<p> CORE AFFECT CONFLICT SESSION RATING FORMS Jan09 Leigh McCullough Ph.D. Modum Bad Psychiatric Center www.AffectPhobia.com</p><p>SESSION # ______DATE:______RATED BY PT:______THERAPIST______BOTH_____ During today’s session, please rate the felt experience of what feelings, anxieties and defenses have been focused on in order to resolve the main problems. And note the # of repetitions of each feeling. MAIN PROBLEMS FOCUSED ON IN TREATMENT RATE SEVERITY 1-10 1.______2.______3.______</p><p>SO THIS IS DONE INSTEAD... THE FEELINGS THAT ARE INHIBITING (DEFENSIVE BEHAVIORS & FEELINGS ) (ANXIETY, GUILT, SHAME, PAIN, DISGUST)</p><p>©2009 Leigh McCullough APT-Core Conflict Rating Forms 1 1 .</p><p>2 2 .</p><p>3 3</p><p>THE BLOCKED HEALTHY FEELINGS - TO LEARN TO BEAR AND EXPRESS WELL (GRIEF, ANGER, CLOSENESS, SELF CARE/ COMPASSION/ ESTEEM These Intensity FEAR, EXCITEMENT, JOY, SEXUAL DESIRE)Repetitions feelings become 1 inhibited by anxieties </p><p>2</p><p>3</p><p>Rate the intensity of core feelings, anxieties and awareness of defenses according to the following scale 0 = No bodily experience of the core feeling or the anxiety, no awareness 1-3 = Low: unclear or few bodily sensations/experiences 4-6 = Medium sensation or bodily experience of feeling or defenses 7-10 = High (intensity or depth) of bodily experience/awareness</p><p>©2009 Leigh McCullough APT-Core Conflict Rating Forms EXAMPLE . Name: André</p><p>Main problems: I have difficulties getting angry. I am afraid (F) others will abandon me if I don’t do what they ask. I also have difficulties caring for my own needs (WWFN) and I feel bad about myself (F) if I care about me. To me, attending to my needs (WWFN) means being selfish (F). To avoid feeling afraid and ashamed I try to accommodate to other’s demands (D) and expectations and I am very observant on others’ reactions towards me (D). I have a lot of negative thoughts about myself (F/D) when I don’t quite want or can live up to others’ expectations. </p><p>FEAR DEFENSE</p><p>Live up to others’ Fear of 1. expectations 1. abandonement</p><p> observant on Shame about 2. others’ 2. being selfish reactions towards me WISH/WANT/ FEELING/NEED 3. negative 3. thoughts about myself Say no, getting 1. angry</p><p>Caring about 2. myself, feeling important and worthy</p><p>3.</p><p>©2009 Leigh McCullough APT-Core Conflict Rating Forms Session nr __5__ Code:</p><p>Describe what during today’s session that has been the most important to you on each of the corners of the triangle (if you are not sure, choose what you think fits best):</p><p>… and this is what …but I am so afraid I do/feel/think to this will happen… avoid that:</p><p>I do what she She will get angry 1. wants 1. with me, won’t want to work with me, and tell I think she is everybody I am lazy 2. right and a poor team player This is what I wish/want/ 3. feel/need… : Saying no to 1. my colleague</p><p>2.</p><p>3.</p><p>©2009 Leigh McCullough APT-Core Conflict Rating Forms Rate each wish/want/feeling/need (=WWFN) and each fear (=F) according to the following scale (if you are not sure, choose what you think fits best):</p><p>0 =No experience of the wish/want/feeling/need 1-3 =Low: unclear or few experiences of the wish/want/feeling/need 4-6 =Medium experience of the wish/want/feeling /need 7-10 =High: Intensive or many experience of the wish/want/feeling/need</p><p>0 =No experience of the fear 1-3=Low: unclear or few experiences of the fear 4-6=Medium experience of the fear 7-10=High: Intensive or many experiences of the fear</p><p>WWFN 1: __2___ F1: ___9__</p><p>WWFN 2______F2______</p><p>WWFN 3______F3______</p><p>©2009 Leigh McCullough APT-Core Conflict Rating Forms</p>