1.What is your therapists name? (this will only be seen by the director of the Center)

2.Therapeutic Empathy

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N/A

My therapist seemed warm and supportive

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N/A

I felt safe to talk about my issues

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N/A

My therapist treated me with respect

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N/A

My therapist did a good job listening

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N/A

My therapist understood my feelings and concerns

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N/A

3.Helpfulness of therapy

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N/A

I was able to express my feelings during sessions

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N/A

I talked about the problems that are bothering me

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N/A

The techniques we used were helpful

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N/A

The approach my therapist used made sense

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N/A

I learned some new ways to deal with my problems

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N/A

4.Satisfaction with therapy

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I believe the therapy was helpful to me

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Overall I was satisfied with my therapy

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N/A

5.Negative feelings during therapy

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N/A

At times, my therapist did not seem to understand how I felt

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N/A

At times, I felt uncomfortable during the session

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N/A

I did not always agree with my therapist

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N/A

6.Difficulties with the questions

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N/A

It was hard to answer some of the questions honestly

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Sometimes my answers did not show how I really feel inside

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N/A

It would be too upsetting for me to criticize my therapist

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N/A

7.At this time, my counseling:

is still in progress

has been completed and I met most/all of my goals

has ended, but I did not meet all of my therapy goals

8.Why did you end therapy (if applicable)?

Agreed with therapist that treatment was complete

Logistics, such as time commitment/scheduling, transportation, unsupportive family member

Unhappy with therapy process (i.e. brought up painful emotions)

Unhappy with therapist (i.e. not a good fit

finances

other reason

9.What did you like the LEAST about the therapy?

10.What did you like the MOST about the therapy

11.Please leave your name If you would like us to respond to your concerns in a personal way.