PART II: WEBINAR EVALUATION FORM for CEs - 30 YEARS OF TRAUMA THERAPY | LESSONS LEARNED 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 Part II, I acquired knowledge of:1. Symptoms of trauma help a person to...* a. Survive in an unsafe world b. Are mainly to develop pathology, or cause pathology c. Are more psychological than physical 2. Trauma symptoms can replace trauma memories...* a. As chronic fear b. as Disorganized Attachment c. As impaired self-care d. All of the above 3. Complex trauma is often followed by...* a. Avoidance b. Family loyalty c. Dependency d. Poor self-development e. All of the above 4. Trauma work is primarily about...* a. Affect regulation b. Establishing earned secure attachment c. Development of the real self d. Facilitating capacity for intimacy e. All of the above 5. Intimacy Disorders are mainly about...* a. Developing the capacity to allow connections b. Sexual system repair c. Making friendships d. Social skills training 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 C. Instructors, Dr. Mark Schwartz and Lori Galperin, LCSW1. Mark and Lori knew the subject matter.* Strongly Agree Agree Neutral Disagree Strongly Disagree 2. Mark and Lori explained the material well and answered questions effectively.* Strongly Agree Agree Neutral Disagree Strongly Disagree 3. The presenters were responsive to questions that were posted or that were to be addressed in this presentation.* Strongly Agree Agree Neutral Disagree Strongly Disagree 4. The presenters utilized course-appropriate technology to support learning.* 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. Articles provided were of interest and relevant.* Strongly Agree Agree Neutral Disagree Strongly Disagree 3. The Hyperseuxal Behavior Inventory is a useful questionnaire for my practice and/or learning.* Strongly Agree Agree Neutral Disagree Strongly Disagree E. 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:
