My Barriers
Hurdles & Apprehension
About ME!!
General information that will help us out!
Name
First Name
Last Name
1. How would you describe your communication style? (Choose 3)
*
Aggressive
Assertive
Avoidant
Defensive
Dismissive
Passive
Passive Aggressive
Submissive
2. How would you describe your typical relationship style? (Choose 3)
*
Accommodating of partner
Avoidant of connection
Caregiver to partner
Companion of partner
Dominant towards partner
Parent to partner
Reliant on partner
Submissive to partner
3. How long do you typically spend between relationships?
*
Less than 1 month
1-3 months
3-6 months
6 months to 1 year
12 months +
Never had a real relationship
Have only had one relationship
4. When your relationships end, who more often initiates the breakup?
*
Usually me
Always me
Usually them
Always them
Sometimes me, Sometimes them!
Mutual
N/A - I'm in a long term relationship
5. My relationships tend to fail because... (Choose 3)
*
Communication issues
Conflict issues
Commitment issues
Lack of quality time
Intimacy/Vulnerability issues
Lack of passion
Incompatible values
Incompatible lifestyles
Too much drama
Abuse (emotional or physical)
6. If I had the chance to live my life over again I would...
*
Change almost everything. Life has been difficult.
Change a lot of things. Life has been challenging.
Change some things. Life has been okay.
Change a few things. My life has been pretty good!
Change nothing. My life has been excellent
7. My expectations from my relationship partner are:
*
Extremely high
Moderately high
Average
Somewhat low
Extremely low
8. When in a long term relationship...
*
I find it easy to be authentic. I can be the real me.
I'm mostly authentic. I reveal almost everything.
I'm somewhat authentic. I hide a lot.
I'm mostly inauthentic. I'm very guarded
I'm always inauthentic. I never get to be me.
9. I have a reliable and supportive network of people in my life!
*
Strongly agree
Mostly agree
Somewhat agree
Somewhat disagree
Mostly disagree
Strongly disagree
10. Regarding unhealed trauma and pain from the past...
*
I have dealt with all of my trauma and pain from the past.
I have some pain and trauma that I'm addressing now.
I have some pain and trauma that I'm avoiding.
I have significant pain and trauma that I'm addressing now.
I have significant pain and trauma that I'm avoiding.
I would rather not deal with any of it.
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Next
My Traits 101-110
Pleasing
101 - When someone asks me to do something for them, I feel guilty if I have to say “No”.
*
No - This is Not True
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is Not True, 10 is Yes - This is Very True
102 - I feel that people don’t understand how much I do for them.
*
No - This is Not True
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is Not True, 10 is Yes - This is Very True
103 - I will adjust what I really want to do if I know that it will please others.
*
No - This is Not True
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is Not True, 10 is Yes - This is Very True
104 - I often apologize to others even when I am not in the wrong.
*
No - This is Not True
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is Not True, 10 is Yes - This is Very True
105 - I feel that an important role of mine is to “give” to others.
*
No - This is Not True
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is Not True, 10 is Yes - This is Very True
106 - I tend to stay quiet and keep my feelings to myself when others hurt my feelings.
*
No - This is Not True
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is Not True, 10 is Yes - This is Very True
107 - I find it hard to be direct with others. If I want something I am very careful about how to ask for it.
*
No - This is Not True
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is Not True, 10 is Yes - This is Very True
108 - I will go to great lengths to avoid conflict of any kind!
*
No - This is Not True
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is Not True, 10 is Yes - This is Very True
109 - I feel resentful of others. It feels like I am being taken advantage of.
*
No - This is Not True
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is Not True, 10 is Yes - This is Very True
110 - I spend a lot of my time in my relationship feeling as if I am “walking on eggshells”! (Staying quiet about how I really feel to prevent drama or negative reactions)
*
No - This is Not True
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is Not True, 10 is Yes - This is Very True
Total - Pleasing
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Next
My Traits 111-120
Dependency
111 - I tend to be a "people pleaser".
*
No - This is Not True
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is Not True, 10 is Yes - This is Very True
112 - I have trouble setting and reinforcing my personal boundaries
*
No - This is Not True
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is Not True, 10 is Yes - This is Very True
113 - I often assume the role of caretaker in a relationship.
*
No - This is Not True
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is Not True, 10 is Yes - This is Very True
114 - It feels like I am always having to defend myself.
*
No - This is Not True
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is Not True, 10 is Yes - This is Very True
115 - I tend to give up my interests in order to keep my relationship.
*
No - This is Not True
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is Not True, 10 is Yes - This is Very True
116 - I avoid conflict.
*
No - This is Not True
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is Not True, 10 is Yes - This is Very True
117 - It feels like I always give more than I get.
*
No - This is Not True
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is Not True, 10 is Yes - This is Very True
118 - It feels as if others take advantage of me.
*
No - This is Not True
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is Not True, 10 is Yes - This is Very True
119 - I often feel unheard, alone and unseen.
*
No - This is Not True
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is Not True, 10 is Yes - This is Very True
120 - I often feel "trapped". I never seem to get my needs fulfilled.
*
No - This is Not True
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is Not True, 10 is Yes - This is Very True
Total - Dependency
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Next
My Traits 121-130
Boundaries
121 - I find it hard to express to someone that they have hurt me.
*
No - This is Not True
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is Not True, 10 is Yes - This is Very True
122 - I tend to overshare with people that I don't know well enough yet!
*
No - This is Not True
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is Not True, 10 is Yes - This is Very True
123 - My relationships are often quite "turbulent". There are a lot of "ups and downs".
*
No - This is Not True
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is Not True, 10 is Yes - This is Very True
124 - I never seem to have enough time in my life for "ME".
*
No - This is Not True
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is Not True, 10 is Yes - This is Very True
125 - I rarely share my real thoughts and opinions. I keep them to myself.
*
No - This is Not True
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is Not True, 10 is Yes - This is Very True
126 - I always seem to be short on time. My schedule is always full.
*
No - This is Not True
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is Not True, 10 is Yes - This is Very True
127 - I always seem to be tired.
*
No - This is Not True
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is Not True, 10 is Yes - This is Very True
128 - I'm at least a tiny bit annoyed most of the time.
*
No - This is Not True
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is Not True, 10 is Yes - This is Very True
129 - I suffer from ongoing guilt and anxiety.
*
No - This is Not True
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is Not True, 10 is Yes - This is Very True
130 - I really hate to let other people down.
*
No - This is Not True
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is Not True, 10 is Yes - This is Very True
Total -Boundaries
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My Traits 131-140
Egoism
131 - I only purchase products of a certain quality or brand name.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
132 - I don't let my emotions get in the way of my decision making.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
133 - I feel that others look up to me and all that I have accomplished.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
134 - I am very confident in who I am, but when I am challenged it makes me secretly question myself.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
135 - I believe that I have talents and skills that are superior to most others.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
136 - I feel good when people compliment me.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
137 - I prefer to associate only with people at my same "level" or above.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
138 - I consider myself a natural born leader.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
139 - People are impressed by my knowledge/looks/power and I like to show it off.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
140 - Whenever I am around, people just naturally gravitate towards me and what I am saying.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
Total -Egoism
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My Traits 141-150
Instability
141 - It seems that the world is always out to get me. I just can’t get a break.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
142 - I often feel “blue” and lack motivation to do anything (apathy).
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
143 - I tend to overreact to even just small things and then I get mad at myself for it.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
144 - I sometimes do things that I know are harmful to me, but can't stop from doing them.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
145 - In general, I just don’t feel like I am a great person or that I bring much value to the world.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
146 - My relationships always seem to be in turmoil. I love them then I hate them.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
147 - I have a habit of taking what people say to me in the worst possible way.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
148 - There are times when I don’t really know who I am. I change my look often trying to find me.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
49 - I can go from happy to really upset in a heart beat. I just get so angry inside…but later in the day I can feel good again.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
150 - I often make impulsive decisions. Change jobs, make large purchases, buy a pet…
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
Total -Instability
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My Traits 151-160
Avoidance
151 - I prefer to avoid conflict of any kind.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
152 - I prefer to keep conversations light and easy (I don't like to go too deep)
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
153 - I find it difficult to apologize.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
154 - I don't like to think or talk about my flaws.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
155 - I would rather not deal with my past.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
156 - I tend to suppress or push away my feelings and emotions.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
157 - I tend to have a lot of unhealthy behaviors.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
158 - I have trouble making commitments.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
159 - I prefer to keep my life really busy! (Work, hobbies, exercise, interests etc.)
