24 Oct

    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

    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.