Evaluation | Addictions UK

Evaluation

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Your contact details

First Name
Last Name
Date of Birth
House Number or Name
Street
Town, City etc.
County
Postcode
Country
Telephone
Fax
Mobile
Email
Reference
Confirmation Code
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1: Booking and reception

1.1: My initial booking was handled effectively

  Not Applicable
  Strongly Agree
  Agree
  Neutral
  Disagree
  Strongly Disagree

1.2: The first contact was helpful and welcoming (if relevant)

  Not Applicable
  Strongly Agree
  Agree
  Neutral
  Disagree
  Strongly Disagree

1.3: The waiting area was comfortable and pleasant

  Not Applicable
  Strongly Agree
  Agree
  Neutral
  Disagree
  Strongly Disagree

1.4: I didn't have to wait too long for my first appointment

  Not Applicable
  Strongly Agree
  Agree
  Neutral
  Disagree
  Strongly Disagree

1.5: I was happy with arrangements for booking further sessions (if relevant)

  Not Applicable
  Strongly Agree
  Agree
  Neutral
  Disagree
  Strongly Disagree

2: Your relationship with your counsellor

2.1: I felt safe and able to tell my counsellor what I needed to

  Not Applicable
  Strongly Agree
  Agree
  Neutral
  Disagree
  Strongly Disagree

2.2: I felt understood by my counsellor

  Not Applicable
  Strongly Agree
  Agree
  Neutral
  Disagree
  Strongly Disagree

3: General

3.1: In general, I was pleased with the arrangements for counselling

  I'm not sure
  Strongly Agree
  Agree
  Neutral
  Disagree
  Strongly Disagree

3.2: The counselling room was appropriate (quietness, comfort appearance)

  I'm not sure
  Strongly Agree
  Agree
  Neutral
  Disagree
  Strongly Disagree

3.3: I benefited from counselling

  I'm not sure
  Strongly Agree
  Agree
  Neutral
  Disagree
  Strongly Disagree

4: Outcome of Counselling

4.1: My relationships and/or social life improved

  Not relevant
  Most/all the time
  Often
  Sometimes
  Rarely
  Not at all

4.2: I have abstained from my addiction during my therapy

  Not relevant
  Most/all the time
  Often
  Sometimes
  Rarely
  Not at all

4.3: I have cut down my addiction behaviour

  Not relevant
  Most/all the time
  Often
  Sometimes
  Rarely
  Not at all

4.4: I am managing better in my studies / at work

  Not relevant
  Most/all the time
  Often
  Sometimes
  Rarely
  Not at all

4.5: I understand myself better

  Not relevant
  Most/all the time
  Often
  Sometimes
  Rarely
  Not at all

4.6: I can cope better with my feelings

  Not relevant
  Most/all the time
  Often
  Sometimes
  Rarely
  Not at all

4.7: I feel better about myself

  Not relevant
  Most/all the time
  Often
  Sometimes
  Rarely
  Not at all

4.8: I am better at managing problems

  Not relevant
  Most/all the time
  Often
  Sometimes
  Rarely
  Not at all

4.9: I am happier and enjoy life more

  Not relevant
  Most/all the time
  Often
  Sometimes
  Rarely
  Not at all

4.10: Use this box if you would like to make further comments on the outcome of your counselling.

5: Your Counselling Process

5.1: Approximately how long did you wait for your first appointment?

  Not relevant
  Appointment was on the day I first asked for one
  Less than one week
  7-14 days
  14-28 days
  More than four weeks

5.2: The number of counselling sessions were

  I’m not sure
  Several too few
  A little too few
  Just right
  A little too many
  Several too many

5.3: What is the best description of how your counselling ended?

