SELF-ASSESSMENT
QUESTIONNAIRE
BONDING
STAGE
(Birth to 6-9 months)
1.
I know when my body needs something (food, air, water, rest, etc).
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1.
I know when my body needs something (food, air, water, rest, etc). |
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3.
I know when I need strokes. |
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4.
I am comfortable in new situations. |
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5.
I can try out new things without getting in trouble or hurting myself. |
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6.
I am comfortable selecting what I like and don't like in new
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7.
I can enjoy myself by exploring something new.
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8.
I feel independent and autonomous. |
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9.
When I make decisions, I count myself and others equally. |
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10.
I am comfortable sharing my ideas and opinions with others who have
ideas of their own, even if their ideas differ from mine. |
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11.
I am comfortable about the ways in which I am different from others. |
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12.
I am comfortable about the ways in which I am similar to others. |
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13.
I am able to be vocal and stubborn in opposing things I think are
destructive. |
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14.
I am comfortable asking questions when I don’t understand or want to
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15.
I can recognize and acknowledge other people's feelings. |
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16.
I have the ability to find out what others feel when I don't know.
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17. I can
confront others when I
see problems in what they are doing, saying, or feeling. |
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18.
I can tell when to give up on something that isn't working. |
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19.
I am willing to feel sadness and grief when I have to let go of
something that was important to me.
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20.
I am comfortable learning how to do new things that I didn't know how
to do before. |
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21.
I do things as well as they need to be done. |
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22.
I finish things that need to be finished. |
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23.
I can recognize and communicate about the reasons for my values and
beliefs. |
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24.
I can recognize and understand that others have different reasons for
their values and beliefs. |
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25.
I am comfortable negotiating openly with others to satisfy our needs
and wants. |
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26.
I recognize and am comfortable with the fact that I am connected to
other people. |
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27.
I can be interdependent with others without sacrificing my own
autonomy.
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(From An Action Plan for Your Inner Child: Parenting Each Other by Laurie Weiss, Ph.D. Deerfield Beach, Florida: Health Communications, 1991.)