Creating New Ways To Bring Psychoanalytic
Psychology into the Public
Domain
A Project of Division 39 (Psychoanalysis) of the American Psychological
Association
Please
fill out the following information and be sure to submit your form by
clicking on the submission button at the bottom of this page.
Psychoanalysis Outreach Online Database Contribution Form
The information requested below will be
published in our Web site at www.div39outreach.org
and made available by download. As such, please understand that anything
submitted on this form will be made public. If you do not wish certain
information about your outreach activities to be made available to the wider
community, please do not include it.
THIS FORM SHOULD ONLY BE
SUBMITTED BY MEMBERS OF DIVISION 39.
IF YOU ARE PART OF AN AGENCY OR PROJECT INCLUDING OTHER PROFESSIONALS,
PLEASE CHECK WITH YOUR DIRECTOR OR ADMINISTRATOR BEFORE FILLING OUT THE
CONTRIBUTION FORM.
Name of Div 39 Member
Contact Information
This should include data to allow
someone to contact you or another individual who is able to provide
current information concerning your organization. This person may be the
director, chair, administrator or community relations representative.
Name
Title
Department
Phone
Fax
E-mail
Name of Organization
Web site
Description of Services
Your listing should
also include a short description of how you have applied your analytic
skills to working in the wider community, extending your skills beyond
your consulting room. Please take a moment to elaborate on the work
you are doing, including the populations served, the issues of interest,
and services offered as well as fees etc. For example, state where you are
teaching, or how you have advertised, or where you have spoken, written,
traveled in pursuit of your outreach goals. You might also wish to include
specialized training you have received (e.g. Red Cross, Crisis
intervention etc.), media attention you may have received, newspaper or
magazine columns you have written, or agencies and organizations who have
worked with.
Categories/Services
Use the checkboxes to the right to indicate the services
that you provide and the populations that you serve. It is important
that these are accurately reflected, since it will directly impact how
your contribution is listed in this website.
For example, placing a checkmark in the box next to
"chronic pain" will result in your practice or organization being listed
on a page in this website entitled "chronic pain".
Conversely, if you treat persons suffering with chronic
pain and you fail to check this box, your practice or organization
will be omitted from the listings of those providing services for that
particular
population.
Education,
Consultation, & Research
Career
Development
Psychoanalytic Training Institute
(check this
box if your contribution IS a psychoanalytic training institute, NOT
if you are simply affiliated with one)
Corporate
Consulting
Psychodynamic Graduate Program
(check this box
if your contribution IS a psychodynamic graduate program)
Education
Consultation
Psychodynamic Postdoctoral Training Program
(check this box ONLY if the
contribution you are submitting IS a postdoc and NOT simply if you attended one personally)
Psychoanalytic Foundation
(check this box ONLY if the contribution you are
submitting IS a psychoanalytic foundation and NOT simply if you are
a member of one)
Psychodynamic Predoctoral Internship Program
(check this box ONLY if your contribution IS a
psychodynamic predoctoral internship program)
Psychoanalytic Organization
(OTHER than a society or foundation --check this box
ONLY if the contribution you are submitting IS a psychoanalytic
organization and NOT simply if you are a member of one)
Research
(check
this box ONLY if the contribution you are submitting reflects an active ongoing research
project, and NOT simply if you are trained in research)
Psychoanalytic Society (check this box
ONLY if the contribution you are submitting IS a society and NOT
simply if you are a member of one)
Teaching
Workshops
(check this box if you or your
organization provides workshops to the community)
Use of
this Web site implies an understanding of the following: This web site
is a complimentary information service offered by the Division of
Psychoanalysis (Division 39) of the American Psychological
Association. The Division and its affiliates do not endorse or make
any representations about the mental health providers contained within
its Web site or information found as a result of following links from
its Web site to other Web sites. No personal referrals can be made to
mental health providers and the resources on this site should not be
used to replace the specialized training and judgment of a mental
health professional.
