1. How long have you been working on the same issues, be they in the area of your career, health, intimate relationships or finances?
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A. Less than 12 months
B. 1-3 Years
C. More than 5 years
D. More than 10 years
2. In the past 12 months, how many times have you misplaced something important, gotten a traffic ticket, had an accident, or destroyed something of value?
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A. Once or twice
B. More than 5 times
C. Never
D. More than 10 times
3. How often do you feel fake, inauthentic, or find that it takes a lot of effort to get people to perceive you in a certain way?
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A. Almost Never
B. Occasionally
C. Often
D. All the damn time
4. If your friends, co-workers and family members were interviewed, would they say that you complain…
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A. All the time!
B. Rarely/Never
C. Sometimes
D. Often
5. In the past 12 months, how many times have you said something that you later regretted, whether immediately or over time?
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A. Rarely
B. Once or twice
C. More than 5 times
D. All the time. Halp!
6. After you’ve achieved a personal goal – reached your desired weight, paid off your credit cards, organised your home or office, etc. – which of the following emotions are you more likely to experience?
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A. Relieved that you made it but wary that you may backslide into old behaviours
B. Entitled – you deserve a reward for all your hard work!
C. Motivated by your success and committed to keeping up the good work
D. Resentful that you had to work so hard in the first place
7. How often do you notice yourself feeling inadequate, not good enough, unloved, or unworthy?
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A. Rarely
B. Sometimes
C. Often
D. All the time
8. On a scale of 1-10, how willing are you to speak your truth, even if it runs contrary to the opinions of others?
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A. Sometimes
B. Most of the time
C. Rarely
D. Often
What is the primary focus of your life right now?
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A. Advancing my career, improving my health, building wealth, or deepening my relationships
B. Managing strained relationships or “putting out fires” at work and at home.
C. Making measurable progress toward my goals over a reasonable period of time.
D. Trying to avert or avoid immediate disaster in the area of my finances, relationships, health or career.
10. What percentage of the time can you count on yourself to keep your word and uphold your promises – whether to yourself or to another?
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A. Less than 10%
B. Less than 25%
C. About half the time
D. Most of the time
11. When you make a "mistake", what are you most likely to do?
A. Fall into a downward spiral of self-criticism
B. Put things in perspective by acknowledging myself for what I did right
C. Interpret my misstep as evidence that I am incompetent, and stop
D. Be gentle with myself and resolve to do things differently in the future
12. How frequently do you feel mistreated, misunderstood, or taken advantage of – in either your personal or professional life?
A. Every day
B. Often
C. Rarely
D. Occasionally
13. When asked to do something that you have no interest in doing, you are most likely to…
A. Say no with a clear conscience
B. Say yes but not follow through
C. Say no but feel guilty about it
D. Say yes but feel resentful about it
14. When you feel hurt by someone or something, what do you tend to do?
A. Keep it to myself
B. Reflect, forgive, and move on
C. Talk about it to everyone but the person involved
D. Confront the situation head-on
15. Imagine that your life is a house with many rooms – some you like, some you feel ashamed of. How many people do you allow to see all of your rooms?
A. One significant person – a spouse, lover, best friend, parent, etc.
B. Nobody
C. There are many people in my life who know me that well
D. A small handful of people know me that well
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