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Interactive Group Questionnaire

Please click Start below and answer the first question, THEN CLICK THE "NEXT" BUTTON TO MOVE TO THE NEXT QUESTION.   

As a requirement for participation in an Interactive IFS Group, you must answer every question.

When you have completed the questionnaire you will see a Restart button, which you can click if you want to go back and change any of your responses. 

You will receive a response. Please check your Spam Folder to make sure you get it.

Click the button below to start.

Start

Question 1 of 22

Please share your name, email address, and phone number. 

Question 2 of 22

What is your gender identity?

Question 3 of 22

Would you like to declare your race, culture, and/or religion?

Question 4 of 22

What experience or training do you have with IFS? 

Question 5 of 22

What experience or training do you have with IFS? 

Question 6 of 22

What experience do you have with interpersonal or process groups? (none required) 

Question 7 of 22

Are you a therapist or coach? (not required) 

Question 8 of 22

What makes you interested in possibly joining this Interactive/IFS Group? 

Question 9 of 22

Since the group focuses mostly on interpersonal issues, which interpersonal issues would you like to work on in the group, and which interpersonal issues do you think may arise for you in the group? 

Question 10 of 22

What would you like to get from the group and in what ways would you like to grow from the group? 

Question 11 of 22

Do you have a history of serious trauma? If so, how much of this have you healed or worked through? Are you currently working on it in therapy?

 

Question 12 of 22

Do you have any history of emotional instability?  If so, please give a brief description. 

Question 13 of 22

Is there any danger that conflicts in the group could be destabilizing for you?  If so, please explain your concern. 

Question 14 of 22

Have you been hospitalized for psychiatric reasons or treated with psychiatric drugs?  If so, please give a brief summary of your experience. 

Question 15 of 22

Are you currently in psychotherapy?  With an IFS therapist? If so, for how long?   

Question 16 of 22

Do you know anyone who is likely to be in the group?

Question 17 of 22

Which of the following would be an important issue for you in an Interactive Group?

(Select all that apply)
A

Feeling OK with conflict and being assertive.

B

Expressing myself without getting too angry or judgmental.

Question 18 of 22

Where do you live? 

Question 19 of 22

If there were enough people in your area, would you be interested in an in-person group? 

Question 20 of 22

If there were enough interest, would you be interested in a weekly group? 

Question 21 of 22

Which of the Interactive Groups can you attend? (Not which you prefer. All that you can attend.)

(Select all that apply)
A

1st and 3rd Mondays of each month - 10am-12pm Pacific Time (1-3pm Eastern)

B

2nd and 4th Mondays of each month 10-12 pacific time (1-3 eastern, 6-8 UK)

C

2nd and 4th Mondays of each month 12:30-2:30 pacific time (3:30-5:30 eastern, 8:30-10:30 UK)

D

1st and 3rd Wednesdays of each month 10am –12 noon Pacific Time (1-3 pm Eastern Time, 6-8 pm UK)

E

2nd and 4th Wednesdays of each month 10am-12 noon Pacific Time (1-3 pm Eastern Time, 6-8 pm UK)

F

2nd and 4th Thursdays 11am - 1 pm pacific time (2-5 pm eastern)

G

2nd and 4th Fridays 10-12 pacific time (1-3 eastern, 6-8 UK)

H

I am in the Asia/Pacific area, so I need a time that works for that area.

I

I am in Europe and your current groups are too late at night for me, or I can't attend a group at night.

Question 22 of 22

By submitting this form, you are signing up for our email list. What information are you most interested in hearing about? 

(Select all that apply)
A

I am interested in becoming a member of an Interactive IFS group with Jay Earley.

B

I am interested in professional training to lead Interactive IFS groups with Jay Earley.

Confirm and Submit