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1. I keep the promises I make to others:

all the time

most of the time

about half the time (50/50)

sometimes, but mostly not

never

2. In my current relationships, I feel:

safe and at peace

safe with some anxiety at times

neutral

unsafe and with anxiety at times

unsafe and with anxiety all the time

3. My ability to influence others for good is:

something I am very good at.

above average.

average.

not that good.

horrible.

4. When I am alone:

I feel peaceful & happy.

I mostly feel positive emotions.

I may feel positive or negative depending on the situation.

I mostly feel negative emotions.

I feel completely empty and scared.

5. My ability to verbalize what I am thinking and feeling in a conversation is:

excellent

above average

average

below average

in need of much improvement

6. In general, I am dependent upon others to fulfill my needs:

False. I am not dependent on anyone to fulfill my needs.

I need a minimal amount from others to fulfill my needs.

I am dependent on others to fulfill my needs about half the time.

I am very dependent on others to fulfill my needs.

I am completely dependent on others to fulfill my needs.

7. I feel loved and appreciated:

by most everyone I interact with.

by about 50% of the people I interact with.

by about 25% of the people I interact with.

by a few people every once in a while.

by no one.

8. When it comes to pride, others generally think that:

I am not prideful at all.

I am mostly not prideful.

I am prideful some of the time.

I am mostly prideful.

I am prideful all the time.

9. How I interact with my family members:

I have a harmonious relationship with all family members.

I have a harmonious relationship with most of my family members.

I have a harmonious relationship with some family members and not so good with others.

I feel hurt & resentment by most of my family members.

I feel hurt and resentment by all of my family members.

10. When having a conversation with someone:

I respect others points of view as I would my own.

I generally give more importance to other's points of view.

I listen to others point of view and sometimes consider them to be inferior to my own.

I feel that my point of view is more valid than others.

I completely reject any opinions offered that differ from my own.

11. I judge others:

almost never.

occasionally.

on a regular basis.

most of the time.

all the time.

12. I feel like I belong:.

always

most of the time

about half of the time

every once in a while

never

13. I love myself:

deeply and unconditionally.

mostly. There are a few things that I still need to work on.

somewhat. Criticism and self appreciation is about 50/50.

rarely. My thoughts about myself are mostly negative.

never. I would rather die.

14. When a group decision is to be made:

I share my ideas, listen to other's opinions and respect the decision made, whether it is the one I preferred or not.

I share my ideas & listen to other's opinions, but if I don't agree with the decision, I won't respect it.

I try to convince others through logic and reasoning that my idea is best. I may shoot down other's ideas and feel a little bad if it doesn't go my way.

I may get argumentative and try to control the direction of the group. I may feel resentment towards others who disagree with my opinion.

Not only do I get argumentative, but I also offend others in the group, and will do whatever it takes to get my way.

15. How I handle disagreements:

I listen & allow the person to express their point of view. Then in a calm way, I share my perspective without allowing my emotions to take over.

I listen & allow the person to express their point of view, but some emotions surface as I feel the need to convince the person of my perspective.

I'm not really trying to understand what they are saying. It gets somewhat argumentative.

Full blown argument. Voices are raised. Feelings are hurt.

Anger & yelling is at a max. There is fighting and people get hurt physically as well as emotionally.

16. I get offended:

almost never

sometimes, but generally get over it quickly

sometimes, but it takes a while to get over it

frequently

all the time

17. I can easily forgive:

regardless of what its about. Forgiveness happens quickly for me.

for most things. There are certain things that are tough to forgive, but I eventually work through it.

if I know the person was truly sorry for it. I still hold some resentment towards some people.

Forgiveness is not easy for me. I have forgiven some people to a limited extent. But mostly, I do not.

I never forgive anyone who has hurt me.

18. When someone completes a job I have asked him/her to do:

I am generally pleased with the work performed because I have chosen the right person for the right job and provided clear instructions for it to go smoothly.

I am pleased with the work performed more than not. Sometimes I feel like I do not provide clear instructions or have chosen the right person.

I am happy with the work performed about half of the time.

I focus on the errors first. Usually within 1 or 2 more tries, the person completes it to my satisfaction.

I only focus on the errors and get upset about it. There are normally many revisions because it is practically impossible to please me.

19. In my current intimate relationship:

I feel ecstasy and bliss. This is the man or woman of my dreams.

I feel pretty good about my current intimate relationship. There are some struggles, but we work through them.

I generally feel ok about my current intimate relationship.

I am more often than not looking for a way out of my current relationship.

I do not currently have an intimate partner, although I would want one.

I do not currently have an intimate partner nor do I want one.

20. I blame others:

never. I accept full responsibility for everything that happens in my life.

occasionally. There are some times when I do blame others.

when they cause problems. I recognize my errors sometimes too.

for most things that go wrong in my life.

for everything that goes wrong in my life.

21. Expressing Gratitude to Others:

I express gratitude every chance I get.

I express gratitude most of the time.

I sometimes express gratitude and sometimes I don't.

I rarely thank others for help they give me.

I never thank others for help they give me.

22. Honesty in My Relationships:

I am 100% honest in my interactions with others.

I am mostly honest in my interactions with others, although I do tell lies on rare occasions if I feel its just justified.

I try to be honest, but I do lie and cheat if I feel its justified

I lie and cheat frequently out of habit, not cause I want to.

I lie and cheat on purpose and don't have any plans on stopping.

23. Respect for Others

I have a healthy respect for others. I also feel like others respect me.

I respect others for the most part. I feel a lack of disrespect from others at times.

My level of respect for and from others is OK. We get by.

I frequently have situations happen where people are not respecting me and I am not respecting them.

Situations involving people not respecting me and me not respecting them happens all the time and its intense!

24. Trusting Others:

In general, I trust others to fulfill their commitments

I do trust others, but I am also skeptical in a number of situations.

I trust others to fulfill their commitments about half the time.

I generally do not trust others to fulfill their commitments.

It seems like people are letting me down all the time.

25. I feel lovable:

most of the time.

some of the time, with my current flaws.

some of the time, but I need to fix my flaws first.

I feel unlovable most of the time.

I feel unlovable all the time. I've pretty much given up.

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