonal Therapy (EFIT) and to practice applying strategies that can be incorporated into your work, regardless of your preferred theoretical framework. You can continue to help resolve your client's diagnostic symptoms while also supporting them to feel more secure in themselves when they face interpersonal problems!

Date:
Friday, July 17th from 10am-2pm EST over Zoom

Led by:
Dave Isbell, LMSW

Cost and Continuing Education:
$200. This course through Mindful ISTDP is approved by the NASW-Michigan Chapter and provides 4 CE credits.

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* 1. Contact Information

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* 2. How did you hear about this training?

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* 3. Please share accommodations you need for this training here:

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* 4. Waiver of Liability

I, as a participant in this program, hereby assume all of the risks of participating in this event. I have agreed to execute this Waiver and Release of Liability Form for myself and acknowledge, agree to, and represent the following:

I understand that I am attending this event hosted by Mindful ISTDP, LLC in order to obtain knowledge, strategies, and techniques to address mental health.

I hereby release, waive, acquit and forever discharge Leslie Auld and Mindful ISTDP, LLC, as well as any employees, volunteers, instructors, representatives, agents, the event holders, event sponsors, and event volunteers (“Releasees”) from every claim, suit action, demand, or right to compensation for damages claimed or that I may have arising out of my own acts or omissions as a result of any advice given or otherwise resulting from my participation in this event. I further declare and represent that no promise, inducement, or agreement has been made other than what is expressed within this agreement.

I further waive and release Releasees from any liability incurred based on or resulting from the implementation of any information obtained at this event.

I indemnify and hold harmless Leslie Auld and Mindful ISTDP, LLC, as well as any other entities or persons mentioned above, from any and all liabilities, claims, demands, or actions made as a result of participation in this event, whether caused by the negligence of release or otherwise. I further indemnify and agree to hold harmless the aforementioned entities from any and all third party claims associated with my participation.

I understand that at this activity or event, I may be photographed. I agree, irrevocably and without restriction, to allow my photo, video, or film likeness to be used for advertising and/or any other purpose by Mindful ISTDP, LLC, as well as the event holders, producers, sponsors, and organizers. I also grant the aforementioned entities or persons the right to alter and copyright the same without restriction.

I recognize that this Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

I certify that I have read this document and I fully understand its content. I am aware that this is a release of liability and a contract, and I sign it freely, voluntarily, and competently.

Please sign below:

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* 5. Condition of Admittance:

The audio-visual material used in this training on 7/17 is provided by patients who volunteered the use of their treatment sessions for purposes of teaching others these techniques. Their willingness is based on the assurance of confidentiality of their identities and histories. You are entrusted with the confidentiality of their identities and histories and the material you will see and hear in this event. In this cooperative spirit, you are requested to sign this “Condition of Admittance”.

This training event is for licensed health professionals or those in training at an institution of higher education. Participants are expected to follow the ethical standards of practice as outlined by their respective licensing board and/or university. I acknowledge that all videotaped and case material to which I am permitted access during this event is the exclusive property of the presenter.

1) I agree that I shall not under any circumstances electronically or in any other way (e.g., Transcription or recording) copy or duplicate such material.
2) I agree that I shall not refer to any specific patient seen, heard or described in such material otherwise.
3) I agree to ensure that at all times I am in a private and confidential space during my participation.
4) I agree that I shall not provide or enable access to the event to any person not registered.

I understand and agree to these terms and conditions with my signature below.

Please sign below by typing your name:

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* 6. Today's Date:

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