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The Sovereign Self Application

Welcome! This program is designed for women who are ready to practice change in real time.

It is reflective, relational, and behavioral. We focus on integration, experimentation, and strengthening self-trust.

Please answer honestly so we can determine whether

this is the right container for you at this time.

Section 1: Basic Information

First name

Last name

Email

Phone

Section 2: What Brings You Here

What drew you to The Sovereign Self program?

In one sentence, what feels like it's shifting in your life right now?

What would make this experience feel successful for you?

Common Patterns and Roles

Many women who are drawn to this work recognize themselves in one or more of these patterns. You may resonate with several, or none of them.

Which of these roles/patterns feel familiar in your life?

The Over-Functioner: You often take responsibility for keeping things running smoothly (emotionally, practically, or relationally) even when others could carry more.

The Explainer: You feel pressure to justify your choices or over-explain yourself so others will understand or approve.

The Peacekeeper: You tend to smooth over tension quickly, even if it means setting aside your own feelings.

The Reliable One: Others depend on you to be steady and capable, which sometimes makes it hard to ask for support or show uncertainty.

The Self-Doubter: You second-guess your instincts and look to others for reassurance before trusting your own decisions.

The Independent One: You handle things alone and rarely let others see when you need help.

Of the roles listed above, which one feels most relevant for you?

How does this role/pattern tend to show up in your relationships or daily life?

If this role softened even slightly, what might change in your life?

Section 3: Readiness & Support

Which best describes your current level of support?

I am currently working with a therapist

I have worked with a therapist in the past

I am not currently working with a therapist

I have never worked with a therapist

I am actively seeking a therapist

Other

Are you currently experiencing any of the following? (Check all that apply)

Active suicidal thoughts

Recent trauma that feels disorienting or destabilizing

Severe depression or anxiety that significantly impacts daily functioning

An active eating disorder

Substance dependency

None of the above

If you checked any of the above, briefly explain how you believe this may or may not impact your participation in this program

Section 4: Embodiment & Practice

This program emphasizes embodied practice. Insight is valuable, but change happens through repetition.

When you gain new insight about yourself, what typically happens next?

I reflect deeply but struggle to change behavior

I understand my patterns but revert to familiar actions under pressure

I experiment with small behavioral shifts

I consistently practice new responses

I'm not sure

Other

When discomfort arises in relationships, I am usually willing to:

Describe a recent moment when you chose to respond to an emotion or relationship pattern differently than you normally would. What did that feel like in your body?

Section 5: Capacity & Commitment

This program requires practicing new responses, even when they feel uncomfortable or imperfect.

If you notice yourself slipping back into old patterns, are you willing to keep practicing?

Do you anticipate any major life events throughout the duration of the program that could limit your participation?

Section 6: Understanding the Program

Please read and acknowledge:

I understand that this is a coaching program, not therapy.

I understand that this program will focus on present and future behavior change.

I understand this program requires group participation and shared reflection.

If unexpected trauma surfaces, I understand I may need to seek mental health support outside of this program, and can return to the program at a later time.

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