1. If you agree that:
You have read the information sheet and you understand that you may ask further questions at any time. And you wish to participate in this study under the conditions set out in the information sheet.
Then: Please tick "I agree," and the sign and date below.
If you do not agree, please feel free to contact the researcher to discuss your concerns. Please note that by submitting your agreement, you are legally consenting to participate in this research.
*If you wish to reread the Information Sheet at this time please visit: http://cbtccstudy.webs.com/ I Agree I Do Not Agree Signature:___________________________ Date:____________________________ 1. Study Information
2. Please enter your demographic information (optional ‐ required if prize is won.)
Name:_________________________________________________________________ Address: ___________________________________________________________ City/Town:______________________________________________________________ Post Code: __________________________________________________________ Email Address:___________________________________________________________ Phone Number:__________________________________________________________
3. What year were you born? ______________________________________________
4. What is your ethnic group? Please tick all that apply.
European New Zealander Maori
Pacific Islander European Asian
Other (please specify):______________________________________________
5. Nationality. Please list all: _____________________________________________
6. What is/are your professional title(s) / affiliation?
Clinical Psychologist Registered Psychologist Nurse
Occupational therapist Social worker / case worker Psychotherapist
General Practitioner Psychiatrist
Other
7. What is your current place of work? Private practice with others Private Practice on own
DHB
Prison
Treatment centre Drug and Alcohol centre
Other (please specify):_____________________________________________
8. How would you describe your primary client group? (For example: children and adolescents; geriatrics, adults). __________________________________________
9. Approximately how long have you been practicing as a CBT therapist? 0‐2 Years 2‐5 Years 5‐10 Years 10‐15 Years 15+ Years
10. Approximate number of hours spent doing CBT per week? _________________
11. Are you currently receiving supervision?
Yes
No
Other
If Yes, How often? _________________________________________________
12. What is your highest academic qualification? ______________________________
13. Do you utilise CBT case conceptualisation / formulation in your psychotherapeutic practice?
Yes
No
If yes, please describe how and when you might use a CBT conceptualisation (I.e All the time or only in specific instances). Please elaborate: _________________________
14. What is your understanding of case conceptualisation / formulation? __________________________________________________________________
15. How do you go about formulating a case conceptualisation? I.e. do you follow a particular format? Do you make notes or just work from memory? How in depth do you go? ________________________________________________________________
16. What kind of client information do you use to formulate your CBT case conceptualisation? _______________________________________________________
17. What tools or measures do you use to formulate your CBT case conceptualisation? ___________________________________________________________________
18. How involved is the client in the conceptualisation process? ___________________
19. Does the conceptualisation influence the therapy and/or treatment of the client? Could you explain how this might occur, include examples if you wish:
_______________________________________________________________________
20. Does your case conceptualisation change as therapy progresses?
Yes
No
Sometimes
N/A
21. If your conceptualisation does change, could you explain how and why this might happen. _____________________________________________________________ 4. Case Conceptualisation Details.
22. Have you ever attended a workshop on CBT case conceptualisation?
Yes
No
N/A
If yes, please elaborate: ___________________________________________________
23. Have you completed any self study in the area of case conceptualisation? I.E. Read books or articles.
Yes
No
N/A
If yes, please elaborate: __________________________________________________
24. Do you experience any difficulties regarding the construction of a CBT case conceptualisation? Could you describe what these might be? __________________________________________________________________
25. If you do experience difficulties how do you think these could be overcome? Reading Attending workshops Supervision Personal therapy other
Thank you for taking the time to answer these questions. The prize winner will be contacted by the end of September.
26. If you wish to have the results of this study sent to you please provide your email or postal address below:
_______________________________________________________________________
Cognitive Behaviour Therapy Case Conceptualisation and
Psychotherapeutic Practice – The Practitioners Perspective.
1. If you agree that:
You have read the information sheet and you understand that you may email the researcher to ask further questions at any time, and you wish to participate in this study under the conditions set out in the information sheet.
Then: Please tick "I agree," and the sign and date below.
If you do not agree, please feel free to contact the researcher to discuss your concerns. Please note that by submitting your agreement, you are consenting to participate in this research.
*If you wish to reread the Information Sheet at this time please visit: http://cbtccstudy.webs.com/ I Agree I Do Not Agree Signature:___________________________ Date:_______________________________ 1. Study Information
2. Please enter your demographic information (optional ‐ required if prize is won.)
Name:_________________________________________________________________ City/Town:______________________________________________________________ Email Address:___________________________________________________________ Phone Number:__________________________________________________________
4. What is your ethnic group? Please tick all that apply.
European New Zealander Maori
Pacific Islander European Asian
Other (please specify):______________________________________________
5. What is/are your professional title(s) / affiliation?
Clinical Psychologist Registered Psychologist Nurse
Occupational therapist Social worker / case worker Counsellor
Psychotherapist General Practitioner Psychiatrist
Other (please specify):______________________________________________
6. What is your current place of work? Private practice
DHB
Hospital Corrections
Specialised Treatment centre Drug and Alcohol centre University Clinic
Child, youth and family services Defence Force
Community organisation Iwi Health Provider
Other (please specify):_____________________________________________
7. Who would you describe as your primary client group? Children and Adolescents
Adults Older adults
Other (please specify):______________________________________________
8. Approximately how long have you been practicing CBT? 0‐2 Years 2‐5 Years 5‐10 Years 10‐15 Years 15+ Years
9. Approximately how many hours do you spend doing CBT per week? _____________
10. Are you currently receiving supervision?
Yes
No
If Yes, How often? _________________________________________________
11. What is your highest academic qualification? ______________________________
12. Do you utilise CBT case conceptualisation / formulation in your psychotherapeutic practice?
Yes
No
If yes, please describe how and when you might use a CBT conceptualisation (I.e All the time or only in specific instances / complex cases). Please elaborate: _______________________________________________________________________
13. What is your understanding (or working definition) of case conceptualisation / formulation? ____________________________________________________________
14. How do you go about formulating a case conceptualisation? I.e. do you follow a particular format? Do you make notes or just work from memory? How in depth do you go? ________________________________________________________________
15. What kind of client information do you use to formulate your CBT case conceptualisation? _______________________________________________________
16. Do you utilise any tools or measures to formulate your CBT case conceptualisation?
Yes
No
If yes, please provide details: ______________________________________________
17. How involved is the client in the conceptualisation process? ___________________
18. Does the conceptualisation influence the therapy and/or treatment of the client?
Yes
No
Sometimes
If yes, could you explain how this might occur, include examples if you wish:
19. Does your case conceptualisation change as therapy progresses?
Yes
No
Sometimes
If yes, could you explain what would cause you to change your original conceptualisation? _______________________________________________________ 4. Case Conceptualisation Details.
20. Have you ever attended a workshop / conference / course on CBT case conceptualisation?
Yes
No
N/A
If yes, please elaborate: ___________________________________________________
21. Have you completed any self study in the area of case conceptualisation? I.E. Read books or articles.
Yes
No
N/A
If yes, please elaborate: __________________________________________________
22. Do you experience any particular difficulties regarding the construction of a CBT case conceptualisation?
Yes
No
N/A
If yes, could you describe what these might be? _______________________________
23. If you answered yes above, can you think of any ways in which these difficulties could be overcome? ______________________________________________________
Thank you for taking the time to answer these questions. The prize winner will be contacted by the end of September. If you wish to have the results of this study sent to you please provide your email or postal address below: _______________________ _______________________________________________________________________
APPENDIX D