ࡱ> -/, $bjbj:: (PP$aaaaauuuuu uppp<apppptaaxaapaa_o1,MuR+{ 03,_a_ppp ':   Suffolk Cognitive Behavioral, PLLC MID-TERM THERAPY FEEDBACK FORM Please answer the questions below so we can better understand how therapy is going for you. Use these questions as an opportunity to be courageous in therapy. Be as genuine as you can so we can continue to make therapy as meaningful for you as possible. I am looking forward to continuing our work together and breaking through any plateaus and stuck points. Right now my highest priorities in therapy are: a. b. c. 2) I would like to spend more of my therapy time working on: 3) Rate these on an 1-through-10 Scale (1 is less important 10 most important) a) Summaries at session end? b) Session agendas, at session beginning? c) Homework between sessions? d) Family participation in therapy? e) More time to express myself? f) Less self-expression, more therapist feedback? f) Therapeutic exercises in session? g) More confrontation in session? h) More validation in session? I) Therapist personal disclosure 4) What would make therapy more useful or meaningful for you? 5) Do you feel understood and valued by me? If not, would you be willing to share how & what I am not seeing as clearly as I could? 6) Has anything in therapy really upset you or angered you? If so, would you be willing to discuss this with me? 7) What has been especially helpful or meaningful to you? 8) In your opinion what can I, as your therapist, do more of in therapy that would help us to make breakthroughs? What can I do less of? 9) What is your wisest opinion about how to make further progress in therapy, what do you need to do more or less of: 9a. In session? 9b. Out of session? 10) Use the back of this form to give me any additional feedback about therapy and how to use therapy to increase your quality of life. "#,ABC$h(fhwWh(fCJ aJ hwWh(f5CJ aJ h(f5CJ aJ hd5 hd'H5hd'Hhd'H5#CD , - .  a 3 4 5 ^gd(f  ^` gd(f dh^gd(f & Fgd(fgd(f$a$gd(f / 0 1 l m n p#$`gd(fgd(f&1h:p(f/ =!"#$%6866666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p(8HX`~8XV~_HmH nH sH tH @`@ ]3NormalCJ_HaJmH sH tH DA D Default Paragraph FontRiR  Table Normal4 l4a (k (No List PK![Content_Types].xmlj0 u$Nwc$ans@8JbVKS(.Y$8MVgLYS]"(U֎_o[gv; f>KH|;\XV!]օ Oȥsh]Hg3߶PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!\theme/theme/theme1.xmlYOoE#F{o'NDuر i-q;N3' G$$DAč*iEP~wq4;{o?g^;N:$BR64Mvsi-@R4Œ mUb V*XX! cyg$w.Q "@oWL8*Bycjđ0蠦r,[LC9VbX*x_yuoBL͐u_. DKfN1엓:+ۥ~`jn[Zp֖zg,tV@bW/Oټl6Ws[R?S֒7 _כ[֪7 _w]ŌShN'^Bxk_[dC]zOլ\K=.:@MgdCf/o\ycB95B24S CEL|gO'sקo>W=n#p̰ZN|ӪV:8z1f؃k;ڇcp7#z8]Y / \{t\}}spķ=ʠoRVL3N(B<|ݥuK>P.EMLhɦM .co;əmr"*0#̡=6Kր0i1;$P0!YݩjbiXJB5IgAФ޲a6{P g֢)҉-Ìq8RmcWyXg/u]6Q_Ê5H Z2PU]Ǽ"GGFbCSOD%,p 6ޚwq̲R_gJSbj9)ed(w:/ak;6jAq11_xzG~F<:ɮ>O&kNa4dht\?J&l O٠NRpwhpse)tp)af] 27n}mk]\S,+a2g^Az )˙>E G鿰L7)'PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 /_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!\theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] $ $  $ 8@0(  B S  ?&&,3&#Bvx&:::::/UIP^`o() ^`hH. pL^p`LhH. @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PL^P`LhH./UIP         (f&@$@UnknownGTimes New Roman5Symbol3 Arial"h+'+'rF % 24%3QHP)?]32!xxTHERAPY FEEDBACK FORM Alexa Foster Wendi Liechty  Oh+'0 (4 X d p |'THERAPY FEEDBACK FORMAlexa Foster Normal.dotmWendi Liechty2Microsoft Macintosh Word@F#@Vk@M@M ՜.+,0 hp|  ' % THERAPY FEEDBACK FORM Title  !"#%&'()*+.Root Entry Fc2,M01TableWordDocument(SummaryInformation(DocumentSummaryInformation8$CompObj`ObjectPool'2,M'2,M F Microsoft Word 97-2004 DocumentNB6WWord.Document.8