FEEDBACK FORM: ENCOURAGING, PARAPHRASING, AND SUMMARIZING
(Date)
(Name of Interviewer)
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1. What were the key discrepancies demonstrated by the client?
2. General interview observations. Was responsibility for the concern placed internally or externally,
or with some balance between the two?
Accuracy rating
Other
Summarization
Paraphrase
Encourager
Counselor statement
Closed question
Write below as much as you can of each counselor statement. Then classify the
statement as a question, an encourager, a paraphrase, a summarization, or other.
Rate each of the last three skills on a scale of 1 (low) to 5 (high) for its accuracy.
Open question
Instructions:
(Name of Person Completing Form)