affectphobia.org, the web site for
Affect Phobia Therapy

The Ten-Session Summary Form is used to summarize and rate therapy sessions. For each session, we record the date, a brief (e.g. one-sentence) summary of the main themes of the session, the core affective conflict focused on in the session, and a 1-10 rating of the insensity at which the patient experienced the adaptive affect. Each form has spaces to rate ten sessions, after which a new form can be started.

In addition, there are spaces to rate a number of items three times over the course of each ten sessions (eg the 21st, 25th, and 30th sessions). These items include the five-axis diagnosis, ratings of target problems (1=no longer a problem, 10=very severe problem), and ratings of core conflcts.

The ratings can be done by the patient and therapist together in the last five minutes of a therapy session, and the discussion can be helpful in the therapy.

The form is available as a pdf and an rtf file.

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