This brief survey allows you an opportunity to provide feedback to the American Mental Health Counseling Association about your most recent experience in therapy. We will use the information collected to help counselors improve the services they offer. As you will note, we do not ask you to identify yourself or your counselor.

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1. Your Gender

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2. Your Age

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3. In what state do you live?

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4. The area in which you live is considered

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5. In which setting(s) did you receive counseling? (Chose all that apply)

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6. Treatment was paid for by

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7. Please answer each question and use the space below to add any additional information you wish to provide.

  Strongly Agree Somewhat Agree No Strong Feelings Somewhat Disagree Strongly Disagree
My counselor listened to me effectively.
My counselor understood things from my point of view.
My counselor focused on what was important to me.
My counselor accepted what I said without judging me.
My counselor showed warmth toward me.
My counselor fostered a safe and trusting environment.
My counselor began and finished our sessions on time.
My counselor followed my lead during our sessions whenever appropriate.
My counselor provided leadership during our sessions when appropriate.
My counselor challenged me when/if that was appropriate.
The sessions with my counselor helped me with the problem that originally led me to seek counseling.
The changes which occurred as a result of my counseling have been positive and welcome.
I am satisfied with the service provided by my counselor.

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8. Which national issue or issues would you like the American Mental Health Counseling Association to lobby for on Capitol Hill? Please choose all that apply.

Thank you for taking the time to complete our survey. We hope the results will help counselors continue to provide competent and compassionate care to all their clients.

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