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Pre-Presentation Survey
While completing the survey, we encourage you to consider your most recent older adult patient interaction when answering the questions.
Scale: Never (1), Rarely (2), Occasionally (3), Sometimes (4), Often (5), Very Often (6), Always (7)
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* Indicates required question
1. ___________ and I agree about the steps to be taken to improve his/her situation.
*
Never
1
2
3
4
5
6
7
Always
2. My client and I both feel confident about the usefulness of our current activity in therapy.
*
Never
1
2
3
4
5
6
7
Always
3. I believe ___________ likes me.
*
Never
1
2
3
4
5
6
7
Always
4. I have doubts about what we are trying to accomplish in therapy.
*
Never
1
2
3
4
5
6
7
Always
5. I am confident in my ability to help ___________.
*
Never
1
2
3
4
5
6
7
Always
6. We are working towards mutually agreed upon goals.
*
Never
1
2
3
4
5
6
7
Always
7. I appreciate ___________ as a person.
*
Never
1
2
3
4
5
6
7
Always
8. We agree on what is important for ___________ to work on.
*
Never
1
2
3
4
5
6
7
Always
9. ___________ and I have built a mutual trust.
*
Never
1
2
3
4
5
6
7
Always
10. ___________ and I have different ideas on what his/her real problems are.
*
Never
1
2
3
4
5
6
7
Always
11. We have established a good understanding between us of the kind of changes that would be good for ___________.
*
Never
1
2
3
4
5
6
7
Always
12. ___________ believes the way we are working with her/his problem is correct.
*
Never
1
2
3
4
5
6
7
Always
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