THIS SESSION WAS:

-| Perfect.
-| Excellent.
-| Very good.
-| Pretty good.
-| Fair.
-| Pretty poor.
-| Very poor.

2.     To what extent did the "doorway" to your feelings open in this session?

-| Not at all. I felt closed and guarded.
-| Slightly. At least once in the session I definitely felt something.
-| Quite a bit. At a few points, I was in touch with feelings.
-| A lot. Several times in the session, some feelings opened up.
-| Extensively. Deep feelings opened up and moved me in unexpected ways.

3.     In approximately what proportions did you and the listener influence the course of the session?
(i.e. decide what to talk about, change the subject, do the talking, etc.)

-| 20% listener -- 80% me
-| 40% listener -- 60% me
-| 50% listener -- 50% me
-| 60% listener -- 40% me
-| 80% listener -- 20% me

4.     How well did your listener seem to understand what you were feeling and thinking this session?

MY LISTENER…

-| Understood exactly how I thought and felt.
-| Understood very well how I thought and felt.
-| Understood pretty well, but there were some things he/she didn't seem to grasp.
-| Didn't understand too well how I thought and felt.
-| Misunderstood how I thought and felt.

5.     How helpful do you feel your listener was to you this session?

-| Completely helpful.
-| Very helpful.
-| Pretty helpful.
-| Somewhat helpful.
-| Slightly helpful.
-| Not at all helpful.

6.     How much did the session leave you with changed or new perspectives on the matters you talked about?

-| Extremely much Things look dramatically different to me now.
-| Very much. There has been a definite shift in my perspective.
-| Some. My view is slightly different than before the session.
-| Not much. My views are pretty much the same.
-| Not at all Everything seems just as it was.

7.     To what extent do you feel you were able to talk about what was valuable for you to discuss?

-| Completely. Everything covered felt important/valuable to talk about.
-| Very much. Most of the session was very valuable to me.
-| Pretty much. Some of the discussion was very good, some so-so.
-| Somewhat. Some stretches of the session were not so useful to me.
-| Not much. We didn't talk about much of real importance to me.
-| Not at all. We talked about things of minor or no importance to me.

8.     In the context of all the therapeutic conversations you've ever had (with therapists or friends), how does this one compare?

THIS SESSION WAS…

-| Terrible. It was worse than any other I have had.
-| Poor. It ranks among some of the worst I've had.
-| Below average.
-| Average. Comparable to many. Useful, not great, nor lacking in any major way.
-| Better than average.
-| Excellent. It was one of the best I've ever had.
-| Superlative. It was better than any other I have had.

9.     Please rate how you felt after and before the session.

a. Do you feel any better after this session?

-| No. I feel worse.
-| No. I feel just the same.
-| A little better, but not much.
-| Yes, there is some relief or improvement in how I feel.
-| A lot. I feel distinctly better.
-| A great deal. I really feel better than I did before the session.

b. How were you feeling when you came in?

-| Pretty fine.
-|
-| O.K.
-|
-| Not very well.

10.     Please rate the following two aspects of the emotional intensity of the session:

a. How intense was the most intense emotion you felt? 

-| extremely intense
-| very intense
-| mildly intense
-| not very intense
-| not at all intense

b. Sometimes people keep their more intense feelings to themselves for various reasons. How much of this session was spent talking about or openly expressing the most intense emotions you felt?

-| none
-| very little
-| some
-| pretty much
-| very much
-| nearly all

11.   To what extent were you able to hold an attitude of friendly curiosity toward the emotions, feelings, and thoughts you experienced during the session?

-| Not at all. I had a lot of disapproval, dislike, or self-criticism about them.
-| Barely. There were only moments of friendly curiosity.
-| Pretty much. But there were a few times I was unable to have a friendly attitude.
-| Nearly the whole time.
-| Completely. I didn’t waver from friendly curiosity toward my feelings & thoughts.

