Relationship Worksheet
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1
2Relationship Worksheet
Name
Name*
Situation or Concern
Situation or Concern
Emotion
Emotion
Sad, hurt, angry, anxious, scared, irritable,
Sad, hurt, angry, anxious, scared, irritable,
frustrated etc. Rate intensity 0 – 100%
frustrated etc. Rate intensity 0 – 100%
Physical sensations
Physical sensations
What did I feel in my body,
What did I feel in my body,
where?
where?
Thoughts / Images
Thoughts / Images
What went through my mind?
What went through my mind?
What did that mean or say about me or them? What’s
What did that mean or say about me or them? What’s
the worst thing about that?
the worst thing about that?
What I did, and/or what I’d like to do
What I did, and/or what I’d like to do
What I noticed about them
What I noticed about them
(how they looked,
(how they looked,
posture, facial expression, voice, eyes, movement etc)
posture, facial expression, voice, eyes, movement etc)
Agreement /Compromise / Action Plan
C Vivyan 2010
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