Practitioner Approval Application
Submission will only be allowed when all sections are completed and proof of registration, insurance and training certificates have been uploaded.
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Section I: Applicant’s details

Full Name:
Address:
Details if different that will be made available on the DBR Trainings Website Listing if different from above:
Name
Address
Please indicate period during which you have provided consultation to this consultee:

(If current consultant does not cover all clients listed here, please ensure you enclose written confirmation of consultation for these cases from the DBR Consultant)

Section II: Criteria for certification as a DBR- Approved Practitioner

I confirm I have met the following criteria for DBR Certified Practitioner:

1. I am a member of DBR Trainings
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4. I have completed a minimum of two years’ experience post-qualification practice within my core training prior to training in DBR
5. I have significant experience of working with trauma and/or complex trauma
6. I have additional training in psychologically based trauma focused approaches
At least 2 year is required post completion of DBR level 1 Training.
8. I have completed at least 100 hours of DBR sessions since completeion of level 1 training (MINIMUM 100 REQUIRED AFTER DBR Level 1)
Corroborated by a DBR-C Approved. (Please provide details using the record form below under Section III)
This to be corroborated by the DBR Approved Consultant who fully supervised the listed clients. (Please provide details using the record form below under Section III)
Selected Value: 25
(It is estimated that this would require a minimum of 25 consultation hours supervision from a DBR-C Approved. Note a minimum of 5 of these hours must have been taken as individual consultations)
11. The DBR Approved Consultant on your application has directly witnessed my DBR practice via recordings (audio and/or visual)
14. I have enclosed a reference of recommendation from an Approved DBR Consultant regarding: my professional use of DBR in practice; consultation; ethics in practice; and professional character. (Please refer to Section IV)
15. I have enclosed a letter of recommendation from a Professional or Notary who is able to attest to your ‘Good Standing’ professionally (Please refer to Section V)
16. I have completed a minimum of 8 personal DBR sessions with a DBR-C or a DBR-P
17. You have paid the application fee of £85 (non-refundable):

Payment details can be found here:

18. You are aware that your DBR-P Approval Certificate is valid for 5 years duration, after which, to continue being DBR-P Approved, your certificate will need to be reviewed.

Further information here:

Clear Signature
Clear Signature
You have stated your supervisor’s name and email address details in Section I

Section III: Record of DBR clinical contact activity

Client Initials

 

Presenting Problem

 

No. of sessions of DBR

 

Setting where treatment took place
NAME AND SIGNATURE OF DBR Approved CONSULTANT
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NAME AND SIGNATURE OF APPLICANT
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THE CLIENTS LISTED MUST REFLECT FIDELITY TO THE DBR PROTOCOL

Section IV: DBR-C Approved Recommendation

Section to be completed by applicant’s DBR Approved Consultant
DBR Approved Consultant REFERENCE GUIDELINE AND CHECKLIST

PART A

    • Consultee demonstrates a grounded understanding of the theoretical basis of Deep Brain Reorienting and is able to convey this effectively to clients in providing a treatment overview.
    • Consultee demonstrates an understanding of traumatology and trauma informed practice
    • The consultee is able to apply sound clinical judgement regarding the client’s readiness to engage with DBR
    • The consultee is able to prepare clients appropriately for DBR (e.g. appropriate time given to develop Where Self where needed for some clients)
Please provide detailed comments in support of each competency – which can include examples from transcripts

PART B: DBR FIDELITY CHECKLIST

Selected issue:
    • The consultee is able to take an appropriate general history of the presenting complaint and examples of recent triggers to symptomatic worsening
    • The consultee is able to work with the client to identify a salient source of distress
    • The consultee is able to apply sound clinical judgement regarding the client’s readiness to engage with DBR
Please provide detailed comments in support of each competency – which can include examples from transcripts
Activating stimulus:
    • The consultee has helped the client to identify the moment of maximal attentional capture? E.g core of the distressing experience: a critical look; angry words,; humiliating dismissal; a sudden sense of loss or abandonment; a threatening expression or action – whatever has captured the attention and comes readily to mind.
    • The consultee has been able to identify a somatic component of the body memory or a somatic complaint which is thought to be trauma-based – or the awareness of the first moment of realising that something bad was going to happen.
Please provide detailed comments in support of each competency – which can include examples from transcripts
Grounding in the “where” self:
    • The consultee has been able to help the client let go of that disturbing experience and to focus on the self that knows where the body is placed in the physical world..

