You will be rated on the below scale for each item TOTAL POSSIBLE POINTS 100

Structural 

Information

Bullet-point format in this section, brief, appx ½ – ¾ page

What are the names (first name only), ages, and birth order of each person?

What are their occupations and education         levels   (where appropriate)?

What is their living arrangement and relationship status?

What are the roles of each?

What does the couple like to do together?

Who does each member spend most of his or her time with?

Who makes decisions within the couple and how are they made?

Developmental

Information

Must be in narrative form,

appx 1- 1 ½ pages)

Describe the developmental stage of the couple at this

time

Detail any recent significant events/losses

Are there any anticipated changes/transitions in the near future? If so, how are these anticipated changes/transitions affecting the couple?

What are the current goals of the couple, including what goals have already been met and how?

Describe the couple’s spiritual life/climate based on individual histories and negotiations as a couple

General 

Impressions

Must be in narrative form,

appx 1½ – 2 pages)

Describe the communication

style observed

Describe the manner of relating to the outside world

(boundaries)

What are you impressions regarding intimacy and emotional closeness?

What are the strengths and weaknesses of this couple?

Other comments/ observations

Evaluation of the

Experience 

Must be in narrative form, appx 2 pages)

Describe what you learned

through this experience

Self-evaluate regarding the interview process

What did you feel were your strong points?

What do you see as areas of further personal or professional development in working with couples and give your overall impressions concerning your working with couples

Total