feedback form

The-exchange

COUNSELLING SATISFACTION QUESTIONNAIRE

Please tick the box that applies

Overall, how useful did you find counselling?

Not at all A little Quite a lot A lot

Were you able to talk about your feelings and thoughts with your counsellor?

Not at all A little Quite a lot A lot

Did the counsellor help you to look at you situation and your feelings in a different way?

Not at all A little Quite a lot A lot

Did the counsellor make it clear to you that everything you said was confidential unless you were at risk?

Not at all A little Quite a lot A lot

To what extent has the counselling helped you to deal with what was bothering you?

Not at all A little Quite a lot A lot

Your main reason for seeking counselling was?
(Select at least one but no more than 3)
What difference did counselling make to helping you with your reason for attending?

Abuse (including sexual)

Not at all A little Quite a lot A lot

Academic

Not at all A little Quite a lot A lot

Anger

Not at all A little Quite a lot A lot

Behaviour related

Not at all A little Quite a lot A lot

Bereavement

Not at all A little Quite a lot A lot

Bullying

Not at all A little Quite a lot A lot

Depression

Not at all A little Quite a lot A lot

Domestic abuse

Not at all A little Quite a lot A lot

Eating disorders

Not at all A little Quite a lot A lot

Family

Not at all A little Quite a lot A lot

Financial concerns / poverty

Not at all A little Quite a lot A lot

Relationships with teachers

Not at all A little Quite a lot A lot

Relationships other than family or teachers

Not at all A little Quite a lot A lot

Self-harm

Not at all A little Quite a lot A lot

Self-worth

Not at all A little Quite a lot A lot

Sexual (including orientation)

Not at all A little Quite a lot A lot

Stress

Not at all A little Quite a lot A lot

Substance misuse

Not at all A little Quite a lot A lot

Suicide

Not at all A little Quite a lot A lot

Other

Not at all A little Quite a lot A lot

I feel better about myself

Not at all A little Quite a lot A lot

I feel more able to deal with my problems

Not at all A little Quite a lot A lot

Do you think counselling is a good way to deal with problems?

No Not sure Possibly Yes

Would you ask to see the same counsellor again if you needed to?

No Not sure Possibly Yes

Would you recommend counselling to your friends?

No Not sure Possibly Yes

Would you tell people you were receiving counselling?

No Not sure Possibly Yes

Did you find it easy to contact the service?

Not at all A little Quite a lot A lot

Did you feel you got as many sessions as you needed?

I wanted more I could have had less I had what I needed

If the counselling did help you, what did the counsellor do that was helpful?

If the counselling did not help you, why was that?

What improvement(s) to the service would you suggest?

Do you have any other comments about the counselling service?

Would you have preferred counselling by a counsellor who was different from the counsellor who worked with you?

Prefer different gender Prefer different age Prefer different culture

About You

Are you?

Male Female

How old are you?

How many times did you see the counsellor?

What was the counsellor's name?

Counselling location