Complete this after EACH session with your couple.

Special note- if you complete a weekly session checklist for the study and then the couple withdraws from treatment without coming in to see you -  please "close their file" by returning to this questionnaire, completing the first 3 questions and then skip down to question 10 to communicate the overall case information for the study.  The final case information will cue us that the case is complete and we will release honorariums.  THANK YOU!

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* 1. Therapist name

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* 2. Date of the Session

Date

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* 3. Your couple's streetname (not full address;  if two different streets, type in both.  It is ESSENTIAL that this name is the same as the couple is using on their online forms)

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* 4. Was this session...

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* 5. Do you have another session planned with this couple within a month?

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* 6. What therapeutic approach did you use in today's session? (Check all that apply)

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* 7. What spiritual interventions did you use or encourage today? Please check all that apply.

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* 8. What counseling topics or issues did you and your client work on today? Check all that apply.

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* 9. Please check what your three or four most important therapeutic intentions were for the therapy session you just completed.

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* 10. Was this the 6th session (or likely the last session for the foreseeable future) with this couple?

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