WEBINAR EVALUATION FORM for CEs - CHRONIC RELAPSE, ADDICTION AS AN ATTACHMENT DISORDER Name* First Last Date Date Format: 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 FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin 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 presented, I can respond to the following questions:1. Which attachment style is most frequently associated with adult psychopathology?...*a. Avoidant attachment styleb. Secure attachment stylec. Disorganized attachment styled. All of the above2. Relapse is related to issues with...*a. Self-cohesionb. Self-agencyc. Self-urgencyd. Both A and B3. Metacognition is...*a. Thinking about one's selfb. Feeling one's feelings authenticallyc. Thinking about thinkingd. Understanding what one is thinking about4. Earned Secure Attachment comes from a cohesive, coherent narrative.*a. TRUEb. FALSEB. Course Content and Learning Experience:1. Content was appropriate for LMFT, LCSW LPCC, and LEP training:*Strongly AgreeAgreeNeutralDisagreeStrongly Disagree2. Information could be applied to my practice.*Strongly AgreeAgreeNeutralDisagreeStrongly Disagree3. Teaching methods were effective.*Strongly AgreeAgreeNeutralDisagreeStrongly Disagree4. Information was current and accurate.*Strongly AgreeAgreeNeutralDisagreeStrongly DisagreeC. Instructors: Dr. Mark Schwartz and Lori Galperin, LCSW1. The presenters knew the subject matter.*Strongly AgreeAgreeNeutralDisagreeStrongly Disagree2. The presenters explained the material well and answered questions effectively.*Strongly AgreeAgreeNeutralDisagreeStrongly Disagree3. The presenters were responsive to questions that were posted or that were to be addressed in this presentation.*Strongly AgreeAgreeNeutralDisagreeStrongly Disagree4. The presenters utilized course-appropriate technology to support learning.*Strongly AgreeAgreeNeutralDisagreeStrongly DisagreeD. Materials and Documents Provided1. Instructional materials were suitable and useful.*Strongly AgreeAgreeNeutralDisagreeStrongly Disagree2. The topic covered in this webinar was of value and useful for my work.*Strongly AgreeAgreeNeutralDisagreeStrongly DisagreeE. Open-ended QuestionsE-1. What was your overall impression of the course? And, what went well in your opinion?*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:
