Your Psyche wants to know...

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Next, let's check in on some areas. Using the slider, if the left represents the low end, and the right represents the higher end of how you feel in different areas of your life. We'll get into specifics in session, but overall, how do you feel in these areas? Let's see how this score changes each time. You'll complete this before each session as well as mid-week between sessions. When your scores are on the lower end, we recommend increasing number of sessions until you're reporting finding more relief. As your scores stabilize over time, we'll talk about coming in less often, as feels appropriate with your situation.

Feedback informed therapy aims to engage you actively in your journey towards something that looks like mental health for you.

Scores that fall to the higher end probably reflect needs that may be more appropriate for coaching. This is something different from psychotherapy, does not require a diagnosis, and is not covered by insurance.

Thinking over the past week, how would you rate how well you're able to meet your basic personal physiological needs? (These include adequate food, clean water, clean air, restful sleep, and personal sexual fulfillment)* This field is required.I am not meeting many of my basic bodily needs I'm taking relative care of my basic bodily needs

Thinking over the past week, how would you rate your sense of safety and security? (These include areas like housing, finances, employment, mental & physical safety & health, and relative freedom from oppression/repression)* This field is required.I feel unsafe and uneasy in many of these areas I feel relatively safe and at ease in most of these areas

Thinking over the past week, how would you rate your ability to feel and express love and belonging with friends, family, intimate relationships, and community?* This field is required. I feel unloving, unloved, and/or unlovable I feel loved by the people I choose to love and spend my time with

Thinking over the past week, how would you rate your accomplishments, personal achievements and growth and your sense that these areas are acknowledged and recognized by others?* This field is required.I feel worthless I feel confident and respected by the people in my world

Over the past week, how would you rate your sense of self-actualization and feeling generally okay in your own skin? (This might mean achieving your full potential in the areas of creativity, morality, acceptance of reality, problem solving, and lack of prejudice).* This field is required.Self Downing, Room for Growth Highly Self-Actualized

Over the past week, how would you rate your ability to feel some connection in the shared experience of being alive on the planet, with all the joys and struggles that being alive entails? Sometimes this unity may be the result of a spiritual awakening, finding your life's purpose, or other peak experience, also known as a transpersonal experience.* This field is required.Feeling Isolated / Disconnected Feeling Unity, Connected / Transcendent

Your Psyche Score: 0 to 20 = Suffering? 21 to 40 = Surviving, but dealing with pain / room for improvement? 41 to 60 = Mostly thriving and applying this work to your daily life successfully?

Let's monitor how this goes up and down as we continue our work.

LogWhat's on your mind thinking of the area/s in which you scored lowest? Any thoughts on the areas in which you scored highest?

If you'd like to talk this out, who from the following would it make sense to contact right now, if anyone?

My Counselor

Emergency Contact

Crisis Counseling Hotline 1-800-273-8255 / 988

Do you find yourself feeling any of these sorts of emotions?Even when things are going okay, we all still might have an emotional upset move through. Which ones feel most familiar since we checked in last?

Angry

Anxious

Depressed

Guilty

Afraid

Worried

Nervous

Ashamed

Jealous

Helpless

Embarrassed

Hopeless

Worthless

Isolated

Alone

Lonely

Overwhelmed

Exhausted

Manic

Numb

Apathetic

Loss of pleasure

Low libido

On high alert

Resentful

Despondent

How am I reacting from those feelings? Does anything make these thoughts and feelings better or worse? How do I feel in my body?

What can I do about this right now? What can I do after that?Is there something constructive you can do right now to address what's going on in your life at this moment? And after that, what can you do next?

Do I need to share this?Does your emergency contact need to see this? Not urgent, but maybe you'd like to share this with a friend? Enter in their email here, and they will receive a copy of this log entry just how you filled it out.

example@example.com

Additional ContactEmergency Contact, Crisis Contact, or just someone to talk to

First Name

Last Name

Have you been seen by one of our clinicians in the new year 2022?* This field is required. If not, no problem! You'll be directed to our informed consent and intake process before scheduling.

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Getting a handle on the areas where you feel the least balanced is a great way to guide your personal development, even when things feel the hardest.

When you click Submit, you'll get a copy of your entry and be directed to scheduling. Our clinical team receives a copy of your log as well as your emergency contact if you elected to share with them.

Your Psyche wants to know...