  I am still receiving a regular support service from my counsellor
  I am now receiving help in relapse prevention programme or was referred to another source of help
  I became aware of my problems and was able to deal with my addiction
  I had had all the sessions that were offered without any decision as to whether I felt better
  Counselling was not helping, and my counsellor and I agreed to stop
  Counselling was not helping, and I stopped coming without wanting to discuss it with my counsellor

5.4: If there was another reason or you wish to give more details please use this space to explain

6: General

6.1: In general, I was pleased with the arrangements for group therapy

  I'm not sure
  Strongly Agree
  Agree
  Neutral
  Disagree
  Strongly Disagree

6.2: The meeting room was appropriate (quietness, comfort appearance)

  I'm not sure
  Strongly Agree
  Agree
  Neutral
  
  Strongly Disagree

6.3: I benefited from group therapy

  I'm not sure
  Strongly Agree
  Agree
  Neutral
  Disagree
  Strongly Disagree

7: Outcome of Group Therapy

7.1: My relationships and/or social life improved

  Not relevant
  Most/all the time
  Often
  Sometimes
  Rarely
  Not at all

7.2: I have abstained from my addiction during my therapy

  Not relevant
  Most/all the time
  Often
  Sometimes
  Rarely
  Not at all

7.3: I have cut down my addiction behaviour

  Not relevant
  By 1 - 10 percent
  By 11 - 25 percent
  By 26 - 49 percent
  By 50 - 75 percent
  By over 75 percent

7.4: I am managing better in my studies/at work

  Not relevant
  Most/all the time
  Often
  Sometimes
  Rarely
  Not at all

7.5: I understand myself better

  Not relevant
  Most/all the time
  Often
  Sometimes
  Rarely
  Not at all

7.6: I can cope better with my feelings

  Not relevant
  Most/all the time
  Often
  Sometimes
  Rarely
  Not at all

7.7: I feel better about myself

  Not relevant
  Most/all the time
  Often
  Sometimes
  Rarely
  Not at all

7.8: I am better at managing problems

  Not relevant
  Most/all the time
  Often
  Sometimes
  Rarely
  Not at all

7.9: I am happier and enjoy life more

  Not relevant
  Most/all the time
  Often
  Sometimes
  Rarely
  Not at all

7.10: Use this box if you would like to make further comments on the outcome of your group therapy.

8: Your Group Therapy Process

8.1: Approximately how long did you wait for your first group session?

  Not relevant
  Appointment was on the day I first asked for one
  Less than one week
  7-14 days
  14-28 days
  More than four weeks

8.2: The number of group sessions were

  I’m not sure
  Several too few
  A little too few
  Just right
  A little too many
  Several too many

8.3: What is the best description of how your group therapy ended?

  I am still receiving a regular support service from my counsellor
  I am now receiving help in relapse prevention programme or was referred to another source of help
  I became aware of my problems and was able to deal with my addiction
  I had had all the sessions that were offered without any decision as to whether I felt better
  Group Therapy was not helping, and my counsellor and I agreed to stop
  Group Therapy was not helping. I stopped coming without wanting to discuss it with my counsellor

8.4: If there was another reason or you wish to give more details please use this space to explain

9: 24/7 Telephone Support

9.1: I have used this service

  Not used it but I am glad it is available
  Most/all the time
  Often
  Sometimes
  Rarely
  Not used it at all and do not plan to

9.2: Telephone support complimented formal counselling and/or group therapy sessions

  Not Applicable
  Strongly Agree
  Agree
  Neutral
  Disagree
  Strongly Disagree

9.3: I found it easy to work with my Counsellor using the telephone

  Not Applicable
  Strongly Agree
  Agree
  Neutral
  Disagree
  Strongly Disagree

9.4: I was able to communicate well using this form of communication method

  Not Applicable
  Strongly Agree
  Agree
  Neutral
  Disagree
  Strongly Disagree

9.5: I found telephone support helpful

  Not Applicable
  Strongly Agree
  Agree
  Neutral
  Disagree
  Strongly Disagree

9.6: Overall, I am pleased with this additional service

  Not Applicable
  Strongly Agree
  Agree
  Neutral
  Disagree
  Strongly Disagree

10: Please use this space to add any further comments