1. How long have you been working on the same issues, be they in the area of your career, health, intimate relationships, or finances?
Less than 12 months
1-3 years
More than five years
More than ten years

2. In the past 12 months, how many times have you misplaced something important, gotten a traffic ticket, had an accident, or destroyed something of value?
Once or twice
More than five times
More than ten times

3. How often do you feel phony, inauthentic, or find that it takes a lot of effort to get people to perceive you in a certain way?
All the time
Almost never

4. If your friends, co-workers and family members were interviewed, would they say that you complain...
Seldom to never
Maybe once a day
All the time

5. In the past 12 months, how many times have you said something that you later regretted, whether immediately or over time?
Once or twice
More than five times
More than ten times

6. After you've achieved a personal goal - reached your desired weight, paid off your credit cards, organized your home or office, etc. - which of the following emotions are you more likely to experience?
Relieved that you made it but wary that you may backslide into old behaviors
Entitled - you deserve a reward for all your hard work!
Motivated by your success and committed to keeping up the good work
Resentful that you had to work so hard in the first place

7. How often do you notice yourself feeling inadequate, not good enough, unloved, or unworthy?
All the time
Almost never

8. On a scale of 1-10, how willing are you to speak your truth, even if it runs contrary to the opinions of others?
8-10; I am very willing to speak my truth.
5-7; Most of the time I am willing to speak my truth.
3-5; I am occasionally willing to speak my truth.
1-2; I am almost never willing to speak my truth.

9. In your life right now, your primary focus is on...
Advancing your career, improving your health, building wealth, or deepening your relationships
Managing strained relationships or "putting out fires" at work and at home.
Making measurable progress toward your goals over a reasonable period of time.
Trying to avert or avoid immediate disaster in the area of your finances, relationships, health or career.

10. What percentage of the time can you count on yourself to keep your word and uphold your promises - whether to yourself or to another?
Less than 10%
Less than 25%
About half the time
Most of the time

11. How much time each day do you spend gossiping - whether talking about someone you know, reading tabloids or watching gossip TV?
Less than one hour a day
More than one hour a day
More than three hours a day

12. Which of the following statements would you use to describe your life?
Most of the time, things work out fairly easily for me.
I have many talents and gifts, but do not use them to their fullest potential.
I am riddled by bad luck and find myself in one bad situation after another.
I have to work hard just to maintain the status quo.

13. How many hours a day do you spend working toward your long-term goals?
Less than twenty minutes per day
An hour or more per day
You have no long-term goals

14. How frequently do you feel mistreated, misunderstood, or taken advantage of - in either your personal or professional life?
Every day
Seldom to never

15. When asked to do something that you have no interest in doing, you are most likely to...
Say no with a clear conscience
Say no but feel guilty about it
Say yes but not follow through
Say yes but feel resentful about it

16. Imagine that your life is a house with many rooms. How many people do you allow to see all of your rooms?
One significant person - a spouse, lover, best friend, parent, etc.
A small handful of people know me that well
There are many people in my life who know me that well

17. When you feel hurt by someone or something, what do you tend to do?
Keep it to yourself
Reflect, forgive, and move on
Confront the situation head-on
Talk about it to everyone but the person involved

18. When you get an impulse or an idea about how to improve some aspect of your life, you usually...
Ignore it completely
Take a few steps in the right direction but rarely see the project through to the finish line
Tell yourself that you'll "get to it one of these days"
Create a support structure around yourself to ensure that you take action.

19. The last time you found yourself with a block of unexpected free time, what did you do?
Squandered it by catalog shopping, watching TV or surfing the internet
Used the opportunity to move forward on an important project
Relaxed and rejuvenated yourself by taking a nap, meditating or reading
Your life is so hectic that you can't recall an occasion when you had an unexpected block of free time

20. When you make a mistake, are you more likely to...
Be gentle with yourself and resolve to do things differently in the future?
Put things in perspective by acknowledging yourself for what you did right?
Fall into a downward spiral of self-criticism?
Interpret your misstep as evidence that you are incompetent, and stop trying?