Racial Trauma Survey

* Indicates required field

Name *

First

Last

Pronouns *

Email *

Address (this round open to MN residents only) *

Line 1

Line 2

City

State

Zip Code

Country

Racial Identity *

Black/African American Other Person of Color (specify below) White (not eligible for racial trauma group)

Specify other POC *

Are you currently in individual therapy with a psychotherapist ? *

This round of the Racial Trauma Group is grant-funded and will be free to participants
(an intake is required for folks who are not my current clients, at a one-time fee of $185)

I can commit to the following dates: *

Wednesdays 1:30-3:00pm (11/8, 11/15, 11/22, 11/29, 12/6, 12/13) Mondays 9:00-10:30am (11/6, 11/13, 11/20, 11/27, 12/4, 12/11) This round will not work for me

How do you address and manage conflict if it arises in group settings *

What current coping skills to you know and use to manage distress? *

What are you hoping to get our of this group? *

What makes you feel safe in a group setting? (particularly in an online shared space) *

Is there anything that you're anxious about with the group? *

What is a song(s) that makes you feel calm, held, or safe? *

Comment *

Submit

Racial Trauma Group Survey

This round of the Racial Trauma Group is grant-funded and will be free to participants (an intake is required for folks who are not my current clients, at a one-time fee of $185)

This round of the Racial Trauma Group is grant-funded and will be free to participants
(an intake is required for folks who are not my current clients, at a one-time fee of $185)