Healthcare Training Institute - Quality Education since 1979
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Appendix C - Controlling Behavior Weekly Logs
Reproducible Client Worksheet

Test | Table of Contents

Instructions: Complete each section. Be specific.

Topic:_____________________________Date:______________Name:________________________________

1. Briefly describe the situation and the action you used to control (statements, gestures, tone of voice, physical contact, facial expressions).
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

2. Intent: What did you want to happen in this situation?
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

3. What feelings were you having?
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

4. In what way did you minimize or deny your actions or blame her?
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

5. Effects: what was the result of your action? Include results of blaming or minimizing.
(on you)__________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
(on her)___________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

6. It would have been better if I...
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

7. How did your past use of violence affect this situation?
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

Caesar, P. Lynn, Treating Men Who Batter, Springer Publishing Company, NY, NY, 1989.