CSEP-II Client #:

Client initials:
CLIENT POST-SESSION Therapist's initials:
QUESTIONNAIRE (10/01) Session number:
Date of session:

Instructions. Please complete this questionnaire as soon after your session as possible. We use it to
find out how you saw the session. We really are interested in your feelings about the session, so try
not to worry about hurting your therapist's feelings. The information you provide will be used to
improve the therapy we do, so both positive and negative feedback are welcomed. Unless we tell
you otherwise, your therapist will not see your ratings. If you have a concern about either your
therapy or the research, please speak to your therapist, the researcher assigned to your case, or to the
Director of the Center for Psychotherapy Research (Dr. Robert Elliott, x 2715, room 1420).

I. Rate the Session in General

1. Please rate how 1. Extremely hindering
helpful or hindering 2. Greatly hindering
to you this session 3. Moderately hindering
was overall. (Check 4. Slightly hindering
one answer only) 5. Neither helpful nor hindering; neutral
THIS SESSION WAS: 6. Slightly helpful
7. Moderately helpful
8. Greatly helpful
9. Extremely helpful

2. How do you feel 1. Perfect

about the session you 2. Excellent
have just completed? 3. Very good
4. Pretty good
5. Fair
6. Pretty poor
7. Very poor

3. How much 1. A great deal of progress

progress do you feel 2. Considerable progress
you made in dealing 3. Moderate progress
with your problems 4. Some progress
in this session? 5. A little progress
6. Didn’t get anywhere in this session
7. In some ways my problems have gotten worse this session

4. In this session 1. Not at all

something shifted for 2. Very slightly
me. I saw something 3. Slightly
differently or 4. Somewhat
experienced 5. Moderately
something freshly: 6. Considerably
7. Very much

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II. Rate Your Relationship with Your Therapist
(WAI-Short Form, © A.O. Horvath, 1982; Revision, Tracey & Kokotowitc, 1989)

Instructions. Below there are sentences that describe some of the different ways a
person might think or feel about his or her therapist. After each statement there is a
seven point scale. If the statement describes the way you always feel (or think) circle
the number 7; if it never applies to you circle the number 1. Use the numbers in
between to describe the variations between these extremes. Work quickly: your first
impressions are the ones we would like to see. Please try to respond to every item.

Never Rarely Occasionall Sometimes Often Very Often Always

y
1 2 3 4 5 6 7

12 3 4 5 6 7 1. My therapist and I agree about the things I will need to do in

therapy to improve my situation.
12 3 4 5 6 7 2. What I am doing in therapy gives me new ways of looking at
my problem.
12 3 4 5 6 7 3. I believe my therapist likes me.

12 3 4 5 6 7 4. My therapist does not understand what I am trying to

accomplish in therapy.
12 3 4 5 6 7 5. I am confident in my therapist's ability to help me.

12 3 4 5 6 7 6. My therapist and I are working towards mutually agreed upon

goals.
12 3 4 5 6 7 7. I feel that my therapist appreciates me.

12 3 4 5 6 7 8. We agree on what is important for me to work on.

12 3 4 5 6 7 9. My therapist and I trust one another.

12 3 4 5 6 7 10. My therapist and I have different ideas on what my problems

are.
12 3 4 5 6 7 11. We have established a good understanding of the kind of
changes that would be good for me.
12 3 4 5 6 7 12. I believe the way we are working with my problem is correct.
III. Rate Your Reactions to the Session
(Revised Session Reactions Scale, ©R. Elliott, 1993)

Take a minute to think back over the therapy session you have just completed.
Please rate the extent to which you have experienced each of the following
reactions to the session. Some of the items include a number of related but
somewhat different descriptions. Where some of the descriptions in an item fit
your experience, but others do not, rate on the basis of the descriptions which fit
best and ignore the others. Circle the appropriate number for each item.

Not at All Slightly Somewhat Pretty Very Much

Much
1 2 3 4 5

1 2 3 4 5 1. SEEING THINGS FROM ANOTHER PERSON'S PERSPECTIVE.

As a result of this session, I have begun to see things (about myself or
others) from another person's point of view, including that of my
therapist.
1 2 3 4 5 2. PRESSURED OR CONTROLLED. As a result of this session, I feel
too much pressure is being put on me to confront something or to
change; or I feel controlled or manipulated by my therapist, or
pushed to do something I don't want to do.
1 2 3 4 5 3. DEFINITION OF PROBLEMS FOR ME TO WORK ON. As a result
of this session, I have realized or become clearer about what I need to
work on or what my problems or goals are, for therapy or in general.
1 2 3 4 5 4. DEPRIVED OR UNCARED-FOR. As a result of this session, I now
feel let down, abandoned, or left on my own by my therapist; I feel
deprived of guidance or support; I feel my needs are being ignored or
not properly attended to by my therapist; or I experience my
therapist as cold, bored, insensitive or uncaring.
1 2 3 4 5 5. INSIGHT INTO SELF: MADE NEW CONNECTIONS ABOUT
MYSELF. As a result of this session, I have come to understand
myself or my feelings or actions better, through seeing reasons or
causes involving what I feel, think or do; I have learned why I do
something.
1 2 3 4 5 6. MORE DISTANCED. As a result of this session, I am less able to
feel certain feelings; or I am now pushing away or stopping myself
from experiencing particular thoughts, feelings, or memories.
1 2 3 4 5 7. SUPPORTED. As a result of this session, I now feel supported,
reassured or protected by my therapist, either as a person or in
specific ways; or I now feel the therapist is "on my side."
1 2 3 4 5 8. INSIGHT INTO OTHERS: MADE NEW CONNECTIONS ABOUT
OTHER PEOPLE. As a result of this session, I have come to
understand someone else better, through seeing reasons or causes for
what they have done or said; or I have come to see why they are the
way they are.
 Not at All Slightly Somewhat Pretty Very Much
Much
1 2 3 4 5

