The Gottman Relationship Center and Referral Network Therapist* Evaluation Form

Which Therapist did you contact? 1) Initial Contact with The Relationship Center and Referral Network: Was the Website and Therapist Directory Informative and Easy to Use?

Yes	No	Didn't Use the Web Directory

2) If you called The Gottman Institute, did you get the information you needed to contact a Certified Gottman Therapist in your area?

Yes	No	Didn't Call The Gottman Institute

Initial Phone Contact with Clinician: The Gottman clinician called me within two business days.

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The clinician displayed an appropriate professional demeanor on the telephone and sounded knowledgeable. I felt reassured that I would receive competent help after my phone conversation with the clinician.

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My phone conversation helped me begin to feel that the therapist was somebody that I could trust.

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After speaking with the therapist, I felt some hope that my relationship might improve with therapy.

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5

The Assessment Process (1st three sessions): The clinician clearly explained the Assessment process.

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The therapist explained our Assessment results clearly and competently, and I understood them.

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During my Assessment, the therapist defined the goals of our therapy and the steps we'd need to take to achieve them.

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By the end of the Assessment process, I felt like our therapist fundamentally understood me and the problems in our relationship.

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The Interventions: The therapist conveyed sensitivity and empathy during our clinical sessions.

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The interventions used by the therapist related to the problems we were raising during each session.

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The therapy improved our relationship at home outside of the sessions.

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The therapist helped me learn the skills needed to better manage conflict.

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The therapist helped us deepen our friendship.

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The therapist helped us improve our physical intimacy.

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The therapist helped us improve our emotional intimacy.

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The therapist helped me understand my partner at a deeper level.

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If you had trouble with the 4 Horsemen before therapy, the therapist helped us decrease the presence of the 4 Horsemen in our relationship. (Note: The 4 Horsemen are: Criticism, Contempt, Defensiveness, Stonewalling)

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If flooding was a problem, the therapist helped me learn methods of self-soothing and how to make repairs in order to decrease the negative effects of flooding.

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The therapist helped us increase the expression of fondness and appreciation in our relationship.

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The therapist taught me how to use softened start-up when bringing up a problem, and I use softened start-up now.

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The therapist helped us develop a plan for honoring each others dreams.

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I feel that I better understand most of what my partner values and what gives my partner's life meaning.

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About the Therapist: What did you especially like about your therapist? Is there anything you did not like about your therapist or your experience with your therapist. Would you recommend this therapist to others?

Yes

No

Comments:

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I Do	I Do Not
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