For Your 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) pdf

Informed Consent (2012) .doc format

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 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. Attachment History Questions Brief Attachment History Questions Developed by Dr. Scott R. Woolley 
8. When We’re Not Getting Along Survey of thoughts, feelings and behaviors when couple is in conflict-beginning window into cycle
9. Understanding Your Negative Cycle Assesses the couples’ ability to track their cycle-reaction patterns
10. Attachment Questionnaire from Parenting From the Inside Out Provides an Introduction into their family of origin history
11. About EFT- Psychology Today By Sue Johnson. Introducing EFT
12. DAS_SpanierDAS ArticleDAS SCORING Snap shot of the couples and how distressed they are. Here is the assessment, the supporting article and the scoring.
13. A – H List of assessment questions from list-serve addressing the areas you need to eventually cover in assessment
14. Cycle Form with note linesTraining Note FormCycle Fill In Form To use as you’re mapping the cycle and learning EFT steps and interventions.
15. Interpersonal Violence Assessment To assess for domestic violence

 

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