We offer several courses in Intensive Short-Term Dynamic Psychotherapy to help increase your effectiveness as a therapist and prevent burnout. Our training is experiential, attachment-based, and affect-focused.

Please complete this form to submit your request to attend one of our trainings, or to have us bring one of our trainings to your organization

*1.Contact Information(Required.)

Name and Credentials

Email Address

Phone Number

*2.How did you hear about us?(Required.)

3.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:

*4.Today's Date:(Required.)

*5.Please mark which course(s) you are interested in us bringing to your organization. A full list of our offerings for businesses can be found at mindfulistdp.com/business-solutions(Required.)

1-hour Introduction to ISTDP

Full-Day Introduction to ISTDP

ISTDP Intervention Training

The Psychotherapy Institute

Foundational Therapist Training

Building Capacity in the Traumatized Client

It's Not Always Depression

Understanding Anxiety

What Is Healthy Emotional Functioning?

Suicide Crisis Intervention: Treating the Cause of Suicidal Ideation

Overcoming Imposter Syndrome as a Therapist

Self-Compassion in Action

Identifying and Overcoming Implicit Bias As a Therapist

*6.Would you like your program(s) delivered in-person or virtually?(Required.)

In-person

Virtually

Open to either