Name of Practitioner: __________________________________
Initials of Volunteer: __________________________________
|Building Relationships||Check if observed|
|AttendingÂ (Did you do/have the following?)|
|Open and accessible body posture|
|Congruent facial expression (matches body language and words)|
|Slightly inclined toward client (not leaning back)|
|Regular, appropriate eye contact|
|No distracting behaviors (fidgeting, tapping pencil, swinging legs, etc)|
|Minimal encouragement (nod head occasionally, mhmm, etc)|
|ObservingÂ (Did you pay attention to the following in your client?)||Check if observed|
|Clientâ€™s facial expressions|
|Body position and movement|
|Muscle tone (relaxed, tense, shaky?)|
|Skin tone changes (did they flush, grow pale, become sweaty?)|
|Refer to Appendix A in text, page 223-224 & assess performance in the following:|
|Level 1,3,or 5|
|Listening: Content and Process Evaluation Scale|
|Empathy Evaluation Scale|
|Warmth Evaluation Scale|
|Respect Evaluation Scale|
|Genuineness Evaluation Scale|
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