Seth Bernstein, Ph.D.
Seth Bernstein, Ph.D.
For EACH change you are considering making, think about each self-assessment area below. We will discuss during our first session.
Possible Change # ___
What I am thinking about changing: (Be as specific as possible. Reference specific behaviors, emotions, interactions, thoughts, fantasies, etc. that are problematic.)
What I might try to do to make this change happen:
Why I think this strategy might work. How I have used it before to successfully make changes:
Why I am concerned that this change strategy might not work.
How motivated I am to work on this change. (Rate using the scale below.)
__________________________________
1 2 3 4 5 6 7 8 9 10
Not ready Unsure Ready
.
For EACH change you are trying/attempting to make, think about each self-assessment area below. We will discuss during our first session.
Change # ___
What I am trying/attempting to change: (Be as specific as possible. Reference specific behaviors, emotions, interactions, thoughts, fantasies, etc. that are problematic.):
What I have tried to do to make this change happen:
RESULTS
What I have accomplished so far: (Be as specific as possible. Describe what you observe in changes to emotions, interactions, thoughts, etc.)
What aspects of my change strategy worked:
What aspects of my change strategy did not work:
How motivated I am to continue working on this change. (Rate using the scale below.)
__________________________________
1 2 3 4 5 6 7 8 9 10
Not ready Unsure Ready
self-assessment
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