THERAPY FEEDBACK FORM



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.

1) 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.

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