WEBINAR EVALUATION FORM for CEs - ATTACHMENT AT THE CENTER OF CHEMICAL DEPENDENCY - PART 2 with Dr. Mark Schwarz and Dr. Lee Larimer Name* First Last Date MM slash DD slash YYYY PhoneEmail* Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Website (if applicable) Your area of expertise, professional interests and focus:*A. Based on the content of the course, I acquired knowledge of:1. Processing trauma requires the individual to have a detailed narrative with an emphasis on one more detail* a. TRUE b. FALSE 2. It is common for the addict with disorganized attachment to have multiple self states that are polarized.* a. TRUE b. FALSE 3. Affect regulation is established by the therapist’s attunement, connection and capacity to model a non-crisis generating reaction.* a. TRUE b. FALSE 4. Grief work is critical to establishing secure attachment.* a. TRUE b. FALSE 5. ognition means being able to:* a. reflect one’s internal experience b. make sense of c.reflect on the __ of others d.all of the above B. Course Content and Learning Experience:1. Content was appropriate for LMFT, LCSW LPCC, and LEP training:* Strongly Agree Agree Neutral Disagree Strongly Disagree 2. Information could be applied to my practice.* Strongly Agree Agree Neutral Disagree Strongly Disagree 3. Teaching methods were effective.* Strongly Agree Agree Neutral Disagree Strongly Disagree 4. Information was current and accurate.* Strongly Agree Agree Neutral Disagree Strongly Disagree 5. Were the learning objectives, as set forth, met satisfactorily?* Strongly Agree Agree Neutral Disagree Strongly Disagree C. Instructors Dr. Mark Schwartz and Dr. Lee Larimer1. Schwartz and Larimer knew the subject matter.* Strongly Agree Agree Neutral Disagree Strongly Disagree 2. Schwartz and Larimer explained the material well and gave adequate examples:* Strongly Agree Agree Neutral Disagree Strongly Disagree 3. Schwartz and Larimer were responsive to questions that were posted or that were to be addressed in this presentation.* Strongly Agree Agree Neutral Disagree Strongly Disagree 4. Schwartz and Larimer utilized course-appropriate technology to support learning.* Strongly Agree Agree Neutral Disagree Strongly Disagree 5. Was the administration of the webinar adequate for the information shared by the presenters?* Strongly Agree Agree Neutral Disagree Strongly Disagree D. Materials and Documents Provided1. Instructional materials were suitable and useful.* Strongly Agree Agree Neutral Disagree Strongly Disagree 2. Were questions (or problems) addressed effectively and in a timely manner during or after the webinar?* Strongly Agree Agree Neutral Disagree Strongly Disagree E. Open-ended QuestionsE-1. What was your overall impression of the course. What went well?*E-2. What could be improved? What suggestions might you have?*E-3. What topics and presenters would you like to see at future HPM presentations?*E-4. Additional comments or requests:EmailThis field is for validation purposes and should be left unchanged.
