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Post Therapy Outcomes Questionnaire (for Therapists)
First Name:
Last Name:
Email
Today’s date:
Date Format: MM slash DD slash YYYY
Number of sessions provided:
Name of therapist:
The client made progress toward their goals.
Strongly agree (5)
Agree (4)
Neutral (3)
Disagree (2)
Strongly disagree (1)
The client was satisfied with the progress made.
Strongly agree (5)
Agree (4)
Neutral (3)
Disagree (2)
Strongly disagree (1)
The client was able to talk to friends or family members about their mental health.
Strongly agree (5)
Agree (4)
Neutral (3)
Disagree (2)
Strongly disagree (1)
The client’s mental health improved because of therapy.
Strongly agree (5)
Agree (4)
Neutral (3)
Disagree (2)
Strongly disagree (1)
The client’s mental health improved because of other reasons.
Strongly agree (5)
Agree (4)
Neutral (3)
Disagree (2)
Strongly disagree (1)
The client’s work situation improved (new job, better job, better hours, better pay or benefits, better attendance)
Strongly agree (5)
Agree (4)
Neutral (3)
Disagree (2)
Strongly disagree (1)
The client’s education improved (went back to school, stayed in school, better attendance)
Strongly agree (5)
Agree (4)
Neutral (3)
Disagree (2)
Strongly disagree (1)
The client’s overall well-being improved (general sense of well-being, life satisfaction).
Strongly agree (5)
Agree (4)
Neutral (3)
Disagree (2)
Strongly disagree (1)
The client’s close relationships improved (better communication, less conflict).
Strongly agree (5)
Agree (4)
Neutral (3)
Disagree (2)
Strongly disagree (1)
The client’s other relationships improved (work, school, friends)
Strongly agree (5)
Agree (4)
Neutral (3)
Disagree (2)
Strongly disagree (1)
The client’s finances improved (more stable, better decision making).
Strongly agree (5)
Agree (4)
Neutral (3)
Disagree (2)
Strongly disagree (1)
I was matched with a client who was appropriate to the level of care I could provide in short term counseling.
Strongly agree (5)
Agree (4)
Neutral (3)
Disagree (2)
Strongly disagree (1)
I would recommend this project to a colleague, a friend/ family.
Strongly agree (5)
Agree (4)
Neutral (3)
Disagree (2)
Strongly disagree (1)
Reason therapy ended (check all that apply):
Goals Met
Finished allotted number of sessions
Bad fit with therapist
Unable to continue therapy due to life circumstances (transportation, scheduling, other
Obtained insurance (new benefit)
Sought services elsewhere
Other:
We welcome any other comments or feedback about your experience:
