DSP APPLICATION FORM

DSP Year Long Training Application
Please complete this form to apply for the Developmental Somatic Psychotherapy, 5 Module training program.

Facilitators Karen Ginsburg, LCSW, Zachary Model, LMHC & Chrys Hakyung Kim, Psy.D. will review your application.

Further information regarding an interview by Zoom will be sent to you once your application and two recommendations have been reviewed.
Full Name:

First NameLast Name
Name in use
Pronouns
Address

Street Address

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Postal / Zip Code
Email
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Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
What is your current profession and educational background?
If you are a practicing psychotherapist, please describe your formal psychotherapy training; the specific theoretical orientation, the years of your training, and an indication of any other courses and trainings you have attended during your career.
What draws you to DSP training? What personal and professional goals do you have for this program?
DSP training is based on Gestalt theory and practice. Please let us know your degree of familiarity with Gestalt theory.
If you don’t have a background in Gestalt theory, are you willing to read supplemental readings to ensure you have a background in this approach prior to the start of the training?
What is your experience with somatic psychotherapy, as a client, practitioner or both?
Have you been in, or are you currently in, psychotherapy? What modality did you choose for your personal psychotherapy? What was the length of time spent in your therapy or therapies? Describe in some detail some of your principal achievements gained in your personal therapy.
Do you have any somatic practices? Yoga, meditation, Pilates, etc. This is not necessary, but is good for us to know.
DSP training is highly experiential, deep emotions can arise. Please let us know any concerns you might have about participating in this training and what kinds of support you have to help you process any material that arises during the training.
Part of the training includes being part of small home groups of 3 to 5 people. We highly recommend meeting in person or on zoom with your home group at least once between modules to review concepts, process experiences and practice. Will this commitment be possible for you?
Is there anything else you feel we should know about you?
Please have two professional recommendations (trainer, supervisor, professor)
Professional recommendation 1 (trainer, supervisor, professor)

Add here or email to kginsburg.lcsw@gmail.com
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Professional recommendation 1 (trainer, supervisor, professor)

Add here or email to kginsburg.lcsw@gmail.com
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Please upload a photo of yourself

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I would like to be added to GTIP's Mailing List to learn about additional workshops and events.
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DSP Year Long Training Application

Please have two professional recommendations (trainer, supervisor, professor)