WEBINAR EVALUATION FORM for CEs - EATING DISORDERS - A DISSOCIATIVE PERSPECTIVE 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 acquired knowledge of:1. In what way is Eating Disorder (ED) a dissociative disorder?*A. It’s a disorder of selfB. Often the ED parts are separated from healthy selfC. Clients numb themselves with foodd. None of the above2. The most likely outcome of disorganized attachment with ED clients is:*A. DepressionB. AnxietyC. DissociationD. Instability3. An Eating Disorder is originally protective or functional and helps the individual titrate...*A. EmotionB. SchoolC. Depression4. Treatment of ED from a dissociative perspective starts with...*A. Using the symptoms as a door into its originB. A good historyC. See the EDI5. Attachment with the ED self requires:*A. ConfrontationB. SupportC. Both confrontation and supportD. Sensitivity of where the client is each sessionB. 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. Instructor Dr. Mark Schwartz1. Dr. Schwartz knew the subject matter.*Strongly AgreeAgreeNeutralDisagreeStrongly Disagree2. Dr. Schwartz explained the material well and answered questions effectively.*Strongly AgreeAgreeNeutralDisagreeStrongly Disagree3. Dr. Schwartz was responsive to questions that were posted or that were to be addressed in this presentation.*Strongly AgreeAgreeNeutralDisagreeStrongly Disagree4. Dr. Schwartz utilized course-appropriate technology to support learning.*Strongly AgreeAgreeNeutralDisagreeStrongly DisagreeD. Materials and Documents Provided1. Instructional materials were suitable and useful.*Strongly AgreeAgreeNeutralDisagreeStrongly Disagree2. Handout provided additionally was of interest and relevant.*Strongly AgreeAgreeNeutralDisagreeStrongly Disagree3. The topic covered by this webinar was of value and useful for my work.*Strongly AgreeAgreeNeutralDisagreeStrongly Disagree4.. Please rate this webinar on a scale from 1 – 5, 5 being awesome, 1 being poor*5 - awesome4 - almost awesome3 - average2 - below average1 - poorE. Open-ended QuestionsE-1. What was your overall impression of the course? And 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:
