Name
*
First Name
Last Name
Email
*
example@example.com
1. Can you keep healthy boundaries with your ex-partner?
*
Yes
No
2. Do you listen to your instincts when your ex makes new co-parenting requests?
*
Yes
No
3. Are you able to recognize your ex-partner’s manipulative behaviors?
*
Yes, most of the time
Not until later
4. Are you able to handle difficult conversations with your ex-partner?
*
Yes
No
5. Are you able to stay calm and composed during conflicts or hot exchanges with your ex-partner?
*
Yes
No
6. It is easy to trust your judgment around co-parenting issues?
*
Sometimes
Rarely
7. Do you feel like you’re managing the post-separation emotional stress well?
*
Almost always
Sometimes
8. Do you have understanding friends and family that you can rely on for emotional support?
*
Yes
No
9. It is easy to balance your needs with the needs of your children?
*
Yes
No
10. Are you handling the any legal and custody issues well?
*
Usually
Sometimes
11. Have you been pretty emotionally stable since leaving the relationship?
*
Usually
No, it's been difficult
12. Are you able to soothe yourself when activated by your ex-partner's actions?
*
Often
Sometimes
13. Are you managing any possible external interference from family and friends well?
*
Usually
Sometimes
14. Since leaving, are you seeing gains in your emotional healing?
*
Most of the time
Not really
15. Are you being able to stay emotionally centered to prevent burnout?
*
Usually
Sometimes
Total Score
Outcome
Submit
Should be Empty: