GTLYW 24 Oct Your Email Address(where the dialog will be sent): Senders Name (YOU - the person requesting the change): Receivers Name: What do you appreciate about the reciever Behavior Change Request Form: Your requests should be SMART: Specific –a behavior Measurable –an observer could count when it is happening Attainable–a small step Relevant–applicable to the frustration or need Time-limited–e.g., daily for the next two weeks Frustrating Behavior: Example: I get frustrated when I don’t hear from you during the day and then you come home and watch TV without speaking to me. ***This should not be something that causes discomfort. My Feeling: Example: I feel angry and sad. My Story: Example: When you don’t call, I get angry and sad. When this happens, the story I tell myself is that you don’t care about me. My Reactive Behavior: Example: When you do that, I react by withdrawing from you emotionally ***IN ORDER TO*** not to feel my fear of being abandoned. My Fear: Example: I am scared that you don't love me any more. My Childhood Memory: Example: It reminded me of when my mom ignored me when she got home from work, making me feel abandoned and invisible. My Global Desire: Example: What I wish would happen all the time is that you would always love me in a way that makes me feel absolutely important and cherished.