0 = Not True
1=Usually not true
2= Usually true
3=True
1. I usually feel inferior to others.
0 = Not True
1=Usually not true
2= Usually true
3=True
2. I normally feel warm and happy toward myself.
0 = Not True
1=Usually not true
2= Usually true
3=True
3. I often feel inadequate to handle new situations.
0 = Not True
1=Usually not true
2= Usually true
3=True
4. I usually feel warm and friendly toward all I
contact.
0 = Not True
1=Usually not true
2= Usually true
3=True
5. I habitually condemn myself for my mistakes and
shortcomings.
0 = Not True
1=Usually not true
2= Usually true
3=True
6. I am free of shame, blame, guilt, and remorse.
0 = Not True
1=Usually not true
2= Usually true
3=True
7. I have a driving need to prove my worth and
excellence.
0 = Not True
1=Usually not true
2= Usually true
3=True
8. I have great enjoyment and zest for living.
0 = Not True
1=Usually not true
2= Usually true
3=True
9. I am much concerned about what others think and say
of me.
0 = Not True
1=Usually not true
2= Usually true
3=True
10. I can let others be "wrong" without
attempting to correct them.
0 = Not True
1=Usually not true
2= Usually true
3=True
11. I have a strong need for recognition and approval.
0 = Not True
1=Usually not true
2= Usually true
3=True
12. I am usually free of emotional turmoil, conflict,
and frustration
0 = Not True
1=Usually not true
2= Usually true
3=True
13. Losing normally causes me to feel resentful and
"less than."
0 = Not True
1=Usually not true
2= Usually true
3=True
14. I usually anticipate new endeavors with quiet
confidence.
0 = Not True
1=Usually not true
2= Usually true
3=True
15. I am prone to condemn others and often wish them
punished.
0 = Not True
1=Usually not true
2= Usually true
3=True
16. I normally do my own thinking and make my own
decisions.
0 = Not True
1=Usually not true
2= Usually true
3=True
17. I often defer to others on account of their wealth
or prestige.
0 = Not True
1=Usually not true
2= Usually true
3=True
18. I willingly take responsibility for the
consequences of my actions.
0 = Not True
1=Usually not true
2= Usually true
3=True
19. I am inclined to exaggerate and lie to maintain a
self-image.
0 = Not True
1=Usually not true
2= Usually true
3=True
20. I am free to give precedence to my own needs and
desires.
0 = Not True
1=Usually not true
2= Usually true
3=True
21. I tend to belittle my own talents, possessions, and
achievements.
0 = Not True
1=Usually not true
2= Usually true
3=True
22. I am free to speak up for my own opinions and
convictions.
0 = Not True
1=Usually not true
2= Usually true
3=True
23. I habitually deny, alibi, justify, or rationalize
my mistakes and defeats.
0 = Not True
1=Usually not true
2= Usually true
3=True
24. I am usually poised and comfortable among
strangers.
0 = Not True
1=Usually not true
2= Usually true
3=True
25. I am very often critical and belittling of others.
0 = Not True
1=Usually not true
2= Usually true
3=True
26. I am free to express love, anger, hostility,
resentment, joy, etc.
0 = Not True
1=Usually not true
2= Usually true
3=True
27. I feel very vulnerable to others’ opinions,
comments, and attitudes.
0 = Not True
1=Usually not true
2= Usually true
3=True
28. I rarely experience jealousy, envy, or suspicion.
0 = Not True
1=Usually not true
2= Usually true
3=True
29. I am a "professional people pleaser."
0 = Not True
1=Usually not true
2= Usually true
3=True
30. I am not prejudiced toward racial, ethnic, or
religious groups.
0 = Not True
1=Usually not true
2= Usually true
3=True
31. I am fearful of exposing my "real self."
0 = Not True
1=Usually not true
2= Usually true
3=True
32. I am normally friendly, considerate, and generous
with others.
0 = Not True
1=Usually not true
2= Usually true
3=True
33. I often blame others for my handicaps, problems,
and mistakes.
0 = Not True
1=Usually not true
2= Usually true
3=True
34. I rarely feel uncomfortable, lonely, and isolated
when alone.
0 = Not True
1=Usually not true
2= Usually true
3=True
35. I am a compulsive "perfectionist."
0 = Not True
1=Usually not true
2= Usually true
3=True
36. I accept compliments and gifts without
embarrassment or obligation.
0 = Not True
1=Usually not true
2= Usually true
3=True
37. I am often compulsive about eating, smoking,
talking, or drinking.
0 = Not True
1=Usually not true
2= Usually true
3=True
38. I am appreciative of others’ achievements and
ideas.
0 = Not True
1=Usually not true
2= Usually true
3=True
39. I often shun new endeavors because of fear of
mistakes or failure.
0 = Not True
1=Usually not true
2= Usually true
3=True
40. I make and keep friends without trying.
0 = Not True
1=Usually not true
2= Usually true
3=True
41. I am often embarrassed by the actions of my family
or friends.
0 = Not True
1=Usually not true
2= Usually true
3=True
42. I readily admit my mistakes, shortcomings, and
defeats.
0 = Not True
1=Usually not true
2= Usually true
3=True
43. I experience a strong need to defend my acts,
opinions, and beliefs.
0 = Not True
1=Usually not true
2= Usually true
3=True
44. I take disagreement and refusal without feeling
"put down" or rejected.
0 = Not True
1=Usually not true
2= Usually true
3=True
45. I have an intense need for confirmation and
agreement.
0 = Not True
1=Usually not true
2= Usually true
3=True
46. I am eagerly open to new ideas and proposals.
0 = Not True
1=Usually not true
2= Usually true
3=True
47. I customarily judge my self-worth by comparison
with others.
0 = Not True
1=Usually not true
2= Usually true
3=True
48. I am free to think any thoughts that come into my
mind.
0 = Not True
1=Usually not true
2= Usually true
3=True
49. I frequently boast about myself, my possessions,
and achievements.
0 = Not True
1=Usually not true
2= Usually true
3=True
50. I accept my own authority and do as I, myself, see
fit.