Practicing Psychotherapy: Patient Aftercare

So here is a survey that I think I’ll start mailing people after they finish therapy.  I’m not trying to make it psychometrically solid or anything, I’m just trying to get feedback for improvement.  If it’s too long or asking for too many details I don’t think people will fill it out.  Suggestions?

Psychotherapy Satisfaction Survey

Please complete this anonymous survey and return in the enclosed SASE.  Your feedback is invaluable in improving the quality of our services. Information on the back of this form is entirely optional, as is your name if you wish to give it.   Name_________________

Please rate your satisfaction with the following by circling a number from 1 – 5.

1. Business dealings with my therapist (answering service, phone, billing) were

1                                  2                                  3                                  4                                  5

Unsatisfactory                                            Neutral                                                    Satisfactory

2. My therapist was easily accessible and available for appointments or phone contacts.

1                                  2                                  3                                  4                                  5

Disagree                                                     Neutral                                                            Agree

3. My therapist understood me and helped me understand my problems and situation.

1                                  2                                  3                                  4                                  5

Disagree                                                     Neutral                                                            Agree

4. I feel better and/or my situation improved because of therapy.

1                                  2                                  3                                  4                                  5

Disagree                                                     Neutral                                                            Agree

5. I continue to use techniques I learned during therapy.

1                                  2                                  3                                  4                                  5

Disagree                                                     Neutral                                                            Agree

6. The use of handouts, homework assignments, or outside information during therapy was

1                                  2                                  3                                  4                                  5

Unsatisfactory                                            Neutral                                                    Satisfactory

7. Coordination with other professionals (MDs, former therapists) or with my support system (church leaders, family members) was

1                                  2                                  3                                  4                                  5

Unsatisfactory                                            Neutral                                                    Satisfactory

8. Therapy termination, aftercare plan, referrals, and/ or follow-up was

1                                  2                                  3                                  4                                  5

Unsatisfactory                                            Neutral                                                    Satisfactory

 [Optional information continued on other side]

What did you find helpful in psychotherapy?

What did you find unhelpful in psychotherapy?

Rate on a scale of 1-10 (1 = poorly, 10 = very well):

Where you were when you began therapy _______

When you ended therapy ________

Where you are now ________

Comments:

Thank you!  Please return this form in the enclosed stamped envelope.  Your feedback is invaluable in improving our psychotherapy services. 

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