Therapeutic Alliance Assessment
Please complete this form to help us understand the quality of the therapeutic relationship.
Client Name
*
First Name
Last Name
Therapist Name
*
First Name
Last Name
Date of Session
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How well do you feel you and your therapist work together to achieve your therapy goals?
*
Not at all
1
2
3
4
5
6
Extremely well
7
1 is Not at all, 7 is Extremely well
How much do you trust your therapist?
*
Not at all
1
2
3
4
5
6
Completely
7
1 is Not at all, 7 is Completely
Do you feel understood by your therapist?
*
Never
1
2
3
4
5
6
Always
7
1 is Never, 7 is Always
To what extent do you agree with the goals set in therapy?
*
Not at all
1
2
3
4
5
6
Completely
7
1 is Not at all, 7 is Completely
How comfortable do you feel sharing your thoughts and feelings with your therapist?
*
Not comfortable
1
2
3
4
5
6
Very comfortable
7
1 is Not comfortable, 7 is Very comfortable
Please rate your overall satisfaction with the therapeutic relationship.
*
1
2
3
4
5
Please provide any additional comments or feedback about your experience.
Submit Assessment
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