Seattle Therapy Alliance
Clinical Training Program Application
Date ______
Thank you so much forinterest in joining our team at STA. To apply, please submita hard copy of your completed application together with your resumé and 1-2 STARecommendation Forms. We kindly ask that you collect the recommendation forms and send them with your completed application to include:
Completed and signed application
Resumé
1- 2 STA Recommendation Forms
Please circle or bold the program you are applying to:
September Start Internship September Start Externship
Personal Information
Name______
Mailing Address ______
Email Address ______OK to email you? Yes No
Best Phone Number to Reach You ______OK to call you? Yes No
Date of Birth ______
School Affiliation______
Program______
Year of Graduation______
In what languages are you fluent? ______
How did you hear about STA? ______
Are you currently in therapy? Yes No For how long? ______
If you are not currently, have you ever been in therapy? Yes No For how long? ______
Have you been convicted of any criminal activity or had any ethics violations? Yes No
If yes, please explain the circumstances. This will not necessarily prevent you from an invitation into our program.
Let Us Get to Know You
Please submit written responses for the questions below. If you wish to handwrite your application, please submit your responses on a separate paper.
Personal
- STA is a rigorous clinical training program. Self-care and a solid support system make it sustainable. In 3-4 sentences, please describe your self-care practices, including what support systems you have.
- In your graduate program and personal therapy, tell us in 3-4 sentences what have you learned about yourself with how you relate to yourself and others?
Social Justice
- At STA, we value social justice and are committed to understanding how social systems impact mental health. We work to incorporate intersectional feminism (critical social theory) into our clinical training and clinical practices. With this in mind, please describe in 2-3 sentences per identity category how you have developed an understanding of and engaged with your intersecting privileged and marginalized identities:
Racial identity:
Gender identity:
Socio-economic status:
Sexual Orientation:
Other salient identity (optional):
- Identify/list two to three areas of resistance that impact your healing work in each social identity. In other words, what do you notice about yourself or what gets going for you that limits/stops you from doing the work. For example, for gender identity you might write, “As a woman, I’ve internalized the social construct of “woman as helpless" which allows metobe dependent. Insome ways it’s more comfortable than doing the work of having agency. Thehealingwork for memight betodevelop the internal muscles to more consistently musclesto take responsibility for my own needs and build trust with myselfthatI will not collude with the ideathatI am helpless.”
Racial identity:
Gender identity:
Socio-economic status:
Sexual Orientation:
Other salient identity (optional):
Clinical
Please respond to the following questions in 3-4 sentences:
- At STA, we believe that there is no neutral space, including the therapy space. Power, rank, and status are always at work. What does this mean to you?
- When sitting with a client, how do you imagine using your internal responses and reactions to inform your clinical work? How do you discern when a reaction you’re having is more about you than about your client?
- You will receive a lot of feedback during your in/externship from your clients, colleagues, and supervisors. How do you handle difficult feedback, especially when it feels like criticism? With this, how do typically you handle tension, conflict, or confrontation in relationships?
Commitment and Availability
STA asks for a weekly time commitment of between 16-20 hours, including direct client hours, individual/dyad and group supervision, and critical social theory class readings and writing. Can you make this commitment? Yes No
Are you able to commit to seeing up to 12 patients per week for one year? Yes No
STA has a number internship and externship positions available. Scheduling availability is a key factor in the extension of an invitation into our Clinical Training Program. As best as you can at this time, please indicate below the days and times you are available to see patients.
M T W Tr F Sat Sun
Morning______
Afternoon______
Evening______
Resume/CV
Please submit a one to two pageresume(no more than two pages please!).
STA Recommendation Forms
Please submit one to two STA Recommendation Forms (no more than two please!)from faculty members and/or supervisors (of any capacity) who can speak to your emotional awareness, commitment to social justice, maturity, and personal growth. Please collect the forms and include them along with the other pieces of your application.We ask that you do not have your recommenders send the form inseparately.
Signature
I understand and agree that submitting this application does not automatically register me as an in/extern with STA.By submitting this form, I attest that the information I have provided on the form is true and is submitted voluntarily.
______
signature date
Submission of Application
Thank you for submitting the hard copy of your completed application form together with all completed pieces and parts, including STA Recommendation Forms.All applications post-marked by the final deadline will be reviewed. We will get back to you via email* regarding your application status no matter how we decide to move forward.
Priority DeadlineFebruary 16, 2018
Final Deadline March 2, 2018
*We prefer email communication throughout the application process. If for any reason it’s not OK for us to contact you via email, we will gladly contact you via the mode of communicaiton you provide on the application.
Please mail your application to:
Seattle Therapy Alliance
Attn: Jacquie Gallaway
200 1st Ave. W Suite 405
Seattle, WA 98119
Thank you! We look forward to getting to know you!