Accreditation Form for Therapists and/or Counsellors Please save your completed accreditation form and send it together with the accompanying supplemental documents (see “V. Supplemental Documents”) either as printout or as electronic file to: registration@viktorfrankl.info or Viktor Frankl Institut Wien z.Hd. Univ.-Prof. Dr. Alexander Batthyány Prinz Eugenstr. 18/12 A - 1040 Wien Österreich Accreditation Form for Therapists/ Counsellors I. General Information 01. Name: 02. Date of Birth: 03. Address: 04. Website & Email-Address: II. Training 05. Title/ Highest Level of Education Completed and Accredited Academic Institution/ Degree: 06. Discipline of Highest Level of Education Completed and Accredited Academic Institution/ Degree (s): 07. Name of Degree-Conferring Graduate Program/ Advanced Training Institute of Highest Level of Education Completed/ Degree(s): 08. Have you completed a formal training program in Logotherapy? 09. If yes, at what institution and in what year have you completed your Logotherapy training? 10. Have you completed training in other psychotherapeutic techniques? 11. If yes, which of these training programs have you completed in a professional framework? III. Practice 12. In what professional context do you practice Logotherapy? (Please select from the following list of options): 1 Psychiatrist 2 Clinical Psychologist 3 Psychotherapist 4 Counsellor / Coach 5 Social Worker 6 Nurse Practitioner 7 Priest/ Minister 8 Other (Please Specify) a in private practice a in private practice a in private practice b in a clinic b in a clinic b in a clinic 13. Do you offer Logotherapy in a private practice, in a public health institute, or both? 14. When did you first begin to practice Logotherapy and Existential Analysis as a form of counselling or therapy? 15. How many patients do you regularly see on average (e.g., monthly or weekly)? 16. In your private practice do you collaborate with members of other health or helping professions (e.g., psychiatrists, a clinic, or medical doctors)? 17. Are your therapeutic or counselling services covered in whole or in part by public or private health insurance? IV. Theoretical Orientations 18. (Optional) Please name your emphasis areas in therapy and / or counselling (max 6) 19. (Optional) Please list here populations whose service you specialize in (e.g., age groups or professional groups) 20. In what language(s) do you offer Logotherapeutic therapy and/ or counselling in? 21. If you offer Logotherapeutic therapy and / or counselling in conjunction with other therapeutic methods, please list these here. V. Supplemental Documents Please include the following supplemental documents with this form, either as a single copy or as scanned documents: (1) Brief Resume (2) Certificate of Completion of Highest Academic Degree/ Professional Degree (3) Certificate of Training in Logotherapy and Completion of Supervision Hours VI. Commitment to Uphold Ethical Guidelines Included with this application form is a copy of the ethical guidelines for the education, research, and practice of psychotherapy and counselling of the American Psychological Association (APA).1 These guidelines can also be found at the URL: http://www.apa.org/ethics/code/ The APA’s code has been adopted for ease of use amongst applicants not fluent in German. The APA’s guidelines represent a conservative articulation of the Viktor Frankl Institute’s ethical standards. The Institute’s guiding document is the ethical guidelines of the Deutschen Dachverbands für Psychotherapie (DVP e.V.). Institutes seeking accreditation through the Viktor Frankl Institute who anticipate regularly encountering difficulty with the APA’s articulation by the nature of organisational activities are encouraged to obtain a copy of the DVP’s guidelines (a German-language document) from the VFI and substitute this document for the APA guidelines. 1 Individuals that are not APA members, including those who are not directly in the profession of Psychotherapy, may willingly and publically commit to uphold the APA code of conduct. We recommend accredited practices to communicate this commitment publically. Accreditation as an institute through the Viktor Frankl Institute constitutes a binding commitment to uphold these ethical guidelines. However, if you are unable to commit to the ethical guidelines of the APA due to personal, ideological, or other grounds, either in whole or in part, then you may submit alternative ethical guidelines to the accreditation committee to supplement or substitute the APA guidelines through your commitment to uphold them. With this solicitation for accreditation through the Viktor Frankl Institute you declare in the name of your institute, unless otherwise expressly agreed upon, your institute’s voluntary commitment to uphold the ethical guidelines and code of conduct of the American Psychological Association (APA). VII. Recommendations for Continuing Education The fulfilment of psychotherapeutic or counselling duties and responsibilities calls for continued self-critical assessment of one’s own personal and professional qualifications and competence, as well as continued efforts for their further development and the observation of one’s own limits. Given this reality, the responsibility arises to stay informed of current best professional practices via the appropriate ongoing education training, and to critically grapple with and selfappropriate this ongoing training into the course of one’s psychotherapeutic or counselling activities. Particularly, with a view of the two years to renewal of accreditation for your practice, we recommend that accredited therapists or counsellors take part in advanced training, congresses, and conferences on psychotherapy and counselling. Specifically, we recommend taking part not only in advanced training programs in Logotherapy, but also in related schools of psychotherapy in order to remain informed of the latest themes and trends in the helping and counselling professions. This recommendation is expressly not a binding commitment for therapists or counsellors accredited through the Viktor Frankl Insitute; it should simply serve to safeguard and enhance the quality of Logotherapeutic psychotherapy and counselling.