Notes for completing the New Client Form

 

Page 1: Helps us to learn a little more about you, your motivations and any other support mechanisms you have in place.

 

Page 2: Each row represents a different goal. This will assist us to focus on what’s most important to you.

 

Example:

• Desired outcome (Goal)

  • Have a happy, loving relationship/marriage | Earn $_____ p/a doing what I enjoy | Achieve and maintain my ideal weight of __ kg | Be a non smoker

 

• How will you feel when you have it

  • Loved | Appreciated | Worthy

 

• How you feel now without it

  • Frustrated | Sad | Angry 

 

Page 3: This is an emotional life summary up to age 21. Research shows that the programming we receive in our early years can dictate our emotional patterns for life. 

 

Please include your age at the time of event, a brief description of events and how you felt. Remember there is no right or wrong, it just is. If you were told about your birth, include this as well and anything else that you can remember. If you don’t remember how you felt, just imagine how someone else would have felt in the same situation.

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Typical examples:

 

• Born premature or forceps delivery - not sure how I felt, probably lonely and afraid.

• 2 yrs old - First day at child care, cried a lot felt sad and anxious.

• 2 yrs old - My baby sister was born, felt jealous angry and unloved.

• 4 yrs old - Migrated to Australia, missed my friends and favourite auntie, felt lonely and angry at parents.

• 5-15 yrs - Dad was very authoritarian and often hit me. Felt stupid, guilty, anxious and angry.

• 8-12 yrs - Bullied at school, felt fear, angry and helplessness.

• 11 yrs - Fell out of a tree, broke my right leg.

• 12 yrs - Mum bought me a second hand uniform for first day at high school. Felt poor, not good enough.

• 14 yrs - My dog Freckles died(hit by a car), I blamed myself, felt guilty, sad and angry.

• 15 yrs - My girlfriend/boyfriend broke up with me and went out with my best friend. Felt hurt and sad.

• 17 yrs - Parents separated and injured in car accident (leg, knee and head injuries). Felt sadness, fear and anger.