Post-Group Experience Clinician Survey - Change, Inc. St. Louis Counseling

Clinician Name*

First Last

Today's Date*

Date of Group Experience Being Evaluated*

Group Facilitator Name*

Please answer the following questions about the Group Experience on the dated listed above.

1. I felt open to sharing about me and what I may need from the group, including my real-time responses to fellow group members and group discussion contents.*

2. I felt a part of my team and was able to connect and be responsive to others' experiences.*

3. My group leader seemed genuinely interested in me and our group's process.*

4. It was challenging to share about myself.*

5. I felt safe throughout the experience, where safety is defined as "the ability talk about difficult issues with the trust what is said will be heard and explored as a means to deepen group process/group member relationships, or resolve presented issues, rather than ignored, discounted, or unduly criticized."*

6. I often worry that sharing during group experience could directly affect my good-standing at Change, Inc.*

7. I can conceptualize the ways in which group experience is useful to my clinical practice.*

8. I think the group experience is crucial for making meaningful connections/staying connected to my team.*

9. I enjoyed going to lunch with my group.*

10. As concretely as possible, what was helpful about this Group Experience? What was effective, supportive, positively impactful, etc.?(Required)*

11. As concretely as possible, what was not helpful about this Group Experience? What was less than effective, less than supportive, negatively impactful, etc.?*

12. Is there anything else you'd like us to know about this Group Experience?*

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POST-Group Experience

CLINICIAN SURVEY

Please answer the following questions about the Group Experience on the dated listed above.