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Download - The Safran Lab

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Appendix C<br />

BRIEF PSYCHOTHERAPY RESEARCH PROJECT<br />

BETH ISRAEL MEDICAL CENTER, ROOM 5F-04<br />

NEW YORK, NY 10003<br />

THERAPIST POST-SESSION QUESTIONNAIRE<br />

Complete immediately after session. Please answer all questions.<br />

Your patient's initials Session number<br />

Your initials Date of session<br />

PART A<br />

1. Please rate how helpful or hindering to your patient this session was overall<br />

by circling the appropriate number below.<br />

1 2 3 4 5 6 7 8 _9<br />

Extremely Neutral Extremely<br />

hindering helpful<br />

2. Please rate to what extent your patient's problems are resolved.<br />

PARTB<br />

1 2 3 4 5 6 7 8 9<br />

Not at all Moderately Completely<br />

1. Did you experience any problem or tension in your relationship with your patient<br />

during the session?<br />

Yes No<br />

2. If so, about where in the session did this problem begin?<br />

Beginning Middle End<br />

3. Please rate the highest degree of tension you felt during the session as a result of<br />

this problem.<br />

J 2 3 4 5<br />

Low Medium High<br />

84

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