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"FAMILY RULES" (Identify the family you grew up in by SELECTING the most accurate description of your childhood experience. (ex. Ranging from Healthy to Very Unhealthy Childhood Experiences)
HEALTHY ----------------------------------------------------------------------------------------------NOT HEALTHY
Choose the answer that is closer to your childhood family life experience.
* Indicates required question
Name ( First, Last)
*
Your answer
Children are free speak of many subjects to
children can't talk about anything because subjects are taboo ( Must keep family secrets)
VERY HEALTHY
A LITTLE HEALTHY
A LITTLE HEALTHY NOT SURE
(BOTH) A LITTLE UNHEALTHY and/ or UNHEALTHY
VERY UNHEALTHY
As a child, it was ok to have feelings or Only "certain" feelings are ok to have?
VERY HEALTHY
A LITTLE HEALTHY
A LITTLE HEALTHY NOT SURE
(BOTH) A LITTLE UNHEALTHY and/ or UNHEALTHY
VERY UNHEALTHY
As an Individual Children all differences were accepted by the family?
*
VERY HEALTHY
SOMEWHAT HEALTHY
NOT SURE
A LITTLE HEALTHY
UNHEALTHY
Required
Children were free express thoughts and opinions?
*
VERY HEALTHY
A LITTLE HEALTHY
A LITTLE HEALTHY NOT SURE
(BOTH) A LITTLE UNHEALTHY AND/OR VERY UNTHEALTHY
VERY UNHEALTHY
Required
As a child your family atmosphere was?
*
VERY HEALTHY
A LITTLE HEALTHY
A LITTLE HEALTHY NOT SURE
(BOTH) A LITTLE UNHEALTHY AND UNHEALTHY
VERY UNHEALTHY
Required
As a child when your family faced or was dealing with stress to Family avoids working with stress
*
VERY HEALTHY
A LITTLE HEALTHY
A LITTLE HEALTHY NOT SURE
(BOTH) A LITTLE UNHEALTHY and/ or UNHEALTHY
VERY UNHEALTHY
Required
As a childdid you deal with a few "shoulds" or did you face with many(should do this/ "shoulds" should do that?
*
VERY HEALTHY
A LITTLE HEALTHY
A LITTLE HEALTHY NOT SURE
(BOTH) A LITTLE UNHEALTHY and/ or UNHEALTHY
VERY UNHEALTHY
Required
Each child is responsible for own actions to Parents try or did parents try to control you as a child and blame responsibility of the child his/her own action (often using criticism, punishment, shaming)
*
VERY HEALTHY
A LITTLE HEALTHY
A LITTLE HEALTHY NOT SURE
(BOTH) A LITTLE UNHEALTHY and/ or UNHEALTHY
VERY UNHEALTHY
Required
The child is more is more important than what he/she does
*
VERY HEALTHY
A LITTLE HEALTHY
A LITTLE HEALTHY NOT SURE
(BOTH) A LITTLE UNHEALTHY AND/OR UNHEALTHY
VERY UNHEALTHY
Required
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