Psychotherapist Candidate Questionnaire
WE WANT TO GET TO KNOW YOU BETTER!
(All questions require an answer)
OK
1.
What is your name (first and last)?
*
2.
I acknowledge that the position requires that I live within an hour's commute of Orillia, Ontario
(Required.)
Yes, that works for me
No, that does not work for me
*
3.
Name the institution your received your Bachelor's degree, and they type of degree received
(Required.)
*
4.
Name the institution you received your Master's degree, and the type of degree you received.
(Required.)
*
5.
How many years of clinical treatment provision do you have??
(Required.)
Less than 3 years
3 - 5 years
More than 5 years
*
6.
Describe what made you interested in this type of work in general.
(Required.)
*
7.
What are your longer term professional goals? Where do you see yourself in 5 - 10 years?
(Required.)
*
8.
How would you best describe your treatment approach?
(Required.)
*
9.
What age of clients do you enjoy working with the most?
(Required.)
children under 12
Youth 12-18
Adults
Couples
Families
Other (please specify)
*
10.
What age of clients do you enjoy working with the least?
(Required.)
Children under 12
Youth 12-18
Adults
Couples
Families
none
Other (please specify)
11.
Have you worked with First Responders providing clinical treatment?
Yes
No
*
12.
Have you worked with First Responders in any capacity?
(Required.)
Yes
No
If yes please specify
13.
Have you provided clinical treatment for individuals struggling with chronic pain, and physical injury related psychological issues.
Yes
No
Other (please specify)
*
14.
Are you trained in any of the following modalities and have certification?
(Required.)
EMDR (Eye Movement Desensitization and Reprocessing)
PE (Prolonged Exposure)
CPT (Cognitive Processing Therapy)
ERP (Exposure and Response Prevention)
ACT (Acceptance and Commitment Therapy)
CBT (Cognitive Behavior Therapy)
DBT (Dialectical Behavior Therapy)
Other (please specify)
None of the above
*
15.
Specifically, why would you like to work at Psychology Matters?
(Required.)
Current Progress,
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