NMCC-WACC Profile Update Form
Name
*
First Name
Last Name
Are you updating or creating a profile page?
I am new to the organization, creating my profile page
I have an existing profile page I would like to update
Please upload your headshot here. A forward-facing photo from the shoulders up, using a self-timer, would be perfect. This is the image clients will see on the website.
*
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Let's build your page for the website! For reference, you can view an example of a clinician profile on the WACC website by
clicking here to view
.
1. Background and Credentials
Please answer the questions below formatted for your website profile.
Where did you receive your undergraduate and graduate education?
Are you currently pursuing any further education?
2. Experience and Specialization
Please answer the questions below formatted for your website profile.
Can you describe your experience working with children and families?
What types of organizations have you worked with in the past?
What are your main areas of focus in your clinical practice?
3. Treatment Focus
Please answer the questions below formatted for your website profile.
What specific issues do you specialize in treating?
Do you have experience dealing with trauma and domestic violence?
What age groups do you primarily work with?
4. Approach to Therapy
Please answer the questions below formatted for your website profile.
What therapeutic approaches do you use in your practice?
Can you explain how trauma-focused therapy guides your practice?
5. Quote
Please answer the questions below formatted for your website profile.
What is your philosophy towards therapy and helping your clients -a quote (either your own or one from an author, including their name) would be great!
How do you approach the process of change in therapy?
6. Ideal Client Profile
Please answer the questions below formatted for your website profile.
Who do you consider your ideal clients?
What kinds of issues do you feel most equipped to handle?
Please click all treatment focus options you are interested in. This will be featured on your therapist profile on the clinic website and can be used to assign patients to you.
*
Children
Teens
Young Adults (including College Students)
Geriatric/Retirement/Aging
Couples
Families
Blended Families
Military & Veteran Counseling
LGBTQIA+
Women’s Issues
Men’s Issues
Motherhood
Pregnancy
Foster Care
Homelessness
Immigrants
Relationship and Interpersonal Issues
Communication Issues
Coparenting
Infidelity
Divorce
Domestic Violence
High Conflict
Family Conflict
Attachment Issues
Anxiety
Depression
Self Harm and Suicide Prevention
Anger Management
Stress Management
Mood Disorders
Phobias
Traumas
Childhood Trauma
Sexual Assault
Loss and Grief
Self Esteem and Emotional Regulation
Substance Abuse
Gambling
Addictions
Autism
ADHD
OCD
Personality Disorders
Psychosis/Schizophrenia
Eating Disorders
Sleep Disorders/Insomnia
Learning Disabilities
Physical Disability/Impairment
Visual Impairment
Developmental Disability
Acquired Brain Injury
Racial, Cultural, & Identity Issues
Sexual Orientation
Gender Identity
Immigrants
Life Transitions
Wellness and Self Care
Career Counseling
Restorative Coaching
Financial Stress
Workplace Stress/Burnout
Chronic Illness/Health Related Concerns
Caregiver Stress
Spirituality/Faith-Based Counseling
Legal Issues/Court-Ordered Therapy
Adoption/Infertility/Reproductive Issues
Parenting Skills
Bullying/Peer Issues
ODD/Behavioral Issues in Children
Body Image Issues
Other
Optional: If you selected "Other" above, please list other specializations.
Please click all the therapy models/approaches you use. This will be featured on your therapist profile on the clinic website.
*
CBT (Cognitive Behavioral Therapy)
TF-CBT (Trauma Focused Cognitive Behavioral Therapy)
DBT (Dialectical Behavior Therapy)
ACT (Acceptance and Commitment Therapy)
REBT (Rational Emotive Behavior Therapy)
Motivational Interviewing
SFBT (Solution-Focused Brief Therapy)
Reality Therapy
EBT (Emotion-Focused Therapy)
Experiential Family Therapy
Art Therapy
Mindfulness / Mindfulness Based Techniques
Strengths-Based Therapy
Holistic Approach
Humanistic Therapy
Existential Therapy
Person-Centered Therapy
Gestalt Therapy
Gottman (Gottman Method Couples Therapy)
Prepare/Enrich
Family Systems Therapy
Minuchin Models (Structural Family Therapy)
Transgenerational/Bowenian Therapy
The Satir Model
Narrative Therapy
Experiential Family Therapy
Attachment Theory
Psychodynamic Therapy
Adlerian
Interpersonal Counseling
Multicultural
Culturally Responsive Counseling
Trauma-Informed Care
Trauma Focused Therapy
Other
Optional: If you selected "Other" above, please list other approaches you use.
