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Sample Sexual Recovery Reference Information Form

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REFERENCE INFORMATION FORM

__________________________________ has registered to attend an upcoming Bethesda

Workshop for _____________ addicts ___________partners. She/he has listed you as a

reference to help Bethesda Workshops staff ensure this experience will be appropriate and

positive.

This clinical intensive is designed for individuals who are seeking sexual recovery. The

participant is either personally struggling with sexual or relationship addiction or is a spouse,

former spouse, or partner of an addict. The workshop involves a comprehensive approach

which includes teaching modules, individual writing, small group processing, and experiential

work such as role-playing or psychodrama. Workshop leaders are licensed clinicians with at

least a master’s degree. We work from a trauma-based model, along with a strong emphasis

on the 12 steps.

Participants who are not in active (or recent) therapy don’t have the benefit of discussing this

option with a therapist. These participants are asked to review information about the

workshop with a trusted pastor or mentor and to ask that person to provide a personal

reference. Attendees are required to submit this form before they come to the workshop or

they will not be permitted to attend.

Not everyone is an appropriate candidate for this intensive workshop. A participant must be

able to function in a group without causing disruption to other attendees or exhibiting

attention seeking behaviors extreme enough so as to be draining of the workshop staff.

Our goal is to educate and empower people to break the cycle of sexual/relationship addiction

and co-addiction, and to live full and holy lives. We would appreciate your prayers during the

weekend.

Thank you,

Marnie C. Ferree, M.A., LMFT, CSAT

Executive & Clinical Director

Sample Sexual Recovery Reference Information Form

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