Worksheet: Family and Friends Network


Household Members

Check each item below that applies to the person you want to help.  Then review the items you have checked and highlight those where family and/or friends might do something to influence change.  Number the highlighted items in order of their importance to the member.

Date:

Your Name:

Member’s Name:

Relationship to Member Pre-cult/Present

1 = Close,

2 = Not close,

3 = Distant

Relationship to Family

1 = Close,

2 = Not close,

3 = Distant

Feeling about cult involvement

1 = great concern,

2 = some concern,

3 = no concern

Possible Problems  

(list all that apply)

A = Physical Health,

B = Mental Health,

C = Behavioral,

D = Current Stress,

E = Family Conflict

Possible sources of support

(list all that apply)

A = Emotional,

B = Information,

C = Political, legal, media,

D = Skills,

E = Financial/material

Potential for personal involvement

1 = strong,

2 = moderate,

3 = possible,

4 = unlikely

        


Other Family Members

Check each item below that applies to the person you want to help.  Then review the items you have checked and highlight those where family and/or friends might do something to influence change.  Number the highlighted items in order of their importance to the member.

Date:

Your Name:

Member’s Name:

Relationship to Member Pre-cult/Present

1 = Close, 2 = Not close, 3 = Distant

Relationship to Family

1 = Close, 2 = Not close, 3 = Distant

Feeling about cult involvement

1 = great concern,

2 = some concern,

3 = no concern

Possible Problems

  (list all that apply)

A = Physical Health,

B = Mental Health,

C = Behavioral,

D = Current Stress,

E = Family Conflict

Possible sources of support

(list all that apply)

A = Emotional,

B = Information,

C = Political, legal, media,

D = Skills,

E = Financial/material

Potential for personal involvement

1 = strong,

2 = moderate,

3 = possible,

4 = unlikely

        


Friends

Check each item below that applies to the person you want to help.  Then review the items you have checked and highlight those where family and/or friends might do something to influence change.  Number the highlighted items in order of their importance to the member.

Date:

Your Name:

Member’s Name:

Relationship to Member Pre-cult/Present

1 = Close, 2 = Not close, 3 = Distant

Relationship to Family

1 = Close, 2 = Not close, 3 = Distant

Feeling about cult involvement

1 = great concern, 2 = some concern,

3 = no concern

Possible Problems

(list all that apply)

A = Physical Health,

B = Mental Health,

C = Behavioral,

D = Current Stress,

E = Family Conflict

Possible sources of support

(list all that apply)

A = Emotional,

B = Information,

C = Political, legal, media,

D = Skills,

E = Financial/material

Potential for personal involvement

1 = strong,

2 = moderate,

3 = possible,

4 = unlikely


Worksheet: Family and Friends Network is adapted from Coping with Cult Involvement: A Handbook for Families and Friends Livia Bardin, M.S.W.  

©1997-2018 Joseph Kelly and Patrick Ryan; Rev: 01/08

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