Problem-Domain Analysis Form
Revised Version
Copyright © Donald Robertson, 2011. All rights reserved.
Purpose: This form is used to help provide a comprehensive overview of problems that you face in different areas of life. It will help you to focus on the domains or areas of life that seem most problematic and clarify what you’re trying to achieve, the obstacles you’re facing, what you’re trying to do to resolve things, and how much you worry about it.
Problems. How satisfied are you in each domain below (0-100%)? Why is it not 100%? What specific problems are you facing?
- Work/study:
- Mental/physical health:
- Finances/legal issues:
- Intimate relationships:
- Family relationships:
- Social/leisure activities:
- Other:
For the domain(s) above where you’re experiencing most problems, try to answer the following additional questions:
- Goals. What are your goals or ambitions? What’s the best you can hope to achieve in this domain?
- Obstacles. What obstacles do you face? Why haven’t you achieved your goals already?
- Coping/Solutions. What are you trying to do to cope or solve the problem(s)? How well does that work?
- Worries. What do you fear might go wrong in this domain? What’s the worst that could happen? How much time do you spend worrying about it?