NOT JUST A NUMBER! Forms may use numbers for each question and your counsellor can add these to the information you have shared in discussions to get the best picture of your specific needs. G N I D N A T UNDERNSD YOUR YOU A ULTIES: DIFFIC D N A S M LP R E H N A C HOW FO S E R I A N N QUESTIO IN SITUATIONS WHEN: there isn’t time to say everything you might want to you feel embarrassed or scared to say things out loud to a therapist or counsellor the issue might not seem so important - but actually is you feel too ‘under the spotlight’ in counselling, particularly early on IF YOU NEED EXTRA HELP WITH QUESTIONNAIRES AND FORMS: your therapist or counsellor It is OK not to fill in a questionnaire or form – you should never feel pressured to complete something that you don’t understand or want to do – this is about you after all! OR IF YOU WANT TO: say things in a different way remember things that you want to say write things that might be more difficult to say aloud. Having a shared understanding with your therapist is important, which is why forms might be used at different times including: the first time you go for counselling or therapy after each session before you leave counselling or therapy. will be able to help by reading questions aloud and explaining them, but the bottom line is that the questionnaire or form should be helpful and you should feel comfortable completing it. ale ing Sc ell-be tal W h Men burg Edin wick– War The WBS) (WEM eks 2 we last . the ghts over thou each and e of ings rienc feel E expe out OF TH your ts ab ALL ME ribes emen sc TI at N st de me st OFTE at be e so x th 5 w ar E OF e bo Belo SOM ME k th E TI o 4 TH se tic t ea LY Pl r 5 RARE fe 3 re NE OF ly. h 4 ly NO TIME ' Y 5 on on THE ER2 s) 3 Time: Y ns EVDate: ay 4 1 DA tio 8d 5 7 2 es -2 3 around the word that shows how often each of these things happen to you. s (2 ATEMENTS qu 23 AYS Please put a circle re 4 . ek ST 1 he t the futu u e t D 6 o 2 w There2 are no right or wrong answers. 5 t y -2 3 haic abou ur tist nk 16 YS 4 r fo a tim 1 A e h op st 5 D 2 5 5 .T eling b pa 3 -1 nsbeen fe mem ul 13 YS 4 he 1 6 I’ve tio e usef 5 ht 2 DA es . R ng 4 2 3 hten feeli wit e qu -1 le be 4 1 laxed 6 AYS I’vreig h ed 5 2 peop 5 ng re rn ll t D in other he 3 feeli ce ra nt 6 3 sted been 4 1-5 on swe 1 teSre I’ve ro c in Y 4 e 5 A 2 e 0 1 b elingD an 2 ar 3 en fe um 5 se e beNO S 4 are ns n 1 a I’v sp ll Y gy to 5 3 le tio te 2 s we er DA .P es Never Sometimes 1 I feel sad or empty36 1 problem ria d en y u ha p ll 4 th 1 4 I’ve ro g q efu 5 ng wi 2 2 in r pp de0ali a a 5 w 3 c en Never Sometimes e be 2 1 Nothing is much fun anymore 4 . arly llo ion 3 I’voef th . g cle 6 S .. fo 5 elf t kin 2 t Y ys 1 le s in e ly m A n r th h 3 out 4 irc on ue ou e been :T 8D 4 od ab Never Sometimes e c s) 3 1 I have trouble sleeping m ethI’ve hq ns 5 ople 2 T2 5 ng go 2 as ay ac e a (wh r pe tio 6 AS 3 r feeli 0 othe Ple 8 d 3 de beoen uc EP it th ht 4 se to 1 I’veurs 2: (2 ea 1 str 5 TH Never Sometimes lim weig ng clo 4 I have problems 4 2 with my appetite In o 1 eks er ho enceen feeli OF 5 3 as 1t e ind 2 Y g to or dent u e be 1 ing I’v nm 64 in pe ns ur w Ple confi AN ak infl 2 my ow 3 no energy eling 0 M try sha tio t fo w Never Sometimes fe 5 I have for things up s 3 to e en 4 W ly e s be mak 1 te our 1 e (8 er I’ve HO 5 Qu e pa le to 2 era y tim in ord ht ab en dse be 2 ON th oI’v lib nce d)? of Never Sometimes 6 I am tired 3 a lot 6 eigt things d de flue ede 1 wou y fo rab ds at all love 0 n 4 n o e ng o a ri elig ings 1 ee in cc w th en fetin pe ing iet ape 2cannot think clearly u b at to e su 5 d e be r ea ape d in ne g th Never Sometimes 7 I h I’v o r n y s v e y u u sh tereste 3 6 r lo an yo uen yo our ve ou ha r in 0 fo ng o Ha od y you rful ingI’ve ybe 1 4 om ce y d)? ne ati t? chhee Never Sometimes 8 I feel worthless fo not ard nce 2 5 e fr uen ede go ut e eigh elingac g 6 fe d e r e u )? en m re 1 o u d be lu infl cc yo itho r w 0 xc 3 u sto les infl deI’ve ) ED e( air g tin 6.0 / How are things? / 20 Session No m xa re e rd so Di Q st ue nq tio ina E- n ion Ea e to e s ve w e o y ru to ee r Never Sometimes 9 1 I feel like I don’t want to move 4 pt t? 5 Ha ore) hap ite er cc 6 d to rde hav em igh fin rd su rie o u m rs 2 2006 de in o ave t an we urgh, u t in yo 2 you 0 10 I feel restless 3 r fla Edinb 4 ve ow it) u h yo like not Never Sometimes y of 5 6 ry lly r ha e o iversit ve u foll e lim t yo 1 ve or ta d Un to hap o Ha at yo er o ick an to d to alori or n 2 ire ur s e it in (f a Warw 3 s ie of d th heth c 4 y r e e o a d g)? 5 v er iversit ut ,a 3 (w 0 ed gy ha s m ste din nd, Un yo ple heth nit in to 1 alth Scotla 2 rie tere rea ve am efi enc 3 r lo r ire S He 4 Ha r ex ht (w © NH (fo ca re in n, o a d flu es ig o r d y d a o in (f we r a f in e 0 ti go u 1 ve ted ing)? nit 4 or 2 uh o in yo ersa 3 efi e it res ad yo aim at gs lin ? ad te re , e in onv eg ad ve e ng m in or 0 hB od th c Ha h th ad 1 ati ht re n, 2 fo on g a it ara uh re ig BSou a atio dS ut te in eMW 5 w ve yo ? WE an bo tra ow lo r w s y ers ve ch ht? 0 urn g a ncen , foll 1 tro Ha ma e o ing onv eig in irb n g p a c k w th o o a F to c c rkin in h on g a 6 s rG ain ts ing he s th lt to o 0 tg ou ate win op los Ha cu le, w igh ab entr llo rist of diffi mp Ch NHS ID: ar ing nc g, fo um 08 7 exa yo ink co rkin e fe 20 at © nit s th lt to o efi r th Service allocated Ha cu le, w ad fea t? e d diffi amp case ID h a nit 8 ex eig uh efi yo ew ad ve los ad Ha uh e to 1/1—Depression/ Low Mood — C h i l d / Y o u n g P e r s o n Version 7 9 yo sir fat? E de ve AG Ha felt ng 2 3 Often Always Often Always Often Always Often Always Often Always Often Always Often Always Often Always Often Always Often Always SUM: London and SouthEast CYP-IAPT www.cypiapt.org P www.corc.uk.net Questions © 2003 Bruce F. Chorpita, Ph.D Visual Solution © Slavi Savic, EBPU