(This is the self that gives a direction to sounds and sights and touch. Also, this self automatically knows where the head and limbs are positioned and how it is balanced in the earth’s gravity field)

Please provide detailed comments in support of each competency – which can include examples from transcripts
Cleaning the slate:
    • The consultee has been able to help the client let go of as much tension as possible from the head and neck area without mentioning breathing, relaxation, or anything likely to induce trance
Please provide detailed comments in support of each competency – which can include examples from transcripts
Orienting to the Activating Stimulus:
    • The consultee has been able to time the introduction of the activating stimulus, and phrase it in the best way possible, for the client to notice the orienting tension that immediately ensues?

 

Please provide detailed comments in support of each competency – which can include examples from transcripts
Tension:
    • The consultee has been able to help the client identify the orienting tension in the forehead, around the eyes, and/or the back of neck.
    • If affect or associated visceral responses came in first was there time spent in tracking orienting sensations to that before proceeding?
    • Is there sufficient time spent deepening into the orienting tension?

 

Please provide detailed comments in support of each competency – which can include examples from transcripts
Preaffective shock:
    • The consultee is able to identify any shock response that comes in with bracing of the shoulders and other parts of the torso. Shiver, shudder, hollowing, emptying, pain in/behind eyes etc.

 

Please provide detailed comments in support of each competency – which can include examples from transcripts
Affect:
    • The consultee can identify and support the initial affective response – fear, rage, grief, shame, or emotional pain – to emerge

 

Please provide detailed comments in support of each competency – which can include examples from transcripts
Processing:
    • The consultee can draw attention to the O-T-A sequence that forms the basis of subsequent processing?
    • Sufficient time and space is provided to allow processing to flow spontaneously
    • The consultee provides an attuned, validating, or educational response to emerging affects and different memories
    • The consultee demonstrates the capacity to track processing in such a way that the client can be guided out of processing when more material is surfacing that will require a further session

 

Please provide detailed comments in support of each competency – which can include examples from transcripts
Anchoring in the orienting tension:
    • The consultee can help the client to return to the orienting tension if there is any risk of overwhelm or dissociation
Please provide detailed comments in support of each competency – which can include examples from transcripts
Release breathing:
    • The consultee is able to judiciously guid the client in long, slow outbreaths to bring in a parasympathetic down-regulation of the activation when required
Please provide detailed comments in support of each competency – which can include examples from transcripts
Head movements:
    • The consultee is able to use observational skills to monitor the head turning away or towards and points this out to the client where appropriate.

 

Please provide detailed comments in support of each competency – which can include examples from transcripts
Closure of session:
    • The consultee has helped the client to release residual tension or distress?
    • The consultee supports grounding in the “where” self to be re-established – when necessary?
    • The therapist is able to use other close-down strategies where required?

 

Please provide detailed comments in support of each competency – which can include examples from transcripts
New Perspective:
    • The consultee asks the client if there is any change in how the client sees the self as a result of the session?
    • The New Perspective been associated with a change in body feeling and position?
    • The client is asked to return to the New Perspective/change in body feeling as much as possible over the following three or four hours so that the new learning is deepened

 

Please provide detailed comments in support of each competency – which can include examples from transcripts

PART C:

    • Consultee demonstrates an understanding of the use of DBR either as part of a comprehensive therapy intervention or as a means of symptom reduction.
    • Consultee demonstrates experience in applying DBR to special situations and a range of clinical problems, e.g. recent events, phobias, somatic disorders.
Please provide detailed comments in support of each competency – which can include examples from transcripts

PART D: (Completion by DBR-C)

 

1. Please specify the context within which the DBR Clinical Consultation took place and the number of hours.

NAME AND SIGNATURE OF DBR Approved Consultant
Clear Signature
I confirm that the Applicant for DBR-Practitioner  Approval has completed a minimum of 25 Hours Clinical Supervision/ Consultation:

as outlined in:

  1. the enclosed reference
  2. the attached framework document in relation to each of the cases listed

I confirm that s/he/they has/have conformed to the level of attainment as stated and prescribed by  DBR Trainings Ltd.

I attest that this is an honest and valid evaluation of the consultee’s competencies

I understand that if for any reason information is forthcoming to suggest that the above conditions were not met the consultant and/or consultee may forfeit their approval status and possibly membership.

DBR Approved Consultant Signature
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Applicant's Signature
Clear Signature

Section V: Second reference in support of the application for DBR-P Approval

This reference forms part of the application process for Approval as a DBR Practitioner
Name of Applicant
I know the applicant from the following context:

To the best of my knowledge I can confirm that the applicant’s professional practice is in accordance with the ethical guidelines of their respective professional organisation.

Clear Signature

Please note that only electronically completed documentation will be considered. In order for your application to be considered thoroughly, please ensure that all necessary information is provided.

Incomplete applications will be returned to applicants.

Thank you for your application.

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