Agency Information

Template

 

The first section is for introducing the client. Please include the following information:

 

Agency Information

Client information (confidentiality of course)

Session Number

Date

Presenting Issue (reason for referral)

Relevant Information

Goal of Session

1. Client Goal

2. Your Goal

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dialogue

Please group dialogue together.

Identify (for each section)

1. Theory

2. Tools

3. Skills

Analysis/assessment of dialogue

What was going on?  What were the patient’s reactions to your feedback?  How did the client respond verbally (quality of voice, tone, did the respond better to closed or open-ended questions?) How did the client respond non-verbally (how did you know they were listening? were they distracted? Did they welcome your feedback?)

Personal reactions and self-reflection to the interaction

What were you thinking?  How do you feel the session went?  What could you have done better?  What will you do differently/the same next time?

 

 

 

     
 

 

 

     
 

 

 

 

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