Summary Sheet

(for the recorded session which is being submitted for rating)

Name of trainee:
Level of Certification I am pursuing (Advanced / Standard):
Date of final workshop on the Certification Programme (ie the workshop which completes the
training):
E-mail address:
Date of the submitted session:

1. This is session number :

2. Date of the session:
3. I chose this particular session for rating because….

4. We are working on….

5. I chose these strategies (i.e. imagery, limited reparenting, mode work, empathic
confrontation, therapy relationship, etc) for this client at this time because….

6. The challenges involved in working with this client and the challenges involved for the
client are…
With the client

For the client

7. Other information that will enhance the rater’s understanding of this session as they listen
or view it: