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.
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