Jul 15 2014
Problems and Concerns
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Why are you interested in counseling now?
Tell me about any prior experience in counseling.Circle the problems you are experiencing:
depresssion
anxiety
fear
trouble concentrating
memory problems
substance abuse
not being understood
being quick to anger
not able to get to sleep easily
waking up in the middle of the night or too early in the morning
prior emotional, physical or sexual abuse
conflicts with personal family members or family members of partner
work related stress
financial problems
legal problems
Post traumatic stress disorder
other mental health diagnosis
difficulty remaining emotionally close
lack of affection
sex related problems
problems with children
share daily life tasks at home
work as a team easily
share power comfortably
able to talk about difficult issues with partner
talking about difficult issues with partner leads to intense arguments
when stressed, I have difficulty sleeping, thinking and become fatigued easily
panic attacks
use alcohol or other drugs too much
people complain about my alcohol or drug use
my relationship is at risk of ending
What else would you like me to know?