Instructions
This questionnaire has two parts. Please complete both in order.
Part A (Sentence Completion): Complete each sentence to express your true feelings. Write whatever comes to mind.
Part B (Self-Report): For each statement, select the number that best describes how much you agree.
A Trust & Safety
How you experience safety, reliability, and support from others and the world.
A1. When I need help, people
A2. The world is
A3. Relying on others
A4. I feel safe when
A5. People in my life
B Autonomy & Agency
Your sense of control, decision-making capacity, and personal responsibility.
B1. I can
B2. When I make decisions
B3. My life is controlled by
B4. I am responsible for
B5. The choices I make
C Identity & Self
Your sense of self, authenticity, and inner identity.
C1. Who I really am
C2. My true self is
C3. I hide
C4. I wish I could be
C5. The mask I wear
D Connection & Relationships
How you experience closeness, trust, vulnerability, and attachment.
D1. Getting close to others
D2. In relationships, I
D3. Being alone
D4. I trust people who
D5. When someone leaves
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E Emotion & Regulation
How you experience, express, and manage your emotions.
E1. When I feel angry
E2. Sadness for me
E3. I cope with stress by
E4. My emotions
E5. When I feel overwhelmed
F Competence & Achievement
Your sense of ability, self-worth, and orientation toward success and failure.
F1. When I fail
F2. My abilities are
F3. I compare myself to others
F4. Success for me is
F5. I feel capable when
G Meaning & Purpose
Your sense of meaning, value, purpose, and life direction.
G1. What matters most to me
G2. I find meaning in
G3. Looking back on my life
G4. What I value in myself
G5. My purpose is
H Reality & Awareness
Your contact with reality, self-awareness, and insight.
H1. When I look at myself honestly
H2. My mind
H3. What I know to be true
H4. I lose myself in
H5. The difference between how I see myself and how others see me
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1 = Strongly Disagree
2 = Disagree
3 = Neutral
4 = Agree
5 = Strongly Agree
A Trust & Safety
A6. I trust people until they give me a reason not to.
A7. I believe the world is fundamentally safe.
A8. I am comfortable depending on others.
A9. I often feel that people will hurt me if I let my guard down.
A10. I find it hard to ask for help.
B Autonomy & Agency
B6. I feel in control of my life choices.
B7. I am confident making decisions.
B8. My life is determined more by me than by outside forces.
B9. I often feel powerless about my direction in life.
B10. I need others to tell me what to do.
C Identity & Self
C6. I have a clear sense of who I am.
C7. I like who I am becoming.
C8. I am authentic — I show my real self to others.
C9. I feel like I don't really know myself.
C10. I change who I am depending on who I'm with.
D Connection & Relationships
D6. I enjoy close, intimate relationships.
D7. I am comfortable being vulnerable with people I trust.
D8. I believe I am worthy of love.
D9. I am afraid of getting too close to people.
D10. I worry that people will leave me.
E Emotion & Regulation
E6. I can manage strong emotions without falling apart.
E7. I understand where my emotions come from.
E8. I have healthy ways to cope with stress.
E9. I often feel overwhelmed by my feelings.
E10. When upset, I do things I later regret.
F Competence & Achievement
F6. I believe in my ability to achieve goals.
F7. I can learn from failure.
F8. My skills and talents are valuable.
F9. I feel inferior to others.
F10. I am afraid to try new things because I might fail.
G Meaning & Purpose
G6. My life has meaning and purpose.
G7. I have clear values that guide my decisions.
G8. I feel grateful for my life when I look back.
G9. I feel that life is meaningless.
G10. I don't know what I value.
H Reality & Awareness
H6. I have a realistic understanding of myself.
H7. I can see my own blind spots and defenses.
H8. I am able to distinguish my perceptions from reality.
H9. I often feel disconnected from reality.
H10. People's view of me is very different from how I see myself.
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Assessment Complete!
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