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00 Do a SELF - SURVEY to get started

Do an honest and searching survey of just where things are for you at present by answering the questions similar to those on this form.

CLIENT INITIAL SELF - SURVEY

Name
Email

You can begin to understand your own problems by defining what you are experiencing in five key areas of your life.

1. Environment
2. Physical Reactions
3. Moods
4. Behaviours
5. Thoughts, Images, Memories in your thinking
6. GOALS of less, more and completion
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In the appropriate boxes below, please describe any recent changes or long-term problems you have experienced in each of the five areas. Check the HINTS with each area and respond to each as appropriate.

Environmental changes/Life-social Situations
Have you experienced any recent changes? What have been the most stressful events for you in the past year? 3 years? 5 years? In childhood? Do you experience any long-term or ongoing difficulties (including discrimination or harassment by others?

Physical Reactions
Do you experience any physical symptoms that trouble you, such as changes in energy level, appetite, and sleep, as well as specific symptoms, such as heart rate fluctuations, stomach aches, sweating, dizziness, breathing difficulties, or pain?

Moods
What single words describe your moods (angry, depressed, anxious, hurt, jealous, envious, shameful...)?

Behaviours
What things do you do that you would like to change or improve? At work? At Home? with friends? By yourself? Do you avoid situations or people when it might be to your advantage to be involved?

Thoughts - Images - Memories
When you have strong negative moods, what thoughts do you have about yourself? Other people significant to you? Your Life? Your future? what thoughts interfere with doing the things you would like to do or think you should do? What images or memories come into your mind when you become negative or upset?

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TAKE TIME to SET SOME initial GOALS for yourself

Thinking about your main presenting issues or desire for counselling help. Most of us seek a happy, healthy, pain-free life with the minimum of frustration. Though its an ideal its not impossible to get most of those things.

What moods and behaviours do you want LESS of in your life?

What moods and behaviours do you want MORE of in your life?

What do you want to COMPLETE or FINISH in terms of your life's aims and purposes?

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00 Do a SELF - SURVEY to get started