Psychodrama Session Submission

Client Reference:

Client Initials:

Date of Session / Assessment [dd/mm/yy]:

Attendance:--None--AttendedDid not attendCancelled - clientCancelled - counsellorAttended - Assessment (outcome measure submission)Attended - Assessment (NO outcome measure submission)Cancelled - pre-arranged client holidayCancelled - pre-arranged counsellor holidayCancelled - LF

Session notes:

(Optional) LF Internal Comments:

HIV Prevention England Stats

HIV-related themes explored?:

Domestic Abuse Partnership Stats

Domestic Abuse related themes explored?:

Donation

Donation Amount:

(Optional) Donation Comments:

ONS Wellbeing

Life Satisfaction:

Life Worthwhile:

Happiness Yesterday:

Anxiety Yesterday:

CORE-10 Questionnaire

1. I have felt tense, anxious or nervous--None--Not at all - 0Only occasionally - 1Sometimes - 2Often - 3Most or all of the time - 4

2. I have felt I have someone to turn to for support when needed--None--Not at all - 4Only occasionally - 3Sometimes - 2Often - 1Most or all of the time - 0

3. I have felt able to cope when things go wrong--None--Not at all - 4Only occasionally - 3Sometimes - 2Often - 1Most or all of the time - 0

4. Talking to people has felt too much for me--None--Not at all - 0Only occasionally - 1Sometimes - 2Often - 3Most or all of the time – 4

5. I have felt panic or terror--None--Not at all - 0Only occasionally - 1Sometimes - 2Often - 3Most or all of the time - 4

6. I made plans to end my life--None--Not at all - 0Only occasionally - 1Sometimes - 2Often - 3Most or all of the time - 4

7. I have had difficulty getting to sleep or staying asleep--None--Not at all - 0Only occasionally - 1Sometimes - 2Often - 3Most or all of the time - 4

8. I have felt despairing or hopeless--None--Not at all - 0Only occasionally - 1Sometimes - 2Often - 3Most or all of the time – 4

9. I have felt unhappy--None--Not at all - 0Only occasionally - 1Sometimes - 2Often - 3Most or all of the time - 4

10. Unwanted images or memories have been distressing me--None--Not at all - 0Only occasionally - 1Sometimes - 2Often - 3Most or all of the time - 4

GAD-7 Questionnaire

1. Feeling nervous, anxious or on edge--None--Not at all - 0Several days - 1More than half the days - 2Nearly every day - 3

2. Not being able to stop or control worrying--None--Not at all - 0Several days - 1More than half the days - 2Nearly every day - 3

3. Worrying too much about different things--None--Not at all - 0Several days - 1More than half the days - 2Nearly every day - 3

4. Trouble relaxing--None--Not at all - 0Several days - 1More than half the days - 2Nearly every day - 3

5. Being so restless that it is hard to sit still--None--Not at all - 0Several days - 1More than half the days - 2Nearly every day - 3

6. Becoming easily annoyed or irritable--None--Not at all - 0Several days - 1More than half the days - 2Nearly every day - 3

7. Feeling afraid as if something awful might happen--None--Not at all - 0Several days - 1More than half the days - 2Nearly every day - 3

PHQ-9 Questionnaire

1. Little interest or pleasure in doing things--None--Not at all - 0Several days - 1More than half the days - 2Nearly every day - 3

2. Feeling down, depressed or hopeless--None--Not at all - 0Several days - 1More than half the days - 2Nearly every day - 3

3. Trouble falling or staying asleep, or sleeping too much--None--Not at all - 0Several days - 1More than half the days - 2Nearly every day - 3

4. Feeling tired or having little energy--None--Not at all - 0Several days - 1More than half the days - 2Nearly every day - 3

5. Poor appetite or overeating--None--Not at all - 0Several days - 1More than half the days - 2Nearly every day - 3

6. Feeling bad about yourself — or that you are a failure or have let yourself or your family down--None--Not at all - 0Several days - 1More than half the days - 2Nearly every day - 3

7. Trouble concentrating on things, such as reading the newspaper or watching television--None--Not at all - 0Several days - 1More than half the days - 2Nearly every day - 3

8. Moving or speaking so slowly that other people could have noticed? Or the opposite — being so fidgety or restless that you have been moving around a lot more than usual--None--Not at all - 0Several days - 1More than half the days - 2Nearly every day - 3

9. Thoughts that you would be better off dead or of hurting yourself in some way--None--Not at all - 0Several days - 1More than half the days - 2Nearly every day - 3

Onward referral

Referral Category:--None--Discharged - no referralAntidoteOther LGBT counsellingOther general counsellingOther LGBT serviceSexual health clinicHIV support/managementOther drug serviceOther alcohol serviceHousingMoney/debtStatutory mental health

Referral Detail:--None--PACEELOPTHTPink TherapyStonewallStonewall Housing56 Dean StreetSwishMortimer MarketKobler ClinicGMFACDCLocal serviceLocal authorityOther

(Optional) Referral Comments: