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Helpful Aspects of Therapy Form

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If you wish to automatically receive a copy of this form insert your email address. You are advised to protect your privacy by creating a separate anonymous email account for this purpose which does not contain any identifying details. I suggest that my clients use their ID number as the email address, rather than their own name e.g. WU456YT@gmail.com

Although this form is completed over a secure link, please don't put your name or any identifying details. This is to protect your privacy
2
Please write your client ID. It should begin with 'WU'
3
Your email address
example@example.com
4
Date you are completing this form* This field is required.
Date
Day
Month
Year
Date
5
Date of the therapy session it refers to:* This field is required.
Date
Day
Month
Year
Date
6
1. Of the events which occurred in this session, which one do you feel was the most important or helpful to you personally? (By 'event' we mean something that hapened in the session. It might be something you said or did, or something your therapist or counsellor said or did)
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2. Please describe what made this event important/helpful and what you got out of it.
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3. How helpful or hindering was this particular event?
1. Extremely hindering
2. Greatly hindering
3. Moderately hindering
4. Slightly hindering
5. Neutral
6. Slightly helpful
7. Moderately helpful
8. Greatly helpful
9. Extremely helpful
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4. About where in the session did this event occur?
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5. About how long did the event last?
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6. Did anything else particularly helpful happen during the session?
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a). If yes, please rate how HELPFUL this event was:
Slightly
Moderately
Greatly
Extremely
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b). Please describe the event briefly:
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7. Did anything else happen during the session which might have been hindering?
YES
NO
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a). If yes, please rate how HINDERING this event was:
Slightly
Moderately
Greatly
Extremely
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b). Please describe the event briefly:
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Dr Alesia Moulton-Perkins, CPsychol

Online Psychology and Counselling Ltd

https://onlinepsychologyandcounselling.com

Form based on Elliott (2011)
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