FCS Core Belief Reflection v2.0

WELCOME TO THE FCS CORE BELIEF REFLECTION

Our beliefs influence how we interpret ourselves, other people, relationships, and everyday experiences. This reflection explores ten common belief areas within Love, Worth, and Self-Efficacy. It can help you notice patterns that you may want to understand, question, or strengthen.

HOW TO RESPOND: Read each statement carefully and select the answer that best reflects what you generally believe—not what you think you should believe. Some statements are intentionally worded in opposite directions. All 100 statements use the same five choices, from “Not true for me” to “Very true for me.” Please answer every statement as accurately as you can. There are no right or wrong answers, and you may stop without submitting.

IMPORTANT: Your inherent worth is not measured by this survey. This FCS-original educational reflection is not a clinical diagnosis, validated psychological test, or guarantee of change. Responses are intended to support thoughtful self-reflection and discussion.

PRIVACY & USE OF RESPONSES

This assessment is administered by Freedom Change Success, LLC (FCS) through Jotform. When you submit, your selected answers and any participant code or optional written responses you provide are recorded. Authorized FCS personnel may review them to support educational feedback, a requested program, or progress discussions. A participant code may allow responses from different assessment dates to be linked. Please do not assume that submitting this form is anonymous, and do not include names or sensitive details about yourself or others in optional written responses.

This form is not a substitute for therapy intake, an emergency contact channel, or a private clinical conversation. If you are receiving therapy through FCS, clarify with your provider how assessment responses will be used and documented. For questions, contact support@fcstherapylasvegas.com. If you do not wish to provide responses under these terms, please do not submit the form.

FCS Participant ID

Administration stage

Email address for your private assessment results

Confirmation EmailUse the email you registered with FCS. This does not sign you up for marketing.

Love / Acceptance

I believe I can be loved even when I disappoint someone.

I worry that being fully known would make people less likely to accept me.

I believe I can receive care without having to earn it.

I believe I must keep others pleased to remain loved.

I believe affection can coexist with disagreement.

When someone needs space, I assume they care less about me.

I believe I can ask for emotional support without shame.

I believe I must hide important parts of myself to be accepted.

I believe others can care about me despite my imperfections.

I fear that being honest about my needs will cost me love.

FCS LA Mean (1-5)

FCS LA Index (0-100)

Belonging

I believe there are places where I can belong as my genuine self.

I expect to be left out when people form groups.

I believe I can enter a new group without assuming I am unwelcome.

I believe I do not fit in anywhere.

I believe I have something meaningful to contribute to a community.

I expect other people to overlook or forget me.

I believe I can belong even when I disagree with others.

I assume that others only tolerate my presence.

I believe meaningful connection is possible for me.

I believe I must change who I am in order to be included.

FCS BE Mean (1-5)

FCS BE Index (0-100)

Others / Trust

I believe trustworthiness can be evaluated through consistent behavior.

I assume most people will deceive me if given a chance.

I believe I can let trust develop gradually as I see evidence.

When one person betrays me, I expect others to do the same.

I believe I can stay open to connection while also protecting myself.

I believe trusting anyone is a mistake.

I believe I can notice warning signs without assuming everyone is unsafe.

When evidence is unclear, I tend to assume people have harmful intentions.

I believe I can change my judgment about someone when new evidence appears.

I expect people to exploit me if I let my guard down.

FCS OT Mean (1-5)

FCS OT Index (0-100)

Value

I believe my value as a person does not depend on my accomplishments.

I believe I have little value unless I am useful to others.

I believe my voice and legitimate needs matter.

When I make a mistake, I feel less valuable as a person.

I believe I deserve dignity even when someone disapproves of me.

I compare myself to others to decide whether I matter.

I believe I have value even when I am not productive.

I believe rejection proves that something is wrong with me.

I believe I can appreciate my strengths without being better than others.

I believe I must meet other people's expectations to deserve respect.

FCS VA Mean (1-5)

FCS VA Index (0-100)

Performance

I believe I can learn skills that are difficult for me today.

I see setbacks as proof that I am incapable.

I believe mistakes can teach me how to improve.

I avoid unfamiliar tasks because I expect to fail.

I believe preparation and practice can improve my abilities.

I doubt my abilities even when I have evidence of competence.

I believe I can evaluate my performance without attacking my identity.

I believe one poor result cancels out my previous progress.

