Document Sample
INSTRUCTIONS: Determine which of the following leads or questions the counselor demonstrated. Check each counselor question or lead
demonstrated. Also check whether the client answered the content of the counselor’s question. Example counselor leads and questions are
provided next to each item of the checklist. These are only suggestions – be alert to other responses by the counselor.

Scoring     Category of information         Examples of counselor leads or questions                                         Client
__Yes__No   1. Explain the purpose and      “Let’s talk about some areas you would like to work on during counseling. This   _indicates
               importance of having         will help us to do things that are related to what you want to accomplish.”      understanding
               goals or positive outcomes
               to the client.

__Yes__No   2. Determine positive           “What would you like to be doing (thinking, feeling) differently?”               _identifies
               changes desired by client    “Suppose some distant relative you haven’t seen for a while comes here in        goal in
               (“I would like..” vs. “I     several months. What would be different then from the way things are now?”       positive terms
               can’t..”                     “Assuming we are successful, what do you want to be doing, or how would this
                                            change for you?”
                                            “In what ways do you want to benefit from counseling?”

__Yes__No   3. Determine whether the        “How much control do you have to make this happen?”                              _identifies
               goals selected represents    “What changes will this goal require of you?”                                    who owns the
               changes owned by the         “What changes will this goal require someone else to make?”                      goal
               client rather than           “Can this goal be achieved without the help of anyone else?”
               someone else (“I want to     “To whom is this goal most important?”
               talk to my mom without
               yelling at her,” rather
               than “I want my mom to
               stop yelling at me.”
__Yes__No   4. Determine whether the        “To what extent do you want to achieve this goal?”                              _identifies
               goal is based on realistic   “To what extent do you believe you should achieve this goal?”                   underlying
               expectations rather than     “To what degree is this goal based on realistic expectations?”                  expectations
               unrealistic or irrational    “To what degree does this goal represent wishful thinking?”
               ideas or self-demands (“I    “How feasible is it for you to __________?”
               want to have more            “Is it reasonable to expect to effect a change in this area?”
               friends,” rather than “I     “To what extent are you leaning toward this goal because you know it’s
               want to be liked by          something you can achieve with little effort or little risk?”
               everyone.”                   “To what extent are you leaning toward this goal because it’s out of your
                                            reach and you’ll be excused if you don’t’ make it?”

__Yes__No   5. Identify advantages          “In what ways is it worthwhile to you and others to achieve this goal?”         _identifies
               (positive consequences) to   “How will achieving this goal help you?”                                        advantages
               client and others of goal    “What problems will continue for you if you don’t pursue this goal?”
               achievement.                 “What are the advantages of achieving this goal—for you? others?”
                                            “Who will benefit from this change –and how?”

__Yes__No   6. Identify disadvantages       “What new problems in living might achieving this goal pose for you?”           _identifies
               (negative consequences)      “Are there any disadvantages to going in this direction?”                       disadvantages
               of goal achievement to       “How will achieving this goal affect your life in adverse ways?”
               client and others.           “How might this change limit or constrain you?”

__Yes__No   7. Identify whether, as the     “These are things I am able to help you work with>”                             _responds to
               helper, you are willing      “I feel uncomfortable working with you on this issue because of my own          counselor’s
               and competent to help the    personal values (or lack of knowledge). I’d like to give you the names of       decision
               client with the stated       several other counselors…”
               goals (decision point)       “This would be hard for me to help you with because it seems as if you’re
                                            choosing something that will restrict you and not give you any options. Let’s
                                            talk more about this.”
__Yes__No   8. Identify what the client      “What do you want to be able to do (think, feel) differently?”               _specifies
               will be doing, thinking, or   “What would I see you doing (thinking, feeling) after this change?”          overt and
               feeling in a concrete,        “Describe a good and a poor example of this goal?”                           covert
               observable way as a result                                                                                 behaviors
               of goal achievement (“I
               want to be able to talk to
               my mom without yelling
               at her,” rather than “I
               want to get along with my

__Yes__No   9. Specify under what            “When do you want to accomplish this goal?”                                  _specifies
               conditions and what           “Where do you want to do this?”                                              people and
               situations goals will be      “In what situations?”                                                        places
               achieved: when, where,
               and with whom (“I want
               to be able to talk to my
               mom at home during the
               next month without
               yelling at her.”)

__Yes__No   10.Specify how often or how      “How much (or how often) are you doing this (or feeling this way) now?”      _specifies
               much client will do           “What is a realistic increase or decrease?”                                  amount
               something to achieve goal     “How much (or how often) do you want to be doing this to be successful at
               (“I want to be able to talk   your goal?”
               to my mom and home            “What amount of change is realistic, considering where you are right now?”
               during the next month
               without yelling at her at
               least once a day.”)
__Yes__No   11.Identify and list small        “How will you go about doing (thinking, feeling) this?”                         _lists possible
               action steps the client will   “What exactly do you need to do to make this happen?”                           action steps
               need to take to reach the      “Let’s brainstorm some actions you’ll need to take to make your goal work for
               goal (that is, break the big   you.”
               goal down into little          “What have you done in the past to work toward this goal?”
               subgoals).                     “How did it help?”
               List of Action Steps.          “Let’s think of the steps you need to take to get from where you are now to
            1.                                where you want to be.”

__Yes__No   12.Sequence the action steps      “What is your first step?”                                                      _assists in
               on the goal pyramid (a         “What would you be able to do most easily?”                                     rank-ordering
               hierarchy) in terms of         “What would be most difficult?”
               a. degree of difficulty        “What is your foremost priority?”
               (least to most)                “What is most important for you to do soon? least important?”
               b. immediacy (most to          “How could we order these steps to maximize your success in reaching your
               least immediate)               goal?”
                                              “Let’s think of the steps you need to take to get from where you are now to
                                              where you want to be and arrange them in an order from what seems easiest
                                              to you to the ones that seem hardest.”
                                              “Can you think of some things you need to do before some other things as you
                                              make progress toward this outcome?”
__Yes__No   13.Identify any people,           “What are some obstacles you may encounter in trying to take this action?”        _identifies
               feelings, or situations that   “What people (feelings, ideas, situations) might get in the way of getting this   possible
               could prevent the client       done?”                                                                            obstacles
               from taking action to          “In what ways could you have difficulty completing this task successfully?”
               reach the goal.                “What do you need to know to take this action?” or “What skills do you need to

__Yes__No   14.Identify any resources         “What resources do you have available to help you as you complete this            _identifies
               (skill, knowledge, support)    activity?”                                                                        existing
               that client needs to take      “What particular thoughts or feelings are you aware of that might make it         resources and
               action to meet the goal.       easier for you to_____?”                                                          supports
                                              “What skills (or information) do you possess that will help you do this more

__Yes__No   15.Develop a plan to monitor      “Would it be practical for you to rate these feelings (count the times you do     _agrees to
               and review progress            this) during the next two weeks? This information will help us determine the      monitor in
               toward the goal.               progress you are making.”                                                         some fashion
                                              “Let’s discuss a way you can keep track of how easy or hard it is for you to
                                              take these steps this week.”

Shared By: