Questions marked with a * are required
INDIVIDUAL ROLE-PLAY SESSION RATING FORM - CLIENT
Dr. Stephen Black, Counseling Techniques, PSYC 4770
Department of Psychology & Child Development
California State University, Stanislaus
PLEASE ENTER YOUR CODE NAME:
*
AS THE CLIENT:
Complete this sentence ~ "TODAY'S SESSION WAS..."
*
Extremely hindering
Moderately hindering
Slightly hindering
Neither helpful nor hindering (neutral)
Slightly helpful
Moderately helpful
Extremely helpful
As the CLIENT:
How do you feel about the session you participated in today?
*
Perfect
Very good
Pretty good
Fair
Poor
Very poor
AS THE CLIENT:
How much progress do you feel was made in dealing with the "problems" in today's session?
*
A great deal of progress
Moderate progress
Some progress
A little progress
Didn't get anywhere in this session
In some ways problems became worse
As the CLIENT:
After today's session, I was able to see something from a different perspective than before.
*
Not at all
Slightly
Somewhat
Moderately
Considerably
Very much
Please indicate on the scale below the number which best describes your
overall
level of competence at this point in the course:
0%-10%
None
20%
30%
40%
Somewhat
50%
60%
70%
80%
Very much
90%
100%
Completely
*
Thank you for your participation in this online survey.
If you have any questions concerning your participation,
please contact freeindeed6108@att.net .
100%
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