Individuals & Couples Services Application

Welcome. This is an application for highly specialized, trauma-informed depth work. Please complete this form to help us understand the root-cause pattern of your struggle and determine if the Adaptive Relational Depth & Mentalization (ARDM) process is the right fit for your transformation.

Section 1: Contact & Intent

First Name

Last Name

Phone *

Email *

Are you seeking:

Individual Therapy CoachingWork (The Masquerade Deep Dive)

Couples Work (Adaptive Relational Protocol)

Specialised Program for Women (Nwa Ada Leadership Code/Legacy)

What is the single most urgent pain point that has made you decide to seek this specific, high-level therapeutic intervention now?

Section 2: Relational System Diagnosis

These questions help diagnose the specific nature of your internal and external trauma loops.

In your most intimate relationships, which of the following dynamics is most disruptive? (Select up to two.)

Power Imbalance: I often feel overpowered, dismissed, or attract emotionally unavailable partners.

Aggression/Explosion: I tend to explode with anger or use sharp, cutting words when stressed (Mazi Onu Gbara Otoro Afo).

Withdrawal/Avoidance: I shut down, avoid conflict, or retreat emotionally for days to cope.

Control/Rigidity: I find myself needing to be right (Mazi Isi Ike) or overly controlling of my environment and others (Oga Naani).

How would you describe your chronic internal experience?

High Anxiety/Hypervigilance (Always waiting for the next bad thing).

Shame/Negative Self-Concept: A profound feeling of inadequacy or being fundamentally flawed (Akpọghị M Onwe M Mmadụ).

Emotional Volatility: My feelings are intense, shift rapidly, and I struggle with effective self-soothing (Mboli-Elu)).

When a conflict happens, what is the hardest thing for you to do?

A. Stop and think before reacting.

B. Understand the other person's perspective.

C. Understand why I reacted the way I did.

Section 3: Commitment & Investment

The ARDM process requires a deep commitment to deep exploration, going beyond symptoms to heal childhood and generational wounds. This is usually long-term work not a one off session. Are you prepared to work at this level of depth and intensity?

Yes, I am committed to root-cause transformation.

I would prefer to start with a less intense approach.

Chotayah practice operates at a premium rate commensurate with specialised trauma-informed care and RLT/ARDM methodologies. Are you prepared to commit financially to your healing?

Yes, I understand the investment and am prepared to proceed.

I need information on subsidized or lower-cost options.

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary.

Referral: How did you hear about the ARDM Method? (e.g., , T, Podcast, Personal Referral)

Friend or Family Member

Clinical colleague

The Five Masquerades framework

Podcast

Search Engine

Social Media

Personal Referral