Name
First Name
Last Name
Situation
WRITE ABOUT ANY UNACCEPTABLE BEHAVIOR BY FILLING IN THE BLANKS BELOW
***Mark Risky Thoughts and Feelings***
Facts about the Situation
Thoughts about the situation
What thinking barriers am I using?
Tactics I used
My feelings about the situation
Corrective tactics I used
My attitudes/beliefs about the situation
My Progress
What behaviors or relationships are you pleased with?
What needs improvement?
What thinking/behavior change am I willing to commit to over the next week?
Who am I accountable to in this change process?
Submit
Should be Empty: