Online Application Form – West Valley Counseling Center

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Application for West Valley Counseling Center Life in Transition Workshops

(We are limited in our ability to accommodate special needs, but we would like to discuss these with you.)

Reason for attending:

WAIVER: I understand my participation in this program, externalization and other related activities, is voluntary. It may involve my emotions in a manner which might subject me to emotional distress. I agree to accept such risks and assume the responsibility of emotional distress and/ or other effects thereof. Further, I release West Valley Counseling Center and Sharon Burnett, PhD, MFT and other staff from all claims made by me or on behalf of me (or my estate) by reasons of illness or damages arising from attendance or participation in the workshops and /or related activities. This release includes the waiver of any responsibility by the above named individuals and/or groups also in the case of negligence.

The West Valley Counseling Center Grief, Loss, and Growth Workshop: The following applicant to the West Valley Counseling Center Grief, Loss, and Growth Workshop has indicated that he/she is working with a therapist, and would like to have Sharon Burnett, PhD, MFT IMF #16203 contact you regarding their participation in this process before the workshop begins. This signed release will also serve as permission for Sharon, as workshop facilitators, to call the applicant’s therapist after the workshop, should that be deemed helpful for the participant’s future therapy:

I, , request and authorize Sharon Burnett PhD, MFT to speak to my therapist,
about my participation in the Grief, Loss, and Growth Workshop on

This process, meaning both the group format used in West Valley Counseling Center Grief, Loss, and Growth Workshops, and the individual externalization process, is not for everyone. Over the years, we have personally observed that this workshop, and the externalization of feelings technique, has been a helpful tool for many people. We’ve received many letters, and heard from many therapists, about the life changing experiences of participants. We continue to use this technique, from time to time, with our own grief work, as well. However, intense emotional processing can leave some individuals feeling “raw” and unstable. We do not recommend this process for individuals who have been diagnosed as personality disordered, “Borderline” or “Bi-Polar”, unless their therapists are knowledgeable about potential “highs” and “lows” that might result. All participants must be 21 years of age, or older.