Boulder Psychotherapy Institute

Advanced Training in Applied Existential Psychotherapy (AEP)

An Experiential Psychodynamic Gestalt Approach   •   Boulder, Colorado

Register for Find a Local Therapist

Complete the first part of this form to add your free Basic Listing to the directory. If you wish, you may go on to begin the process of creating your Expanded (paid) listing.

You may fill out all or part of the Expanded Listing section, and your extra work will be saved but not published or charged for.

After clicking the "Submit" button your Basic Listing will launch. You will also receive a personal password. With your email address and this password you may return to the site at any time to modify your entry, or go on to Expand your entry. In no case will you be charged until you are ready, even if you have started work on your Expanded (paid) Listing.

Remember that you'll need your password to go back and edit both the Basic and the Expanded parts of the listing. Public users of the directory will see only the Basic part of the listing until you upgrade (Expand / pay / and launch) your listing.

Tip: if you want only a Basic Listing, but you go ahead and complete the checkboxes for the Expanded Listing, your Basic Profile will be found (along with the Expanded Entries) when users search for "Specialty Areas' or "Treatment Approaches".

Your free Basic Listing will become visible to the world as soon as you click any "Submit" button. Remember, no matter how much work you do on your Expanded (paid) Listing you will not be charged unless you complete the credit card authorization at the very end of the process (or make other arrangements with Reed). If you decide to authorize it, your credit card will be charged a (one time only) fee of $150.00 for your Expanded Listing.

If you Pay and Launch an Expanded Listing, you can be sure that we will help you in any way needed to make your listing as complete and attractive as possible.

We recommend that you write the sign-up form "descriptions" in a word processor. Then "save" your work, and then "copy and paste" into the form. (This is not absolutely necessary, but would secure and save your creative work.)

Please be sure to click "Submit" each time you edit your entry, or your work will be lost. Send Reed an email if you have questions. He's happy to crop or edit your digital photo if you need help with that.

 Basic Listing
*First:
  Middle:
* Last:
  Company:
  Credentials:
Ph.D. Psy.D. M.D. D.D. R.N. M.A. M.S.
L.A.C. L.P.C. L.C.S.W. M.S.W. L.M.F.T. C.A.C. I C.A.C. II
C.A.C. III          
  If you have a specific credential that is not included here among the check boxes, you may request that it be added by emailing BPI.
* Address:
* City:
* State:
* Zip:    Hide my address
  Phone:    Hide my phone
* Short Description:
  (required)
850 Characters Left
Hide this Listing:
* Email:   Email addresses are for BPI admin purposes only and not be shown on your listing.
* I am aware of, and follow, Colorado state laws regulating the practice of psychotherapy. I am also either an actively licensed, or registered, mental health practitioner in the State of Colorado, or I am a registered practitioner, or licensed practitioner from another state who has completed the necessary registration as a registered psychotherapist with the Colorado Department of Regulatory Agencies. Or my field of practice does not require licensure or registration. For more information see Colorado Dept. of Regulatory Agencies (DORA).
IMPORTANT INSTRUCTIONS:

If you stop now, (and click the"Create Basic Listing" button) you will have created your "Free Basic Listing". Or, you can continue-on to begin creating your "Expanded Listing". If you go on, you can return any time to work on it more. You won't be charged until you specifically indicate you want to "Pay and Launch".

Please help us fight spam by duplicating the "peculiar-letters" in the blank box below them, then click the "Create Basic Listing" button.

Important - If it seems like the "Security Code" isn't working for you, try refreshing your browser. Use the circular "Refresh" button at the top of your page. Be sure to save your work before you refresh.

The "Security Box" is designed to avoid spambots. It is intentionally hard to read. For example: what looks like an i may be an r, or a 1 may be an l (L), etc.

Once you "Submit" your profile you will receive a password by email so that you can "Log-In" to return. The "Log-In" link is in the left column of the "Find a Local Therapist" page. Once you "Log-In" you can edit or expand your listing. If your password doesn't arrive it will be in your computer's email spam filter, or in your ISP's, email spam filter. You can also ask Reed to generate a new password and email it to you.

Your email address is your unique identifier, so you cannot create another account with that password. You will need to "Log-In". In other words, if you have a "Basic Listing", you need to "Log-In" to change it, or make it into an "Expanded Listing".

You can continue filling out the "Expanded" part of your listing now or at any time. Any work you do on the "Expanded Listing" will be saved, and you can return at any time (with your password) to view, edit, or "Pay and Launch". This will make your profile visible to users of the directory.

Please Note - The items in the very bottom category - "My Information", can only be added after you have created an "Expanded Listing" and returned (Logged-In) with your password.

You can edit and "Submit" (Create Listing) as often as you like without being charged. When you are ready you can choose "Pay Now and Launch" from the "User Option Page" which is presented when you "Log-In". Under no circumstances will you be charged until you indicate are ready to pay. Remember subscribers will not be charged again until March of 2013.
* Security: security code





 Expanded Listing

You may continue to work on an expanded listing. You will not be charged our one time fee of $150.00 unless you choose "Pay and Launch" and then select either pay by credit card or pay by check. If you continue, your work will be saved when you click "Create My Listing." You can return anytime via the small log-in link, at the very bottom of our BPI web pages. Use your email address and password to log in.