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
160 - Change is uncomfortable and a bit scary. It's easier to keep things as they are.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
Total - Avoidance
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My Traits 161-170
Self-Abuse
161 - I frequently compare my level of success and accomplishment to others. I seem to be behind.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
162 - I reject or struggle to accept compliments from others.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
163 - I tend to push away anyone who wants to be close to me.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
164 - When I feel hurt by someone, I usually keep it to myself. I don’t want to create drama.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
165 - I often feel bad about myself, and it leaves me feeling that I must not be a good person.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
166 - I often feel like I don’t fit in or don’t belong in some way.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
167 - It feels like people let me down a lot, so it’s easier to not put too much trust in anyone else.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
168 - I believe that with all I have been through, I am damaged to a level that is tough to fix.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
169 - When I see my reflection in a mirror, I’m not very happy with what I see.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
170 - When I make a mistake, I tend to fall into a downward spiral of negative self-talk and self-criticism.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
Total - Self-Abuse
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My Traits 171-180
Kindness
171 - When people offer advice, I appreciate it, but it seems that others have no idea how difficult my situation is.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
172 - When others disappoint me, I find it really hard to forgive them.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
173 - I keep trying to make changes, but it doesn’t seem to matter, things just don’t seem to change for me.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
174 - When it comes to coping effectively with life’s problems, I feel somewhat powerless.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
175 - Whenever something good happens, I know that something bad will happen shortly!
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
176 - When something bad or negative occurs in my life, it is usually something that was beyond my control.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
177 - I must have done something really wrong in a past life, because nothing seems to ever go right for me.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
178 - Most other people haven’t been through what I have been through.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
179 - When somebody challenges me to make changes in my life, it’s obvious they don’t understand .
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
180 - I’m not all that surprised when things go wrong, because it happens to me all the time.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
Total - Suffering
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My Traits 181-190 (Almost done!)
Drama
181 - When somebody says, “we need to talk”, my mind immediately races to all the worst case scenarios and it ruins my day/week.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
182 - All of my relationships seem to involve a lot of turmoil. There always seems to be a lot of mistrust, jealousy and walking on eggshells!
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
183 - I have trouble controlling my emotions. I can cry easily or be angry in a way that’s not justified for the situation I am in. It seems to frustrate others when I do this.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
184 - My partner never seems to listen to my side of things, but often accuses me of not listening to them?
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
185 - I struggle to hold back my opinions. I find it hard to resist the temptation to let people know my point of view on things.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
186 - I tend to be very expressive with my hands, arms and tone of voice. People often assume that I am being more emotional than I feel I am being.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
187 - I have a tendency to “overreact” when I am under stress or in conflict. I can get angry and lash out or I can withdraw and avoid.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
188 - I have trouble setting and/or enforcing my personal boundaries.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
189 - It’s easy for me to get involved in a heavy debate or argument about something, even though most of the time the subject really doesn’t matter.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
190 - After conflict, I find it really hard to reset my mood and get back to enjoying the relationship. I especially find it hard to apologize.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
Total - Drama
Back
Next
My Traits 191-200 (Final Questions for This Section)
Forgiveness
191 - I have regrets about not being more open to both changes and opportunities in my life.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
192 - I have regrets about not taking better care of myself both physically and emotionally.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
193 - I have regrets about worrying too much about what others think of me.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
194 - I have regrets about not saying what I really wanted to say because I feared abandonment/judgement/rejection.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
195 - I have regrets about not being able to tell the important people in my life how much I care about them.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
196 - I have regrets about not being more confident in myself to go after what I wanted.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
197 - I have regrets about living a life that was more about what others wanted.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
198 - I have regrets about not living more “in the moment”. I didn’t appreciate what I had at the time.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
199 - I have regrets that I didn’t put in the time and effort to maintain or keep a relationship.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
200 - I have regrets about not being more confident and assertive in my relationships.
*
No - This is False
1
2
3
4
5
6
7
8
9
Yes - This is Very True
10
1 is No - This is False, 10 is Yes - This is Very True
Total - Regret
Total - Barriers
Submit
Should be Empty: