New Road Psychotherapy Applicant Form

We take on both qualified therapists seeking to work in private practice, as well as students seeking a placement.

If you are interested in working at New Road Psychotherapy, please fill in the form below:

Placements:

This is for students in training, who have completed a minimum of 2 terms of their 1st year, are in their 2nd year, or recent graduates who want to build up their hours.

We focus in mentoring therapists to work in private practice.
We require our Placement practitioners to be in weekly therapy for the duration of their training.
In an academic year we provide you with a minimum of 20 * 1hr & 50 minutes free supervision sessions. The maximum group size is four supervisees.
Our supervisors are fully qualified in supervision. We offer both psychodynamic, integrative and humanistic supervision groups. Our supervisors work in a relational way.
We offer free and subsidised meetings and workshops
The commitment for a placement at New Road, is 18 months, it is possible to concurrently build your private practice at New Road, once you have graduated.
For reasons of confidentiality and boundaries if you have seen a therapist at New Road and they are currently working here, unfortunately we cannot accept your application.
*Once you have filled out the form, please send a copy of your CV (PDF) to work@newroadpsychotherapy.com

If you are interested in a placement at New Road, please fill in the form below

Today's Date

YYYY

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Your email

2nd email

Can clients contact you on the email given above? If not please add another email address here:

Date of Birth

dd/mm/yyyy

YYYY

Are you able to see a minimum of four low-cost clients per week?

Go to 'not applicable' for private practitioners.

Professional Identity current, or once graduated

Humanistic Counsellor, Integrative Counsellor, Psychodynamic Counsellor, Psychotherapist etc

What year of your training are you in, or when did you graduate?

Name of your training organisation. If seeking a placement please provide, contact person's name and email i.e. person that deals with placements

Write 'not applicable' if seeking to work privately.

Member of/Registered with:

Are you are willing to obtain Professional Liability insurance before you begin working at New Road?

12. If working with anyone under 18, are you willing to submit a DBS check before working with them?

Yes

Training or trained to work with? (adults, couples, groups, young people. etc)

Briefly, what formal counselling experience, if any, do you have in working with clients?

Experience/special interest in?

Approximately how many hours of personal therapy have you had since your training started?

Placement only, otherwise mark N/A: Would you be able to attend one of our supervision groups at these times?

If none, would you be willing to pay for your own private supervision? - select yes or no

Friday

None - I can't make Fridays (please also select yes/no regarding finding your own supervision below)

Yes

N/A (private therapist)

What is your general availability to see clients at New Road like?

When would you be ready to start seeing clients at New Road?

What appeals to you working at New Road Psychotherapy?

Do you know anyone working at New Road Psychotherapy where there could be a boundary issue? i.e. current or past therapist or supervisor?

22. We want two references: One from a training tutor or supervisor and the other from a manager, supervisor or colleague. Please supply the names, positions, and email addresses of the two people willing to offer you a reference.