Image
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How do I upload my picture?
Add a Video: I have a short video I would like to display on my expanded page. Please send me additional instructions.
I would like help in creating a short video. Please send me information about third party assistance.
I do not want a Video right now. A video can be added later by contacting Reed.
Expanded Description:
Office Address:
Office City:
Office State:
Office Zip:    Hide my office address
Office Phone:    Hide my office phone
Website:
Therapist Information
Therapist Gender:
License or Registration
Licensed Psychologist School Psychologist Psychiatrist (M.D.)
Psychiatric Nurse Licensed Professional Counselor Licensed Clinical Social Worker
Licensed Marriage and Family Therapist Certified Addictions Counselor Licensed Addiction Counselor
Registered Psychotherapist  
If you have a license or registration that is not included here among the check boxes, you may request that it be added by emailing BPI.
  License Number:     State:
Years in Practice:
Fee Range:
Client Focus
  Mode of Therapy:
Individual Couple Family Group Organizational
       
Age Specialty:
Client Gender:
Client Sexual Orientation:
Ethnicity:
  Languages Spoken
(other than English):
American Sign Language Arabic Chinese French German
Greek Hebrew Italian Japanese Korean
Russian Spanish Tibetan  
Specialty Areas: (Check a maximum of 10)
1.Depression 2.Anxiety or Fears 3.Shyness or Social Phobia
4.Anger or Impulse Control 5.Addiction or Substance Abuse 6.Trauma or PTSD (Post Traumatic Stress Disorder)
7.Relationship & Marital Issues 8.Sex Therapy 9.Parenting Issues
10.GLBT Issues: Gay/Lesbian/Bisexual/Transexual 11.Open Relationship Issues 12.Domestic Violence
13.Divorce 14.Infertility 15.Adoption
16.Life Transitions 17.Work Issues 18.Diversity Issues
19.Grief or Loss 20.Spirituality 21.Creativity
22.Personal Growth 23.Chronic Pain or Illness 24.ADHD (Attention Deficit Hyperactivity Disorder)
25.OCD (Obsessive Compulsive Disorder) 26.Bipolar/Manic Depressive Disorder 27.Eating Disorders
28.Body Image Disorders 29.Brain Injury 30.Dementia
31.Sensory Integration 32.Learning Disabilities 33.Psychosis
34.Dissociative Disorders 35.Personality Disorders 36.Impulse Control Disorders
37.Attachment Disorders 38.Thinking Disorders 39.Family Therapy
40.Death & Dying 41.Bereavement 42.Peri-natal Mood Disorder
43.Adult Children of Self Absorbed Parents  
Identify your top 4 specialties in order; use numbers above:   #1  #2  #3  #4

If you have a specific specialty area that is not included here among the check boxes, you may request that it be added by emailing BPI.
Treatment Approaches: (Check a maximum of 4)
Applied Existential Psychotherapy Acceptance and commitment therapy (ACT) Art Therapy
Bioenergetic Therapy Body Oriented Psychotherapy Brainspotting
Career Counseling Cognitive Behavioral Therapy Core Energetic Therapy
Dance Therapy Dialectical Behavioral Therapy Eclectic Therapy
EMDR (Eye Movement Densitization and Reprocessing) Emotional Freedom Technique Energy Psychotherapy
Existential Therapy Family Therapy Forensic Psychology and Psychiatry
Gestalt Therapy Hakomi Therapy Humanistic Therapy
Hypnotherapy Internal Family Systems Therapy Interpersonal Psychoanalysis
Jungian Analysis Jungian Oriented Therapy Modern Psychoanalysis
Music Therapy Neurolinguistic Programming Organizational Consulting
Person Centered Therapy Psychoanalysis or Psychoanalytic Psychotherapy Psychodynamic Therapy
Psycho-Emotional Kinesiology Psychological Testing Rational Emotive Therapy
Reichean Therapy Rubenfeld Synergy Method Schema Therapy
Self Psychology Sensorimotor Psychotherpay Somatic Breath Work
Somatic Experiencing Therapy Somatic Psychology Transactional Analysis
Transpersonal Therapy Wilderness Therapy
If you have a specific treatment approach that is not included here among the check boxes, you may request that it be added by emailing BPI.
Now you can create your free listing OR pay for your expanded listing and launch it immediately. Please help us fight spam by filling in the two words in the white box, then click the "Create My Listing" button.
* Security: security code







 My Information. This section can be competed only after you have established your expanded listing.
This is a place to share information about yourself - books, publications, and the groups you lead. Also web links you'd like to share with others.

IMPORTANT! Please save any changes that you have made above by first clicking the "Submit" button, then return to this page to add to or edit "My Information."
My Publications/Media:
(May be added after initial registration)
My Presentations:
(May be added after initial registration)
My Groups:
(May be added after initial registration)
My Links:
(May be added after initial registration)
My Documents:
(May be added after initial registration)

1140 Lehigh Street, Boulder, Colorado 80305  •  303 494 0393

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