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Emotional and Relationship Patterns Self-Reflection

Helps adults reflect on emotional, relationship, self-image and impulsive patterns over the past year; non-diagnostic.

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Questions in this template

Your Emotions

  1. Thank you for taking part. These questions invite you to reflect on patterns in your feelings, relationships and behaviour over the past year. Your answers are confidential.

  2. This is a self-reflection exercise, not a diagnostic test. If any of these patterns cause you distress, consider talking to a doctor or mental health professional.

  3. Thinking about the past year, how much do you agree with each statement?

    • My feelings often become so strong that they take over.
    • My mood can shift quickly and without warning.
    • I sometimes get far angrier than a situation calls for.
    • Once I am upset, it takes me a long time to settle.

    For each row: choose one:

    • Strongly disagree
    • Disagree
    • Neither agree nor disagree
    • Agree
    • Strongly agree

Your Relationships

  1. Does each statement describe your experience over the past year?

    • My opinion of people close to me swings between extremes.
    • I often feel that others do not value or understand me.
    • My close relationships tend to be unsettled.
    • I often feel that people treat me badly.

    For each row: choose one:

    • Yes
    • Not sure
    • No

Your Sense of Self

  1. How steady is your sense of who you are?

    Choose one:

    • Mostly steady
    • Often changing
    • It depends on the situation

  2. Would you like to say more about this? (optional)

    Open answer

Behaviour Patterns

  1. In the past year, which of these have you done on impulse in a way you later regretted? Select all that apply.

    Choose any that apply:

    • Spending money
    • Risky sexual activity
    • Heavy alcohol or drug use
    • Reckless driving
    • Binge eating
    • None of these

  2. If you wish, describe the circumstances around the behaviours you selected. (optional)

    Condition: Shown when at least one behaviour was selected

    Open answer

Feeling Detached

  1. In the past year, how often have you felt cut off from yourself or your surroundings, as if things were unreal or you were observing yourself from outside?

    Choose one:

    • Never
    • Rarely
    • Sometimes
    • Often

  2. Please describe when this tends to happen. (optional)

    Condition: Shown when the feeling occurred at least rarely

    Open answer