Self-Evaluation Prior to Problem Solving

SELF-EVALUATION PRIOR TO

PSYCHOLOGICAL OR RELATIONSHIP PROBLEM SOLVING

Usable draft

Name: ______Date: ______

Referring not to your “act”, but how you are when you let your hair down, such as with family or an intimate, paying special attention to their feedback: (Some boxes are available to “help” the process along, but you may use any answers that suit you.)

TEMPERAMENT:
Hostile Angry Defensive Impatient Quiet Kind and gentle
OPERATING STYLE:
Supportive Detailed Perfectionistic Aggressive Dictatorial
Intellectual Humorous Silly Flighty Serious
LEVEL OF SELF-CONFIDENCE/SELF-ESTEEM On a scale of 10, 10 being high or very true and 1 being low or not true, I rate the following:
___ I like myself ___ I approve of myself ___ I criticize myself. ___I am mean to myself. ___ I know I am capable and effective. ___ I think I’m not very confident.
___ I am good in social situations. ___ I am not good in social situations.
WHAT I DO WITH MY TIME
Hours per week: ______
Work ___ TV ___ Talk with my intimate ___ Dating with my intimate ___
Hobbies ___ Golf ___ Read novels ___ Self improvement reading/study ___ Reading to improve work knowledge/capability ___ Spiritual/religious ___ Exercise/health ___ Social ___ Other recreation ___ Maintenance activities ___
VIEWS, BELIEFS - ABOUT MY SELF
Worthy Good enough Wonderful Unworthy, not enough, not good enough Stupid Lazy Not ambitious Undirected
VIEWS, BELIEFS – INTIMATE/FAMILY RELATIONSHIPS
I blame and/or resent Hard Partner unfair Partner has to serve me
Others let me down
Men are:
Insensitive Untrustworthy Interested in only one thing Cruel
Women are:
Too emotional Untrustworthy Judgmental Critical Frigid
VIEWS, BELIEFS - LIFE
Hard Gotta be tough I’m so grateful Life is full of miracles Life is full of love Life is low on love Life is a struggle
MY SENSITIVITIES:
Stupid Criticism Being corrected Being directed Being dominated
Approval/disapproval My body My looks My personality
I realize that if these are my sensitivities and that my filters may cause me to exaggerate or mislabel what is going on. I am willing to change this reactivity. I am willing to change the entire basis for those sensitivities.
REACTION STYLE[1]
Exaggerate; Defend with Explanation Attack (anger); Be a victim (cry)
I recognize need for change I am willing to change
EXPRESSION STYLE[2]:
Calm Attacking or hostile Object Complain Loud Raise voice Quiet Talk a lot Withdrawing Tantrums Dramatic Understated
Exaggerate
I recognize need for change. I am willing to change.
INTERACTION STYLE[3]
Resist Give up Accept Conciliatory Acknowledging/Empathetic
KNOWLEDGE ABOUT RELATIONSHIPS
High Medium high Fair amount So-so Low Very low
Mostly surmised from life and experience; Studied: a little some a fair amount a lot; Was taught a little some a fair amount a lot
KNOWLEDGE ABOUT PERSONAL PSYCHOLOGY OVERALL
High Medium high Fair amount So-so Low Very low
Mostly surmised from life and experience; Studied: a little some a fair amount a lot; Was taught a little some a fair amount a lot
KNOWLEDGE ABOUT OWN PSYCHOLOGY
High Medium high Fair amount So-so Low Very low
Mostly surmised from life and experience; Studied: a little some a fair amount a lot; Was taught a little some a fair amount a lot

I recognize that I need to know more as indicated by the above answers.

I am willing to learn more, to the following degree: a little a fair amount

a lot To real (sufficient) mastery to have a great relationship

INTIMATE RELATIONSHIP HISTORY: # of marriages ___;
# of additional long term relationships: Up to six months ___ Six month to 24 ___
More than 2 years ___
Reason for break ups: Just fell out of love My partner just fell out of love
My infidelities My partners’ infidelities Physical abuse Verbal abuse
We just didn’t get along My partner refused to do the counseling and studying needed to improve our relationship
FAMILY RELATIONSHIP HISTORY:
Mother:
Like Dislike Close Distant; Contact every ____
Father:
Like Dislike Close Distant; Contact every ____
Brother:
Like Dislike Close Distant; Contact every ____
Sister
Like Dislike Close Distant; Contact every ____
In my close relationship, I feel like a
Fully rational, nurturing adult ___% of the time A child A controlling parent A critical parent A strong critic I have a strong inner critic

Insert in your About Me Notebook after providing a copy to whomever requires it.

[1] How you react to what someone else says or does.

[2] How you express yourself. What you say out loud or how you act.

[3] What you do when interacting with others.