What brings you and your partner to therapy? _______________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ How concerned are you and your partner about the problem (circle the one that applies): Level of Concern □ □ □ □ No concern Little concern Moderate concern □ Serious concern Very serious concern Frequency □ □ □ □ No occurrence Occurs rarely Occurs sometimes □ Occurs frequently Occurs nearly always Partner: of Concern No concern Little concern Moderate concern Serious □ □ □ □ concern Very serious concern □ Frequency No occurrence Occurs rarely Occurs sometimes □ □ □ □ Occurs frequently Occurs nearly always □
What brings you and your partner to therapy? _______________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ How concerned are you and your partner about the problem (circle the one that applies): Level of Concern □ No concern □ Little concern □ Moderate concern □ Serious concern □ Very serious concern Frequency □ No occurrence □ Occurs rarely □ Occurs sometimes □ Occurs frequently □ Occurs nearly always Partner: of Concern □ No concern □ Little concern □ Moderate concern □ Serious concern □ Very serious concern Frequency □ No occurrence □ Occurs rarely □ Occurs sometimes □ Occurs frequently □ Occurs nearly always
rebuilding_lives_counseling_and_consulting.docx