Assessment

What is the longest continuous period of silence and/or emotional distance you’ve experienced between yourself and your father?

How many memories of painful words of criticism or disapproval from your mother do you have today?

How many memories of painful words of criticism or disapproval from your father do you have today?

How many memories of painful or disapproving treatment from your mother do you have today?

How many memories of painful or disapproving treatment from your father do you have today?

Was there a period of time that you did not live with both parents between the ages of birth and 18 years?

How many stories about your mother's childhood has she shared with you that you remember today?

How many stories about your father's childhood has he shared with you that you remember today?

How many times has your mother openly and honestly shared with you her positive feelings about you that you remember?

How many times has your father openly and honestly shared with you his positive feelings about you that you remember?

Was there a period of time that you did not have contact with your maternal grandparents between the ages of birth and 18 years?

Was there a period of time that you did not have contact with your paternal grandparents between the ages of birth and 18 years?

On a scale of 1-10 (1=lowest, 10=highest), what is the level of your current dissatisfaction with your relationship with your mother from birth to age 4?

On a scale of 1-10 (1=lowest, 10=highest), what is the level of your current dissatisfaction with your relationship with your father from birth to age 4?

On a scale of 1-10 (1=lowest, 10=highest), what is the level of your current dissatisfaction with your relationship with your mother from age 5 to age 12?

On a scale of 1-10 (1=lowest, 10=highest), what is the level of your current dissatisfaction with your relationship with your father from age 5 to age 12?

On a scale of 1-10 (1=lowest, 10=highest), what is the level of your current dissatisfaction with your relationship with your mother from age 13 to age 19?

On a scale of 1-10 (1=lowest, 10=highest), what is the level of your current dissatisfaction with your relationship with your father from age 13 to age 19?

On a scale of 1-10 (1=lowest, 10=highest), what is the level of your current dissatisfaction with your relationship with your mother from age 20 to the present?

On a scale of 1-10 (1=lowest, 10=highest), what is the level of your current dissatisfaction with your relationship with your father from age 20 to the present?

On a scale of 1-10 (1=lowest, 10=highest), to what extent are you aware of feeling that your best and most successful life has been undermined by challenges in your relationship with one or both of your parents?

On a scale of 1-10 (1=lowest, 10=highest), what is the level of your current dissatisfaction with your past?

On a scale of 1-10 (1=lowest, 10=highest), what is the level of your current dissatisfaction with your financial situation?

On a scale of 1-10 (1=lowest, 10=highest), what is the level of your current dissatisfaction with your career path?

On a scale of 1-10 (1=lowest, 10=highest), what is the level of your current dissatisfaction in your relationships with your spouse, children and/or extended family?

On a scale of 1-10 (1=lowest, 10=highest), what is the level of your current dissatisfaction in your relationships with your colleagues, friends, and/or general support network?

On a scale of 1-10 (1=lowest, 10=highest), what is the level of your current dissatisfaction in your relationship with God/spiritual life/inner life?

On a scale of 1-10 (1=lowest, 10=highest), what is the level of your current dissatisfaction with your health?

On a scale of 1-10 (1=lowest, 10=highest), to what extent are you aware of feeling that your best and most successful life has been undermined by choices you have made in response to feeling rejected by your parents?

What is your age range?

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