1:1 Somatic & Family Systems Healing Container — Application

Name

First

Last

What is drawing you to this container at this time?

(2–4 sentences is enough)

What are you currently noticing in your emotional life, nervous system, or relationships that you’d like support with?

(General themes only — no need to share details.)

body-based, like What

Have you worked with somatic, body-based, or relational approaches before?

If yes or somewhat, feel free to share a sentence or two.

This container is a 3-month, paced process. Are you able to commit to this timeframe and session rhythm?

Are you currently receiving support from a therapist, counselor, or healthcare professional?

(This question is for context only.)

Is there anything else you feel would be helpful for me to know at this stage?

(Optional — short response.)

Acknowledgment

I understand this container is not crisis therapy and is offered as a supportive, integrative process.