Feedback Survey

Talk Me Better

Cognitive Behavioural Counselling and Psychotherapy

Alex Drummond

Talk Me Better

Vale View House, Victoria Road

Maesycwmmer Hengoed CF82 7RF South Wales

07730 592549 or 01443 819926

Bookmarks

Feedback Survey

Helping me know how you are experiencing therapy will help us both work more effectively. Please use this feedback form during our work let me know how you feel about things.

This part of the form is to help monitor your wellbeing during our work.

I would currently rate my personal well-being on a scale of 0-10 as:

1 - Not Coping at all
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10 - Coping Reasonably Well

I would currently rate my interpersonal relationships (partner/family/close friends) on a scale of 0-10 as:

1 - Not at all satisfying
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10 - Generally good or better

I would currently rate my social functioning (ability to work/socialise) on a scale of 0-10 as:

1 - Really Struggling
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10 - Able to Function Well

I would currently rate my overall sense of well-being on a scale of 0-10 as:

1 - life feels grim
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10 - I'm feeling good

This part of the form is to help monitor how you are experiencing the therapeutic relationship.

Rating my experience of our last session on a scale of 0-10, I’d say:
1 - I didn’t feel heard understood and respected
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10 - I felt heard understood and respected

Rating the focus and usefulness of our last session on a scale of 0-10, I’d say:

1 - We didn’t work on or talk about things I wanted to work on or talk about
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10 - We worked on things that were important for me to talk about

Rating the approach or methods used in our last session on a scale of 0-10, I’d say:

1 - I didn’t find the approach at all helpful
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10 - I think these methods and interventions will help me

Rating the helpfulness of our last session on a scale of 0-10, I’d say:

1 - The session did not meet my needs
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10 - I found the session helpful

Feedback Survey

This part of the form is to help monitor your wellbeing during our work.

This part of the form is to help monitor how you are experiencing the therapeutic relationship.

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