In the present invention, therapy for a psychiatric disorder related to personal relationships is efficiently performed. A diagram drawing area (140) that causes a patient to draw a specific scene concerning oneself and a companion is arranged in a sheet center. A self-emotional list (121) that causes the patient to circle his own emotions and a self-message entry column (122) that causes the patient to write in his expectations and intentions toward the companion are arranged in the sheet left side. A companion-emotional list (131) that causes the patient to imagine the emotions of the companion and circle said emotions and a companion-message entry column (132) that causes the patient to imagine and write in the expectations and intentions of the companion towards the patient are arranged in the sheet right side. A third party comment area (150) that causes the patient to imagine and write in the comments of a third party, assuming the third party is present on the scene, is arranged in the sheet lower part. By the patient himself writing in for each column, the psychiatric disorder is improved.