Optional: If you would like to update your quote under your therapist profile, please upload it here.
Optional: If you would like to update your "About the Clinician" section of your profile, please upload an updated version here or tell us what you'd like to remove.
Optional: If you would like to update your "Credentials" section of your profile, please upload an updated version here or tell us what you'd like to update.
Would you like to update your treatment focus section?
Yes
No
Please click all treatment focus options that apply. This will be featured on your therapist profile on the clinic website and can be used to assign patients to you.
*
Children
Teens
Young Adults (including College Students)
Geriatric/Retirement/Aging
Couples
Families
Blended Families
Military & Veteran Counseling
LGBTQIA+
Women’s Issues
Men’s Issues
Motherhood
Pregnancy
Foster Care
Homelessness
Immigrants
Relationship and Interpersonal Issues
Communication Issues
Coparenting
Infidelity
Divorce
Domestic Violence
High Conflict
Family Conflict
Attachment Issues
Anxiety
Depression
Self Harm and Suicide Prevention
Anger Management
Stress Management
Mood Disorders
Phobias
Traumas
Childhood Trauma
Sexual Assault
Loss and Grief
Self Esteem and Emotional Regulation
Substance Abuse
Gambling
Addictions
Autism
ADHD
OCD
Personality Disorders
Psychosis/Schizophrenia
Eating Disorders
Sleep Disorders/Insomnia
Learning Disabilities
Physical Disability/Impairment
Visual Impairment
Developmental Disability
Acquired Brain Injury
Racial, Cultural, & Identity Issues
Sexual Orientation
Gender Identity
Immigrants
Life Transitions
Wellness and Self Care
Career Counseling
Restorative Coaching
Financial Stress
Workplace Stress/Burnout
Chronic Illness/Health Related Concerns
Caregiver Stress
Spirituality/Faith-Based Counseling
Legal Issues/Court-Ordered Therapy
Adoption/Infertility/Reproductive Issues
Parenting Skills
Bullying/Peer Issues
ODD/Behavioral Issues in Children
Body Image Issues
Other
Would you like to update your approach section?
Yes
No
Please click all the therapy models/approaches you use. This will be featured on your therapist profile on the clinic website.
*
CBT (Cognitive Behavioral Therapy)
TF-CBT (Trauma Focused Cognitive Behavioral Therapy)
DBT (Dialectical Behavior Therapy)
ACT (Acceptance and Commitment Therapy)
REBT (Rational Emotive Behavior Therapy)
Motivational Interviewing
SFBT (Solution-Focused Brief Therapy)
Reality Therapy
EBT (Emotion-Focused Therapy)
Experiential Family Therapy
Art Therapy
Mindfulness / Mindfulness Based Techniques
Strengths-Based Therapy
Holistic Approach
Humanistic Therapy
Existential Therapy
Person-Centered Therapy
Gestalt Therapy
Gottman (Gottman Method Couples Therapy)
Prepare/Enrich
Family Systems Therapy
Minuchin Models (Structural Family Therapy)
Transgenerational/Bowenian Therapy
The Satir Model
Narrative Therapy
Experiential Family Therapy
Attachment Theory
Psychodynamic Therapy
Adlerian
Interpersonal Counseling
Multicultural
Culturally Responsive Counseling
Trauma-Informed Care
Trauma Focused Therapy
Other
Optional: If you would like to update your headshot on the clinic website, please upload it here. A forward-facing photo from the shoulders up, using a self-timer, would be perfect. This is the image clients will see on the website.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Please list languages you can provide services in. This will be featured on the website.
Optional: Some clients request to be matched with a clinician who has a particular background or area of experience. If you are comfortable, you may share aspects of your identity, background, or cultural experience that you feel are relevant to client matching. Please indicate whether you would like this information displayed on your website profile or used only by the Patient Care Team for matching purposes.
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