If yes describe the nature of the group. 2. What are some of the commonalities you associate with the present group members? 3. How do you think you differ from the members of the group? 4. What do you hope to gain by participating during the group sessions? 5. What concerns do you have about being a member of this group? 6. Have you been a beneficiary of any mental health services in the past or present Yes No If yes describe. 7. What are some of your core values? And how do you think they will either inhibit or facilitate your work as a Group counsellor/leader 8. What are some of your core beliefs, and how do you think they will either inhibit or facilitate your work as a Group counsellor/leader 9. What specific kinds of clients might you have difficulty working with because of clash of values and beliefs? 10. What would you like to change about the way you relate to or interact with others? 11. What are some of the aspects of how you relate and interact with others about which you might like to receive feedback and how do you think it might be helpful / challenging for you? 12. What are the possible challenges you think you would encounter being part of this group? How would you like to deal with it? 13. Are you experiencing any crisis at this time that might make it hard for you to focus on issues relating to this group? Yes No. If yes describe. 14. Do you believe that you can commit to the level of participation expected in Group sessions such as – regularly attending sessions, participating in group discussions/ role-plays/ activities, and completing follow-up homework assignments? 15. Do you have any questions?