1 2 3 4 5 10. STUCK/LACK OF PROGRESS. As a result of this session, I now

feel stuck, blocked, floundering, or unable to progress in therapy; or I
feel impatient, frustrated, angry, bored, disillusioned, or critical of
therapy or my therapist.
1 2 3 4 5 11. CLOSE TO THERAPIST. As a result of this session, I feel close to
my therapist; I trust my therapist; I am impressed by my therapist,
including his/her caring or competence; I have come to experience
my therapist as a person or fellow human being; or I feel less alone
because of the therapy relationship.
1 2 3 4 5 12. UNDERSTOOD. As a result of this session, I now feel understood
by my therapist, either generally as a person or in specific ways; or I
am impressed by how accurately my therapist understood what I was
thinking, feeling or trying to say.
1 2 3 4 5 13. CRITICIZED. As a result of this session, I now feel attacked, put
down, rejected or judged by my therapist; or I feel my therapist has
been critical or judgmental of me.
1 2 3 4 5 14. MORE AWARE OR CLEARER ABOUT OTHER PEOPLE. As a
result of this session, I have become more aware of things about
other people (not counting my therapist), or my situation; I am facing
the reality of an other or outside situation; or I have become more
aware of another person's responsibility for things that have
happened.
1 2 3 4 5 15. DISTRESSED. As a result of this session, I now feel upset or
uncomfortable (for example, scared, overwhelmed, depressed, sad,
embarrassed or in physical pain); I feel worse than when I started
the session today; or I am more bothered by unpleasant thoughts,
feelings or memories.
1 2 3 4 5 16. MORE AWARE OR CLEARER ABOUT SELF. As a result of this
session, I am now more in touch with my feelings, thoughts or
memories; I have realized something about myself or who I am; I
have become clearer about things in myself that I had been avoiding
or having trouble putting into words; or I am able to "own" particular
experiences of mine or aspects of myself.

$
 Not at All Slightly Somewhat Pretty Very Much
Much
1 2 3 4 5

1 2 3 4 5 18. INVOLVED IN THERAPY. As a result of this session, I feel

invested in what I need to do in therapy; I feel more responsible for
what happens in therapy; I find myself continuing to think about the
issues raised; I feel challenged to go on working on my issues
outside of therapy; I feel more free to express myself or work on my
problems; or I feel confident about the possibility that therapy may
help me deal with my problems.
1 2 3 4 5 19. MISUNDERSTOOD. As a result of this session, I now feel that my
therapist does not fully understand me as a person or
misunderstands something about me; or I feel my therapist is trying
things which just don't fit me as a person or my situation or
problems.
1 2 3 4 5 20. POSITIVE BELIEFS ABOUT SELF. As a result of this session, I
have come to see myself or specific things about me more positively
or less negatively; I have come to feel stronger, more powerful or
entitled, or more complete or whole; I have a sense of having begun
to make progress; or I have gained hope about the possibility of my
changing in the future.
1 2 3 4 5 21. DISTRACTED OR CONFUSED. As a result of this session, I now
feel more confused about my problems or issues; I feel interrupted, or
sidetracked by my therapist; or I feel I have been allowed to stray or
become distracted from what is important for me to work on in
therapy.
1 2 3 4 5 22. PROGRESS TOWARDS KNOWING WHAT TO DO ABOUT
PROBLEMS. As a result of this session, I have figured out how to go
about resolving a specific problem or how to achieve a specific goal;
or I decided what to do about my problems or situation.
1 2 3 4 5 23. OTHER REACTIONS. Please describe and rate any other
reactions you might have had to this session:

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V. Describe Helpful Aspects of Your Session
(HAT: Helpful Aspects of Therapy Form, (©R. Elliott, 10/01)

1. Of the things that happened in this session, which one do you feel was the
most helpful or important for you personally? (It might be a moment in the
session, or it might be a quality of the session. It might be something you said or did, or it
might be something your therapist said or did. It might also be some combination of these.)

2. Please describe what made this moment or quality helpful/important and

what you got out of it.

3. How helpful was this particular moment or quality? Rate it on the following
scale. (Put an "X" at the appropriate point; half-point ratings are OK; e.g., 7.5.)

HINDERING <-------------- Neutral ---------------> HELPFUL

1 2 3 4 5 6 7 8 9
|---+---|---+---|---+---|---+---|---+---|---+---|---+---|---+---|
E G M S S M G E
X R O L L O R X
T E D I I D E T
R A E G G E A R
E T R H H R T E
M L A T T A L M
E Y T L L T Y E
L E Y Y E L
Y L L Y
Y Y

4. About where in the session did this moment or quality occur?

5. About how long did it last?

6. Were there any other particularly important moments or qualities in this
session? (This could include hindering moments or aspects.)
YES NO

&
 (a. If yes, please describe them briefly: )

(b. Please rate how helpful they were; if there were more than one, mark them
separately:)

HINDERING <-------------- Neutral ---------------> HELPFUL

1 2 3 4 5 6 7 8 9
|---+---|---+---|---+---|---+---|---+---|---+---|---+---|---+---|
E G M S S M G E
X R O L L O R X
T E D I I D E T
R A E G G E A R
E T R H H R T E
M L A T T A L M
E Y T L L T Y E
L E Y Y E L
Y L L Y
Y Y