I believe asking for help is compatible with being capable.

If I cannot do something well immediately, I believe I should stop trying.

FCS PE Mean (1-5)

FCS PE Index (0-100)

Justice

I believe I can respond constructively even when life is unfair.

I believe being a good person should protect me from disappointment.

I believe I can recognize unfair treatment without becoming defined by it.

When others receive advantages I do not, I believe my life cannot be satisfying.

I believe fairness matters even when I cannot control the outcome.

I believe I cannot move forward until an unfair outcome is corrected.

I believe I can seek accountability without expecting perfect fairness.

I believe I am owed favorable results because of what I have endured.

I believe I can accept limits while still advocating for fair treatment.

I believe unfairness makes meaningful progress impossible for me.

FCS JU Mean (1-5)

FCS JU Index (0-100)

Security

I believe I can take reasonable steps to manage uncertainty.

I tend to believe the worst outcome is the most likely.

I believe I can seek help when I face genuine danger.

I believe that even ordinary changes mean disaster may be coming.

I believe I can distinguish realistic risks from imagined catastrophes.

I believe I must anticipate every possible threat to stay safe.

I believe reasonable precautions are enough even without total certainty.

I avoid reasonable opportunities because I expect them to be unsafe.

I believe I can cope with unexpected challenges using support and planning.

I tend to believe I am in danger even when evidence suggests little immediate risk.

FCS SE Mean (1-5)

FCS SE Index (0-100)

Control

I believe my choices can influence important parts of my life.

I believe nothing I do makes much difference.

I believe I can distinguish what I control from what I do not.

When people disagree with me, I feel I must control the outcome.

I believe I can choose my behavior even when strong feelings arise.

I believe unexpected events leave me completely powerless.

I believe I can adapt my plans when circumstances change.

I believe I must control everything to prevent failure.

I believe I can take responsible action without guaranteeing an outcome.

I often believe circumstances leave me no choice about my own actions.

FCS CO Mean (1-5)

FCS CO Index (0-100)

Autonomy

I believe I can make meaningful decisions for myself.

I need other people's approval before I trust my judgment.

I believe I can express a preference even when others disagree.

I avoid saying no because I expect people to reject me.

I believe I can ask for help without being helpless.

I believe I cannot function unless someone directs me.

I believe I can stay connected while honoring my legitimate needs.

I believe I must abandon my values to keep other people pleased.

I believe I can tolerate others' disappointment when I make responsible choices.

I feel selfish whenever I prioritize a legitimate need of my own.

FCS AU Mean (1-5)

FCS AU Index (0-100)

Standards

I believe high standards can coexist with flexibility.

I believe I must be perfect to be acceptable.

I believe I can set ambitious but realistic goals.

I believe mistakes are unacceptable even when I am learning.

I believe rest is compatible with being responsible.

I believe falling short of an ideal makes me a failure.

I believe steady effort matters more than flawless performance.

I believe relaxing my standards at all will make everything fall apart.

I believe I can adjust expectations when my capacity changes.

I expect others to meet my standards even when we have not agreed on them.

FCS ST Mean (1-5)

FCS ST Index (0-100)

FCS Love Domain Index (0-100)

FCS Worth Domain Index (0-100)

FCS Self-Efficacy Domain Index (0-100)

FCS LA Index Display (whole number)

FCS BE Index Display (whole number)

FCS OT Index Display (whole number)

FCS VA Index Display (whole number)

FCS PE Index Display (whole number)

FCS JU Index Display (whole number)

FCS SE Index Display (whole number)

FCS CO Index Display (whole number)

FCS AU Index Display (whole number)

FCS ST Index Display (whole number)

FCS Love Domain Display (whole number)

FCS Worth Domain Display (whole number)

FCS Self-Efficacy Domain Display (whole number)

FCS Love Focus Area

FCS Love Starter Practice

FCS Worth Focus Area

FCS Worth Starter Practice

FCS Self-Efficacy Focus Area

FCS Self-Efficacy Starter Practice

Which statement was hardest to answer?

What belief would you like to understand better?

What is one small action that might help you test a belief thoughtfully?

FCS Love Focus Code (1-3)

FCS Worth Focus Code (1-3)

FCS Self-Efficacy Focus Code (1-4)

FCS Core Belief Reflection v2.0

Core reflection items

Participant and administration details

Optional reflection prompts and closing