Please circle the number that best describes how you feel about each of the statements listed below. If you are not currently in an intimate relationship‚ please indicate how you felt and acted in your previous intimate relationships.
1= Strongly disagree‚ 2= Somewhat disagree‚ 3= Neither agree nor disagree‚ 4= Somewhat agree‚ 5= Strongly agree
I think it is best to put myself first because no one else will look out for me.
I don’t speak my feelings in an intimate relationship when I know they will cause disagreement
Caring means putting the other person’s needs in front of my own.
Considering my needs to be as important as those of the people I love is selfish.
I find it is harder to be myself when I am in a close relationship than when I am on my own.
I tend to judge myself by how I think other people see me.
I feel dissatisfied with myself because I should be able to do all the things people are supposed to be able to do these days.
When my partner’s needs and feelings conflict with my own‚ I always state mine clearly.
In a close relationship‚ my responsibility is to make the other person happy.
Caring means choosing to do what the other person wants‚ even when I want to do something different.
In order to feel good about myself‚ I need to feel independent and self-sufficient.
One of the worst things I can do is to be selfish.
I feel I have to act in a certain way to please my partner.
Instead of risking confrontations in close relationships‚ I would rather not rock the boat.
I speak my feelings with my partner‚ even when it leads to problems or disagreements.
Often I look happy enough on the outside‚ but inwardly I feel angry and rebellious.
In order for my partner to love me‚ I cannot reveal certain things about myself to him/her.
When my partner’s needs or opinions conflict with mine‚ rather than asserting my own point of view I usually end up agreeing with him/her.
When I am in a close relationship I lose my sense of who I am.
When it looks as though certain of my needs can’t be met in a relationship‚ I usually realize that they weren’t very important anyway.
My partner loves and appreciates me for who I am.
Doing things just for myself is selfish.
When I make decisions‚ other people’s thoughts and opinions influence me more than my own thoughts and opinions.
I rarely express my anger at those close to me.
I feel that my partner does not know my real self.
I think it’s better to keep my feelings to myself when they do conflict with my partner’s.
I often feel responsible for other people’s feelings.
I find it hard to know what I think and feel because I spend a lot of time thinking about how other people are feeling.
In a close relationship I don’t usually care what we do‚ as long as the other person is happy.
I try to bury my feelings when I think they will cause trouble in my close relationship(s).
I never seem to measure up to the standards I set for myself.
* If you answered the last question with a 4 or 5‚ please list up to three standards you feel you don’t measure up to.
Copyright‚ 1991. Dana Crowley Jack‚ All rights reserved