Lembar Identifikasi

Terapis : Klien :

ESQ Matrix
1. SQ
a. Higher Purpose (Tujuan kehidupan, kualitas hubungan dengan Tuhan)
Kondisi saat ini:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Sugesti:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

ESQ Hypnotherapeutic:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

b. Kontribusi
(Kontribusi yang bisa Anda berikan lebih bagi keluarga, lingkungan kerja dan masyarakat)
Kondisi saat ini:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Sugesti:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

ESQ Hypnotherapeutic:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
2. EQ
a. Pertumbuhan Diri
(Kebiasaan positif baru yang akan di mulai, kebiasaan negatif yang akan di stop, keahlian atau
pendidikan yang diperlukan)
Kondisi saat ini:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Sugesti:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

ESQ Hypnotherapeutic:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

c. Relasi – Cinta
(Kualitas hubungan dengan keluarga, orang tua, rekan kerja, tim kerja, pimpinan dan lingkungan
sosial)
Kondisi saat ini:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Sugesti :
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

ESQ Hypnotherapeutic:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
 d. Eksistensi
(Eksistensi di hadapan keluarga, orang tua, rekan kerja, tim kerja, pimpinan dan lingkungan sosial)
Kondisi saat ini:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Sugesti:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

ESQ Hypnotherapeutic:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

3. IQ
a. Tantangan
(Karir, hobi, perjalanan dan sebagainya)
Kondisi saat ini:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Sugesti:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

ESQ Hypnotherapeutic:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
 b. Kepastian
(Pendapatan, rumah, kendaraan, tas, kesehatan dan lain-lain)
Kondisi saat ini:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Sugesti:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

ESQ Hypnotherapeutic:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Terapis Klien
 Lembar Rencana Tindak Lanjut

Terapis : Klien :

ESQ WAYS 165

1. Mission Statement:
Sugesti Self Hipnosis
Rencana Tindak lanjut:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

Hambatan:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

Dukungan yang di perlukan:

________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

2. Character Building:
Kebiasaan Baru yang di lakukan
Rencana Tindak lanjut:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

Hambatan:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
 Dukungan yang di perlukan:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

3. Self Controlling:
Kebiasaan Buruk yang dihentikan
Rencana Tindak lanjut:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Hambatan:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

Dukungan yang di perlukan:

________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

4. Strategic Collaboration:
Kebiasaan Baik yang perlu di lanjutkan
Rencana Tindak lanjut:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

Hambatan:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
 Dukungan yang di perlukan:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

5. Total Action:
Rencana Tindak lanjut:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

Hambatan:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

Dukungan yang di perlukan:

________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

Terapis Klien
 Lembar Monitoring

Terapis : Klien :

ESQ Matrix
1. SQ
a. Higher Purpose (Tujuan kehidupan, kualitas hubungan dengan Tuhan)
Kondisi Perubahan:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Kondisi Perbaikan:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

ESQ Hypnotherapeutic:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

b. Kontribusi (Kontribusi yang bisa Anda berikan lebih bagi keluarga, lingkungan kerja dan masyarakat)
Kondisi Perubahan:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Kondisi Perbaikan:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

ESQ Hypnotherapeutic:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
2. EQ
a. Pertumbuhan Diri (Kebiasaan positif baru yang akan di mulai, kebiasaan negative yang akan di stop,
keahlian atau pendidikan yang diperlukan)
Kondisi Perubahan:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Kondisi Perbaikan:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

ESQ Hypnotherapeutic:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

b. Relasi – Cinta (Kualitas hubungan dengan keluarga, orang tua, rekan kerja, tim kerja, pimpinan dan
lingkungan sosial)
Kondisi Perubahan:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Kondisi Perbaikan:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

ESQ Hypnotherapeutic:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
 c. Eksistensi (Eksistensi di hadapan keluarga, orang tua, rekan kerja, tim kerja, pimpinan dan
lingkungan sosial)
Kondisi Perubahan:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Kondisi Perbaikan:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

ESQ Hypnotherapeutic:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

3. IQ
a. Tantangan (Karir, hobi, perjalanan, dan lain-lain)
Kondisi Perubahan:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Kondisi Perbaikan:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

ESQ Hypnotherapeutic:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
b. Kepastian (Pendapatan, rumah, kendaraan, tas, Kesehatan, dan lain-lain)
Kondisi Perubahan:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Kondisi Perbaikan:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

ESQ Hypnotherapeutic:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Terapis Klien
 Lembar Feedback

Terapis : Klien :

Silakan tuliskan narasi singkat tentang pengalaman Hypnotherapy Anda dalam item berikut :

1. Bagaimana Pandangan Anda tentang sesi Hypnotherapy untuk membantu Anda menangani masalah
pribadi atau bisnis / masalah karier Anda?
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

2. Komentar Anda tentang proses Hypnotherapy?

______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

3. Apa yang dapat ditingkatkan dalam sesi Hypnotherapy ini, untuk memastikan sesi menjadi alat yang
ampuh meningkatkan kesuksesan pribadi?
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

4. Apakah Anda akan merekomendasikan Hypnotherapy kepada orang lain atau organisasi Anda?
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

Terapis Klien