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Parent Form - What's going on?

Please complete this before your first consultation.
I need to have a good understanding of the problem and be able to understand what is occurring for the child, within the context of the family.

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Question 1 of 23

Name

Question 2 of 23

Child's name:

Question 3 of 23

Child's Age:

Question 4 of 23

Address: (Optional - I send therapy welcome packs, birthday cards and certificates to children through the post)

Question 5 of 23

How would you describe the problem your child is facing?

Question 6 of 23

What was your child’s early development like?

Question 7 of 23

What were your child’s early attachments like? Who and what were they close to?

Question 8 of 23

How are other family members responding to the problem? How does your child relate to other family members?

Question 9 of 23

How long have you been aware of it?

Question 10 of 23

Do you know what triggered it?

Question 11 of 23

Do these problems run in the family?

Question 12 of 23

What have you tried to solve this problem?

Question 13 of 23

What made you look for help now?

Question 14 of 23

Is there a pattern to the problems? E.g weekends, holidays, visitors, school events, exams?

Question 15 of 23

What makes things worse?

Question 16 of 23

What makes it better?

Question 17 of 23

What do you think keeps the problem going?

Question 18 of 23

How would your child describe themselves at their best? What are their strengths?

Question 19 of 23

How would your child describe themselves at their worst?

Question 20 of 23

What is your child interested in?

Question 21 of 23

How is your child getting on at school?

Question 22 of 23

What would you like to change?

Question 23 of 23

How did you hear about Claire Peirson and Pivotal Mind?

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