POST-SESSION SURVEY - AFTER A SESSION

This survey is meant to be completed after one of your therapy sessions. Your responses give your therapist immediate feedback about the usefulness of a session that will help in making adjustments as needed.
  • (If you are coming with your spouse, this helps us to identify you further, but it is not required)
  • I. OVERALL PORGRESS

  • Select a number below that best reflects how much improvement you feel you have made in resolving those concerns, thus far.
  • II. HELPFULNESS OF THE SESSION

  • (i.e. In terms of feeling heard and understood, creating a plan, fostering hope, understanding the issues better, being able to talk things out, getting unstuck, etc..)
    Please enter a number from 1 to 10.
  • (i.e. Were there topics you wanted to discuss but didn't, things you would like to change about the counselling process, approaches that might work better for you? etc..)
  • III. NEW LEARNING

  • Note: This could be a positive shift in your emotions, perspective, behavior, or attitude that creates hope, new possibilities or leads to solutions. Examples include seeing a new perspective, learning something new about yourself, seeing your partner in a different way, letting go of hard feelings, or developing a skill that helps you to accomplish your goals.
  • IV. CLEAR PLAN

  • (Be sure to print this page out or write these steps down somewhere before you hit the submit button so you can refer to them later.)