SELF Survey


Please provide the following contact information (email essential):

Your full name:

Email address:

 


You can begin to understand your own problems by defining what you are experiencing in seven key areas of your life in relation to why you seek counsel.

1. WHO are the significant people involved directly
2. WHO are the significant people indirectly involved but influencing things for you.
3. Environment
4. Physical Reactions
5. Moods
6. Behaviours
7. Thoughts, Images, Memories in your thinking

The TWO questions to keep in mind

1. How is my Life going?

2. What is the MAIN THING right now?


In the appropriate boxes below, please describe any recent changes or long-term problems you have experienced in each of the five areas. If you have difficult, use the HINTS that follow.

WHO are directly involved or associated with you?

WHO are indirectly involved but influence things? e.g. 3rd parties; observers; spectators


ENVIRONMENT - The Where of your surroundings, social surroundings; actual location


PHYSICAL REACTIONS - The How you find your body responses or impact


MOODS - The negative emotions


BEHAVIOURS - How you find yourself reacting; your behaviours or actions


THOUGHTS - IMAGES - MEMORIES - Your negative conclusions; ideas; self-talk




HINTS

The WHO: The significant people around you can be part of your immediate group who directly influence things by acting upon you or the things around you and the other SOPs who influence from a distance, but who may not be acting directly in your space.

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

Physical Reactions
Do I experience any physical symptoms that trouble me, 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 my moods (angry, depressed, anxious, hurt, jealous, envious, shameful...)?

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

Thoughts - Images - Memories
When I have strong moods, what thoughts do I have about myself? Other people? My future? what thoughts interfere with doing the things I would like to do or think I should do? What images or memories come into my mind?


Practical Application of Self-Survey
This process is more about practice than theory. The learning is in the doing. Take time to use the five headings above and to do a general survey of your life as it relates to your upsets at present. This begins a focusing exercise where you refine and refine until you arrive at the key activity to do to start to bring change or adjustments that address why you’re upset.

MAIN THINGS
Go back over what you’ve written and pick out the MAIN THING, the one that for you causes the most upset at present. It could be an emotion, another person or group, an unhelpful habit or behaviour. Using Reframe we invite you to give it some shape and form by personalising that aspect or MAIN THING as if it was a person or unit. Do not try and unpack it or get inside it, just sense it there as a complete person or unit.

What is your MAIN THING? (email any questions you have to the Online Counsellor)

To get a RECORD of this, PRINT THE PAGE or ask the counsellor for an email copy.