Mclain Edit App Principles Course 2015

Experiential Group Application Northeastern Society for Group Psychotherapy

Indicate which offering(s) you are applying for:

___ Module 1: October 7, 2016 to January 27, 2017; $400 ___ Module 2: February 10, 2017 to May 12, 2017; $400 ___ Both (Module 1 and Module 2; October 7, 2016 to May 12, 2017); $750

See page 2 for more details about the Experiential Group (EG). More information is also available on the main training page at https://nsgp.com

Please email completed applications to Jenn McLain, MD, CGP at [email protected].

Once you have emailed Jenn your application, you can expect an email confirming your application has been received. Jenn will connect you with someone from NSGP’s Training Committee to have a brief conversation around your expectations for the EG and review the group agreements. After this phone conversation, you will receive an email with a link to register. You may pay with a credit card when you register or make checks payable to NSGP, and mail them to Northeastern Society for Group Psychotherapy, Inc., PO Box 356, Belmont, MA 02478.

Name: Address: Phone: Email: Professional Discipline:

Write as much as you need below. Feel free to go onto the second page.

Tell us where you are in your career.

Describe your current and past experience with groups, if any.

of 2 2

How did you learn about the program?

What do you hope to take away from the experiential group?

Experiential Group Information:

Meetings will take place on Fridays from 10:15am to 11:30am. The group will be led by Annie Weiss, LICSW, CGP, at her office in Newton. Twelve meetings will include eleven experiential meetings and one didactic wrap-up session discussing group development and dynamics, leadership choices, and themes as they pertained to the experiential material. 15 CEU credits are available for social workers, psychologists, and mental health counselors. CMEs (for physicians and nurses) are unfortunately not available

Module 1 will meet weekly for 12 weeks from October 7, 2016 to January 27, 2017 (no meetings on 11/18/16, 11/25/16, 12/23/16, 12/30/16, and 1/6/17); $400 – application deadline September 15, 2016

Module 2 will meet weekly for 12 weeks from February 10, 2017 to May 12, 2017 (no meeting on 3/3/17 and 3/10/17); $400 – application deadline January 19, 2017

Maximum number of members: 10

Tuition: $400, which includes CEU credits. Register for Module 1 and Module 2 at the same time for $750 and save $50! If you are interested in applying for a scholarship, click the link on the main training page to download the scholarship application.

Pay by credit card or make checks payable to NSGP, and mail them to Northeastern Society for Group Psychotherapy, Inc., PO Box 356, Belmont, MA 02478.

For more information about the Experiential Group, email Jenn McLain, MD, CGP at [email protected]

Northeastern Society for Group Psychotherapy, Inc., PO Box 356, Belmont, MA 02478-3201