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* 1. Family Name: (optional)

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* 2. How many times has the therapist met with your family within the last week?

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* 3. If zero, on what date did the therapist last see anyone in the family?

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* 4. The therapist tried to understand how my family’s problems all fit together.

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* 5. My family and the therapist worked together effectively.

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* 6. My family knew exactly which problems we were working on.

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* 7. The therapist recommended that family members do specific things to solve our problems?

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* 8. The therapist’s recommendations required family members to work on our problems almost every day.

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* 9. The therapist understood what is good about our family.

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* 10. My family and the therapist had similar ideas about ways to solve problems.

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* 11. The therapist tried to change some ways that family members interact with each other.

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* 12. The therapist tried to change some ways that family members interact with people outside the family.

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* 13. My family and the therapist were honest and straightforward with each other.

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* 14. The therapist’s recommendations should help the children to learn to regulate or identify their emotions.

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* 15. Family members and the therapist agreed upon the goals of the session.

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* 16. My family talked with the therapist about how well we followed her/his recommendations from the previous session.

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* 17. My family talked with the therapist about the success (or lack of success) of her/his recommendations from the previous session.

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* 18. We got much accomplished during the therapy session.

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* 19. My family was sure about the direction of treatment.

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* 20. The therapist’s recommendations made good use of our family’s strengths.

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* 21. My family accepted that part of the therapist’s job is to help us change certain things about our family.

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* 22. The therapist’s recommendations should help family members to become more responsible.

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* 23. The therapist talked to family members in a way we could understand.

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* 24. Our family agreed with the therapist about the goals of treatment.

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* 25. Did the therapist assign homework to practice a new skill?

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* 26. The therapist checked to see whether homework was completed from the last session.

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* 27. The therapist did whatever it took to help our family with tough situations.

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* 28. The therapist helped us to enforce rules for the child.

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* 29. The therapist helped family members talk with each other to solve problems.

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* 30. The therapist helped us keep our child from hanging around with troublesome friends.

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* 31. The therapist helped us improve our child’s behavior at school.

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* 32. The therapist helped us get our child to stay in school every day.

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