Tavistock Relationships

Programme Information

TAVISTOCK RELATIONSHIPS QUALIFICATION IN COUPLE PSYCHOANALYTIC PSYCHOTHERAPY

Entry: Academic Year 2024-25

Your Details

Forename	Surname
Title	Date of Birth

House No/Name and Street

Town/City

Post Code

Mobile Phone

Email

Have you previously applied to a TR training course?

Yes

No

Please provide details (course title, dates applied)

How did you hear about this training ?

About You

Nationality

Country of Permanent Residence

Please note this training is hybrid with some mandatory in-person attendance.

I confirm I am able to make appropriate arrangements to attend.

English Language Proficiency

Is English your first language?

Was English the language of instruction of other degrees you have completed?

If you answered “no” to both questions above, please provide information below on which English qualifications you hold and at which level (e.g. IELTS 7.0). In the case of applicants whose first language is not English, IELTS 6.5 or equivalent is required with a minimum score of 6 on ‘writing’.

Experience and Work

Current Employment

Current Occupation

Name of Employer

Dates of Employment

Details

Previous Employment

Please provide details of your previous work experience (including nature of your work) and dates of employment. Please include any voluntary work.

Name of Employer

Dates of Employment

Job Title/ Position Held

Details

Please tell us about any other work experience (paid or voluntary) that may be relevant to your application

Does your current employer/agency support you undertaking this training?

Education and Training

Academic Qualification Type (E.g. BA, MA, Bsc, A-Level)	Course/Award Title
Name of Awarding Institution	Course Duration
Result	Year of Completion/Expected Completion

Academic Qualification Type (E.g. BA, MA, Bsc, A-Level)	Course/Award Title
Name of Awarding Institution	Course Duration
Result	Year of Completion/Expected Completion

Other Training Information

Please add below any further information/comments related to training you have completed. Please include any training/modules you have attended in psychoanalytic theory.

Psychotherapy/ Counselling Practice

Please give details of your current and previous practice. Please include number of individual, couple, relationship or psychosexual hours worked.

Name of Employer/ Self Employed

Dates of Employment

Job Title/ Position Held

Details (No. counselling and therapy hours worked, and whether individual, relationship, couple, psychosexual)

Previous Experience of Therapy

Have you having, or have you previously had, any personal therapy? (e.g. counselling, psychotherapy, psychoanalysis)

YesNo

Please give details of any personal therapy (e.g. counselling/psychotherapy/psychoanalysis) you have had, or are having. Please include your therapist’s name (or names if you have had more than one therapist), professional training body (if known), dates and frequency of sessions.

Personal Statement

Personal Statement - Education and Professional Life

Please tell us about your education and/or professional development and work life so far, highlighting aspects that are relevant to your interest in this course, your interest in counselling, and any career plans which you consider relevant to your application. Word count: max 400

Additional information

Is there anything that has been significant about your life that you would like to share to support your application. You may wish to highlight something specific about your childhood or family history, a significant personal event, a past or present relationship. Do include your reflections on these experiences. Please add any thoughts you may have about how your life experiences link to your interest in counselling and psychotherapy. Word count: 300 max

References

References Please give names and contact details of two referees and the capacity in which you are known to them. Where possible, one should be an employer or supervisor who knows your work and your capabilities to work at a high academic level.

Name of first referee	Name of second referee
Capacity in which they are known to you	Capacity in which they are known to you
Contact email address	Contact email address

Equal Opportunities

At Tavistock Relationships we aim to be a fair, diverse and inclusive organisation. Understanding our clients, trainees and staff helps in the development of the services we offer. If there are any questions you do not wish to answer, then please leave these blank.

Gender and Gender Identity	Other (please specify)
Ethnic Origin	Other (please specify)

Age

Sexual Orientation

Other (please specify)

Disability
The Equality Act 2010 defines a disabled person as someone “with a physical or mental impairment which has a ‘substantial’ and ‘long-term’ negative effect on your ability to do normal daily activities”

Do you consider yourself to have an illness or disability as defined by the Equality Act 2010?

Please specify

Privacy

Any personal information provided in this application form will be used for the purpose of providing you with training services. You can read more about how we keep your data safe in our Privacy Notice.

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