Forms for Couples
Forms and Handouts for Couples
| FORM NAME | PURPOSE |
| 1. What is EFT | Sample handout explaining EFT |
| AN EFT ROADMAP FOR COUPLES | Explanation of goals of treatment. By Pat LaDouceur |
| 2. Informed Consent (2012) | Video Tape Consent is in this document.
Editable format |
| 3. Couples Questionnaire | Used during intake and reviewed after first session |
| 4. Couples Screening Form (Doug Tilley) | This is a self-reporting questionnaire about can you buy fioricet online each person and their partner. It asks about specific contraindications – First DV assessment tool |
| 5. Couple Satisfaction Checklist | A check list of areas of distress-easy to see hot spots in where the couple may experience conflict-helps with themes of distress |
| 6. Individual Problem Checklist | Helps indicators to be aware of such as physical and relational patterns, stressors of past several years |
| 7. When We’re Not Getting Along | Survey of thoughts, feelings and behaviors when couple is in conflict-beginning window into cycle |
| 8. Understanding Your Negative Cycle | Assesses the couples’ ability to track their cycle-reaction patterns |
| 9. Attachment Questionnaire from Parenting From the Inside Out | Provides an Introduction into their family of origin history |
| 10. About EFT- Psychology Today | By Sue Johnson. Introducing EFT |
| 11. DAS_SpanierDAS ArticleDAS SCORING | Snap shot of the couples and how distressed they are. Here is the assessment, the supporting article and the scoring. |
| 12. A – H | List of assessment questions from list-serve addressing the areas you need to eventually cover in assessment |
| 13. Cycle Form with note linesTraining Note FormCycle Fill In Form | To use as you’re mapping the cycle and learning EFT steps and interventions. |
| 14. Interpersonal Violence Assessment | To assess for domestic violence |
Sandy Jardine’s After First Session HomeworkAssessment Questions “This is the couples questionnaire I give to all couples at the end of the first session. I ask them to fill it out and get it to me either at our individual session or prior to it if at all possible.” Sandy Jardine