| 1 | I want to know | |||||||||
| what I’m feeling | ………………………………………………………………………………….. | |||||||||
| why I’m feeling it | ………………………………………………………………………………… | |||||||||
| other | ………… | ………………………………………………………………………………….. | ||||||||
| 2 | I want to stop feeling | |||||||||
| confused …………….. | ………………………………………………………………………………….. | |||||||||
| trapped | ……………………………………………………………………………………………… | |||||||||
| angry | ………………………………………………………………………………………………. | |||||||||
| sad | ………………………………………………………………………………………………. | |||||||||
| lonely | ………………………………………………………………………………………………. | |||||||||
| afraid | ………………………………………………………………………………………………. | |||||||||
| other | ………………………………………………………………………………………………. | |||||||||
| 3 | I want to learn to express | |||||||||
| anger | ………………………………………………………………………………………………. | |||||||||
| fear | ………………………………………………………………………………………………. | |||||||||
| sadness | ………………………………………………………………………………………………. | |||||||||
| joy | ………………………………………………………………………………………………. | |||||||||
| other | ………………………………………………………………………………………………. | |||||||||
| 4 | I want help in making decisions…………………………………………………………………… | |||||||||
| 5 | I want help in solving problems……………………………………………………………………. | |||||||||
| 6 | I want help in becoming more confident………………………………………………………….. | |||||||||
| 7 | I want to become more employable……………………………………………………………… | |||||||||
| 8 | I want to know what I want………………………………………………………………………… | |||||||||
| 9 | I want to be able to ask for what I want ………………………………………………………… | |||||||||
| 10 | I want to be able to say “No” to unfair requests……………………………………………….. | |||||||||
| 11 | I want to get along better with people, which includes knowing why I have trouble | |||||||||
| getting along with people …………………………………………………………………………. | ||||||||||
| ending involvements with destructive men………………………………………………………. | ||||||||||
| having better sexual relationships………………………………………………………………… | ||||||||||
| making better friends……………………………………………………………………………….. | ||||||||||
| coping better with children………………………………………………………………………… | ||||||||||
| being a better parent……………………………………………………………………………….. | ||||||||||
| 12 | I want to | |||||||||
| gain more control over my life…………………………………………………………………… | ||||||||||
| be more disciplined…………………………………………………………………………………. | ||||||||||
| make better plans…………………………………………………………………………………….. | ||||||||||
| stick to my plans……………………………………………………………………………………… | ||||||||||
| learn to take better care of myself…………………………………………………………………. | ||||||||||
| other…………………………………………………………………………………………………… | ||||||||||


