GEMMA loves cookies, they’re delicious and make every day a little bit better. We use cookies on this website to enhance your experience, including the use of videos and interactive maps. To enable this content, click “Accept”. Alternatively, click “Decline” to reject all cookies, in which case the video content will be disabled.

Privacy Policy
Gemma Institute Logo

GEMMA

logo

GEMMA

ENDE

A

Application (Families)

At GEMMA, counselling is intended to be a cooperative therapeutic process.

I approach my clients with respect and empathy and see them as individuals with unique needs based on their current situations. I would like to help you reach your goals and find the necessary skills and tools within yourself. For this reason, certain information is helpful for me at the beginning of our relationship.

This is why I request that you fill out this short self-declaration. Feel free to limit your answers to keywords as needed. This will form the basis of our initial conversation, during which we can address any questions you may have and that you perhaps are unable to write about in detail at this time.

01

Self-disclosure report

Please note

Each person in the family must fill out their own form.

Personal Details

I will contact you by phone in the next two to three weeks to discuss your questions for me and to better prepare myself for our first session. Please let me know the date and time you are available and the phone number at which I can reach you directly.

1. The Worries Questionnaire

A family therapist is someone who talks with families, when someone in the family is worried about something. Before therapy starts we want to ask the following questions.

1.1

Who in your family is the most worried at the moment? You, or someone else?

1.2

How worried is that (most worried) person at this moment on a scale from 0 to 10?

1
2
3
4
5
6
7
8
9
10
Not worried at allExtremely worried
1.3

Can you describe in a few sentences what the most worried person is concerned about?

1.4

Can you describe in a few sentences why the most worried person thinks therapy can be useful or not useful at this moment?

1.5

If you are not the most worried family member, how worried are you at this moment on a scale from 0 to 10?

1
2
3
4
5
6
7
8
9
10
Not worried at allExtremely worried
1.6

If you are not the most worried family member, can you describe in a few sentences what you are concerned about?

1.7

If you are not the most worried family member, can you describe in a few sentences why you think therapy can be useful at this moment; or why you think it might not be useful?

2. Previous Therapies

2.1

Did you have therapy or any kind of psychosocial counseling before? One or more times? Can you explain it a little bit?

2.2

What was your positive experience with it? How has it been useful for you or for your family?

2.3

What was your negative experience with it? How has it been not useful for you or for your family? What has hurt you or disappointed you?

3. Terms & Conditions

Cancellation

I declare that I have been informed of and agree to the following:

A cancellation period of 24 hours shall apply. In the event that a consultation is not cancelled in advance of the 24 hour cancellation period, GEMMA Institute will be entitled to issue an invoice to the client for the full consultation amount.

Costs

We would like to draw your attention to the fact that couples and families have to pay for the therapy sessions privately (Selbstzahler). We charge €300,00 for 90 minutes. If you have any questions, please contact us.

Privacy Policy

Video recording (optional):