THE SEVERNSIDE INSTITUTE FOR PSYCHOTHERAPY
APPLICATION TO CLINICAL TRAINING IN PSYCHOANALYTIC
PSYCHOTHERAPY
Applicants should note:
All material given on this form will be held confidentially. It will form the basis of the
interviews.
The application is in three parts; please ensure you complete all three.
1.The first part of the application ‘Personal Information’ points 1-12,
including your signature and date, should be completed by answering the
points in numbered order on continuous pages.
2.For the second part ‘Two Personal Statements’ please complete on
separate sheets of A4 paper.
3.The third part of the application is your portfolio of pre-clinical learning and
experience. Please make sure include as much detail as possible about
completed courses, including providing essays and reports. Please attach
the portfolio check list to the front of your portfolio.
SIP requests that all application papers be submitted electronically, either by email to
administrator@sipsychotherapy.org or on a memory stick, and in either case
password protected, with the password passed on to the General Administrator by
telephone to 0117 927 3898. If an applicant cannot submit these papers electronically,
then they must submit seven printed copies to the Psychoanalytic Training Intake Coordinator, c/o The Administrator, The Severnside Institute for Psychotherapy, 11
Orchard Street, Bristol BS1 5EH.
The application fee is £160. It covers administration costs and two selection
interviews. Should you withdraw from the application process prior to being
interviewed, half of the fee may be returnable.
All applicants should send a hard copy of the first part of the application, duly signed,
together with the application fee of £160 (cheque payable to the Severnside Institute
for Psychotherapy) to the Administrator, 11 Orchard Street Bristol BS1 5EH
Severnside Institute for Psychotherapy has a policy to monitor all applications
to help us reach more diverse communities than we currently do. As part of this,
we would be grateful if you could complete the anonymous Equality Monitoring
form (available from the SIP website or by request from the General
Administrator) and return it with your application, in a separate envelope if you
prefer.
Page 1 of 4
THE SEVERNSIDE INSTITUTE FOR PSYCHOTHERAPY
APPLICATION TO CLINICAL TRAINING IN PSYCHOANALYTIC
PSYCHOTHERAPY
APPLICATION FORM PART 1: PERSONAL INFORMATION
1.
Full Name
Address for correspondence
Email Address
Telephone numbers: Home
Work
Mobile
2.
Educational Information - higher education and qualifications, with names of
institutions and dates
3.
Training and qualifications with names of awarding bodies and dates
4.
Membership of professional bodies
5.
Employment history and relevant honorary or voluntary experience
Please give details of your present and previous employments,
including dates, job title, main responsibilities and employer. Please
ensure you include dates, brief description and the name or any
organisation where you have held any relevant honorary or voluntary
experience, whether clinical or psychiatric.
(You will be asked to give more relevant detail of your occupations
and placements in part 3 of your application, the portfolio of preclinical learning).
Page 2 of 4
THE SEVERNSIDE INSTITUTE FOR PSYCHOTHERAPY
APPLICATION TO CLINICAL TRAINING IN PSYCHOANALYTIC PSYCHOTHERAPY
6.
Pre-Clinical courses or equivalent: please give names and dates of the preclinical courses and name of the course provider. (You will give details of
these in part 3 of your application, the portfolio of pre-clinical learning.)
7.
Personal psychotherapy. Please give details of your current and any past
psychotherapy with dates, name of psychotherapist and frequency of
sessions.
8.
If you have received any form of psychiatric help at any time please give
details.
9.
Please give a brief indication of what other time commitments you have or
anticipate having alongside the training.
10.
Please give a brief indication of how you hope to finance yourself through the
training.
11.
Referees. Please give names and addresses of two people who know your
work well and can speak directly of your professional experience and ability.
Please state your relationship to each referee.
12.
Please sign and date this part of your application.
Signature................................................................Date...................................
Page 3 of 4
THE SEVERNSIDE INSTITUTE FOR PSYCHOTHERAPY
APPLICATION TO CLINICAL TRAINING IN PSYCHOANALYTIC PSYCHOTHERAPY
13.
APPLICATION FORM PART 2: PERSONAL STATEMENTS
Clinical Training in Psychoanalytic Psychotherapy. In approximately 500
words explain why you would like to train as a psychoanalytic
psychotherapist and why you are applying for this clinical training in
psychoanalytic psychotherapy.
14.
In approximately 700 words please describe the important relationships
within your family of origin, your more recent past and in the present. Please
mention the experiences, both positive and negative, which have helped you
develop the qualities of understanding you feel will be useful to you as a
psychotherapist.
(These statements will go straight to the interviewer and will help her/him to understand
a little of your background and spend the time in interview getting to know you. They will
be destroyed after the interviews and selection procedure.)
APPLICATION FORM PART 3: PRE-CLlNICAL PORTFOLIO
Applicants should gather together evidence of their pre-clinical learning and experience
into a portfolio. Once the portfolio is assembled, the applicant should submit it with their
application, with the portfolio checklist attached to the front. The notes which follow give
details of what evidence is to be included, and the portfolio checklist may be found at
the end of them.
Page 4 of 4