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A - Reproducible Client Worksheets
CD track 1 for more information on this technique
Client places a check mark
next to the statements that best describe their feelings about the sexual abuse:
_____I feel different from other people because of the abuse.
_____I feel guilty about what happened.
_____I'm filled with
_____I'm afraid a lot of the time.
_____I don't enjoy things the
way I used to.
_____My future looks awful.
_____I don't think things are
ever going to get better.
_____I'm not eating or sleeping the way I did before
_____I don't like to be around people, and I stay by myself a lot.
_____I don't know what I feel about the person who abused me.
or worried most of the time.
_____I feel lousy about myself.
confused about how sex should be for me now.
_____I blame myself for what
_____My moods change all the time.
_____I can't control much
of anything now.
_____I can't trust very many people now.
doesn't affect me much.
_____I have to be on the alert all the time now.
_____I don't see friends much anymore.
_____I feel terrified of certain things.
_____My eating patterns are all messed up.
_____I think I would be better
_____I think about dying.
_____I've tried to hurt myself since
_____I can't seem to get along with other kids anymore.
want to do sexual things with other kids.
_____I get into fights or blow up
a lot at other people.
_____I don't want to do what adults
tell me to do.
_____I'm having a lot of trouble sleeping well at night.
_____I feel like running away from home.
_____I feel "spacey" or
in another world a lot of the time.
_____I feel sick often.
have gone downhill for me at school.
_____I use drugs or alcohol to avoid
thinking and feeling.
Play CD track 1 for more information on this
Client answers the following questions to help him become aware
of the effects his abuse is having on his development:
1. How do you think
the abuse affects your life now?
2. What do you think your life will be like
in ten years?
3. If the molestation had not been reported, what would your
life be like now?
4. List three of your best qualities or strengths.
List three things about yourself that you sincerely want to change.
6. Do you
think there is any way to tell if a person is a molester? I so, please explain.
If you had three wishes, what would they be?
8. How has being molested affected
your feelings toward your mother?
9. How has being molested affected your feelings
toward your father?
10. List three goals for yourself (other than in therapy)
for the next six months.
11. List three goals for yourself in this group.
If you could say anything to the person or people who molested you (and be completely
safe without any possible consequences), what would you say?
13. Have you had
recurrent, intrusive memories of what happened? When? How often?
14. Why do
you think that the abuse happened?
15. Rate your overall trust level right
now from 1 (no trust at all in family and friends) to 10 (complete trust in family
16. Is there anything about the molestation that you have not
discussed with anyone? If so, how can we help you feel safe enough to talk about
CD track 2 for more information on this technique.
Client answers the following
questions to help them open up to you about the alleged abuse:
1. How many
people have molested/sexually abused/raped you?
2. What are these people's
3. For each person you listed in item 2 above, answer the following:
How old were you when it started?
- How old were you when it stopped?
Did it happen one time? A few times? Many times?
- Where did it take place?
What things did he or she do to you? Ask you to do?
- Who else knew about it?
What happened to make the abuse finally stop?
- How do you feel when you think
about the molester?
Play CD track 3 for more information on
Client places a checkmark under the person who they would talk
to about the following situations:
(M-Mother Fa-Father G-Grandparent B-Brother
S-Sister T-Therapist Fr-Friend)
You made an embarrassing mistake.
2. You had a medical problem that worried
3. You felt angry enough to hurt someone.
4. You got an "F".
You thought you had a problem with drugs.
6. You wanted to have a girlfriend.
You wanted to kill yourself.
8. You thought you made someone pregnant.
A friend hurt you.
10. You felt lonely.
11. You decided to run away.
You thought about killing yourself.
13. You knew your mom was upset
needed some help.
14. You were still being molested.
15. Someone threatened
16. You were pressured by friends to use drugs.
17. You saw a good
18. You were being physically abused at home.