Radically Open DBT Tampa - Skills Class Only

RO DBT Skills Class Interest Form

The following form will help determine if Radically Open DBT skills classes are the best fit for you and get you started in class. RO DBT skills classes are intended for individuals who already have an individual therapist and are looking to add additional skills and accountability to their personal growth. The RO DBT Skills classes meet once a week for 90min through a series of 30 skills. The cost is $75 per week.

If you are seeking traditional DBT or are unsure what RO DBT is, please visit this page first before proceeding: What is RO DBT?

If you are seeking to participate in the full RO DBT Treatment Program with individual therapy and skills class, please apply here: RO DBT Program New Client Form

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* 1. How did you learn about Radically Open DBT?

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* 2. Individuals often pursue RO DBT therapy when they have troubling thoughts, emotions or problems in relationships . Please select all of the symptoms you have experienced in the last year?

Prolonged depression, apathy or down mood

Prolonged worry or rumination

Obsessive thoughts - frequent intrusive unwanted thoughts or images

Compulsive behaviors - strong desire for repetitive behavior such as checking, ordering, cleaning, sorting, etc.

Restricted eating, over-exercise, or binge-purge behavior

Social anxiety, isolation or lack of social connectedness

Outbursts in private - emotional outbursts (i.e. anger, sadness) only when alone or with people in your immediate family/romantic partners

Rigid, rule governed, or stubborn behavior

Striving for perfection

Difficulty expressing honest and vulnerable thoughts and feelings to others

Difficulty labeling or understanding other's non-verbal social cues

Feelings of loneliness or exclusion

Intolerant of mistakes or changes in plans

Insisting that processes are done the 'right way'

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* 3. Radically Open DBT is a treatment designed for individuals who have an over-controlled temperament type. Individuals with over-control temperament are often described as detail oriented, guarded, rigid, perfectionistic, hard working, anxious and prone to loneliness. Does this style describe you?

Yes, the over-control style describes me

No, this does not describe me

I don't know, I need additional information to decide.

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* 4. The following symptoms are not indicated for treatment with RO DBT. Have you experienced any of these in the past year?

Addiction - physical or chemical dependence on a substance not prescribed to you by a doctor

Psychosis - seeing/hearing/sensing/believing things that other people tell you is not real

Mania - intense periods of energy and elated mood that result in destructive behavior, typically a part of bipolar disorder

Destructive to Property/Harm to Others - actions or strong urges to destroy property or harm another person

Outbursts in Public - emotional outbursts (i.e. anger, sadness) in public places or directed at people outside of your immediate family/romantic partners

None of the above

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* 5. Radically Open DBT skills classes consist of weekly 90min online learning sessions for a duration of 30 weeks. Attendance at or above 80% of the scheduled sessions is an essential component to learning and living in a skillful way.

Yes, I am able to participate in weekly sessions for the duration of 30 weeks

No, this is too much of a time commitment for me. Do you have asynchronous distance learning options?

I don't know. I would like more information before making a decision.

Other (please specify)

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* 6. Radically Open DBT skills classes are a structured and active form of learning. When participating in a skills class you will be asked to:
- sign on from a private location
- participate in virtual sessions with your camera on
- engage in skills class discussion and activities
- independently practice skills and self-enquiry between sessions

How willing are you to participate at this level?

A great deal

A lot

A moderate amount

A little

None at all

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* 7. In order to participate in RO DBT skills classes, all learners must be actively seeing an individual therapist and be willing to sign a Release of Information for safety and continuity of care.

Yes, I am actively meeting with a therapist and willing to sign an ROI

No, I do not currently have a therapist

Other (please specify)

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* 8. Please provide information about yourself and a member of our team will follow-up with you.

Name *

Address

City/Town

State/Province

ZIP/Postal Code

Email Address *

Phone Number

Radically Open DBT Tampa - Skills Class Only

RO DBT Skills Class Interest Form

Question Title

* 1. How did you learn about Radically Open DBT?

Question Title

* 2. Individuals often pursue RO DBT therapy when they have troubling thoughts, emotions or problems in relationships . Please select all of the symptoms you have experienced in the last year?

Question Title

Question Title

* 4. The following symptoms are not indicated for treatment with RO DBT. Have you experienced any of these in the past year?

Question Title

* 5. Radically Open DBT skills classes consist of weekly 90min online learning sessions for a duration of 30 weeks. Attendance at or above 80% of the scheduled sessions is an essential component to learning and living in a skillful way.

Question Title

Question Title

* 7. In order to participate in RO DBT skills classes, all learners must be actively seeing an individual therapist and be willing to sign a Release of Information for safety and continuity of care.

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* 8. Please provide information about yourself and a member of our team will follow-up with you.

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* 9. Is there additional information you would like us to know?