12.   Did the session result in your coming up with any solutions to your problems?

-| Yes.
-| Not really.
-| Definitely not.

13.   Do you now have any specific actions you intend to take which will be steps forward on your issue(s)?

-| No, no actions that I can think of.
-| I have a sense of what I need to do, but it’s not very specific in action terms.
-| Yes, I have a very specific picture of what action steps to take next.

14.   The attitude of my listener seemed more

Evaluative |----|----|----|----|----|----| Unconditionally accepting

15.   I had a sense that

I led the way |----|----|----|----|----|----| I was guided or led by my listener

16.   The spirit of our relationship in this session seemed to be more like

interpersonal contact |----|----|----|----|----|----| task-oriented work on my issues

17. To what extent were you able to express the full complexity of your situation and your feelings about it?

|----------|-----------|-----------|-----------|----------|-----------|-----------|-----------|

Completely, with all     Medium: there is    Not much: I was unable to
nuances, subtle          more to it than     articulate many important
relationships, and       I was able to       things that relate to
inner feelings           bring out           these concerns

18. How much did you feel anxious or uptight or self-conscious related to what you might discover or reveal about yourself?

|----------|-----------|-----------|-----------|----------|-----------|-----------|-----------|

A great deal:         At some points              Not at all:
I was worried         in the session              I remained relaxed
in this way           I felt anxious              and comfortable with
throughout            about what might            myself and not at
the session           come out                    all defensive 

19. To what degree were you able to observe your own feelings and experiences with neutrality, witnessing what was there without getting caught up in evaluative reactions?

|----------|-----------|-----------|-----------|----------|-----------|-----------|-----------|

None: I was caught         I was able to       Very much: I felt solidly
up in evaluative           observe most        grounded in a “witnessing”
reactions to               things without      part of myself and was
everything I               thinking of them    not identified with my  
said and felt              as “good” or “bad”  evaluative reactions

20. Please rate the extent to which you felt able to “let go” to change and the “unknown.”

|----------|-----------|-----------|-----------|----------|-----------|-----------|-----------|

Not at all. I felt           Medium         A great deal: I was
very self-protective                        not defensive or
and resistant                               self-protective and could
to being changed                            surrender to new things

21. Which spot on the ruler indicates the mood are you in at this moment regarding other people in general?

|----------|-----------|-----------|-----------|----------|-----------|-----------|-----------|

Others are mostly hostile                    People are pretty likable,
to me with interests                         having basic abilities,
competing with my own.                       feelings, and strivings
Stupidity abounds.                           similar to mine.

22. Compared to every day life, how safe from criticism did you feel during the session?

|----------|-----------|-----------|-----------|----------|-----------|-----------|-----------|

Unsafe: I felt          Not very safe: Even     Extremely safe:
criticized in many      More safe than          I felt unusually free
ways though I           usual: I felt           of any sense of criticism
wasn’t explicitly       relatively free of      or negative evaluation
criticized, I feel      negative evaluation
I was being judged

23. Please mark the spots on the rulers below which indicate how your body feels now compared to how it felt at the beginning of the session (we understand that it might have been different in the middle of the session, but please compare how your body ended up with how it began).

                              no difference

        more tense |-----------|-----------|-----------0----------|-----------|-----------| more relaxed

            calmer |-----------|-----------|-----------0----------|-----------|-----------| more agitated

         more numb |-----------|-----------|-----------0----------|-----------|-----------| more sensory awareness

  shallower breath |-----------|-----------|-----------0----------|-----------|-----------| deeper breathing

            warmer |-----------|-----------|-----------0----------|-----------|-----------| cooler

      reduced pain |-----------|-----------|-----------0----------|-----------|-----------| increased pain

        more solid |-----------|-----------|-----------0----------|-----------|-----------| more shaky

      more tearful |-----------|-----------|-----------0----------|-----------|-----------| less tearful

   more vulnerable |-----------|-----------|-----------0----------|-----------|-----------| less vulnerable