unhappy ...............average .............very happy
next question--scroll down...
2. How is your sleep pattern?
1----2----3----4----5----6----7----8----9----10
don't sleep well ................no problem sleeping
next question--scroll down...
3. How much transition or change is occurring in your life?
1----2----3----4----5----6----7----8----9----10
Major changes or .................................minor or
several changes ...................................few changes
next question--scroll down...
4. How is your health?
1----2----3----4----5----6----7----8----9----10
many or serious .......................excellent health
health problems
next question--scroll down...
5. How are your relationships with friends, family, spouse?
1----2----3----4----5----6----7----8----9----10
very unhappy ................................very content
next question--scroll down...
6. Do you have trouble expressing your needs and feelings and saying no when you don't feel like doing something? Do significant others report that you have trouble expressing your feelings?
1----2----3----4----5----6----7----8----9----10
trouble expressing needs .....assertive with my
and saying no ........................needs and feelings
next question--scroll down...
7. How is your sex life?
1----2----3----4----5----6----7----8----9----10
very bad ..................fine .....................excellent
next question--scroll down...
8. Is your sexual behavior healthy and satisfying?
1----2----3----4----5----6----7----8----9----10
unhealthy ............................................. healthy
next question--scroll down...
9. Are you comfortable with your sexual orientation?
1----2----3----4----5----6----7----8----9----10
no .............unsure .........................................yes
next question--scroll down...
10. Do you have problems with sexual/life issues (such as concerns about having children, fertility, pregnancy, birth control, or abortion)?
1----2----3----4----5----6----7----8----9----10
difficulties ..................no significant problems
next question--scroll down...
11. Have you noticed problems with your memory?
1----2----3----4----5----6----7----8----9----10
trouble with memory ..............perfect memory
next question--scroll down...
12. Do childhood memories or lack of them cause you any distress?
1----2----3----4----5----6----7----8----9----10
yes ..........unsure ............................................no
continue...
13. Do you accept the way that you look and feel good about your body?
1----2----3----4----5----6----7----8----9----10
hate your appearance ........feel good about your looks
14. Are you taking time out for yourself?
1----2----3----4----5----6----7----8----9----10
don't have time ...........................self-nurturing
15. Do you have excessive feelings of anxiety, fear, or distressing phobias?
1----2----3----4----5----6----7----8----9----10
regularly ....................................................never
16. Are you having occupational, school problems, or problems taking care of your family?
1----2----3----4----5----6----7----8----9----10
problems ..........................................no problem
17. Are there any stressful situations occurring in your life?
1----2----3----4----5----6----7----8----9----10
high stress .........................................low stress
18. Are you or someone close to you faced with a life-threatening illness?
1----2----3----4----5----6----7----8----9----10
yes ...................................................................no
19. How has your energy state been lately compared to your normal state?
1----2----3----4----5----6----7----8----9----10
large change .........................little or no change
20. Do you find it difficult to understand and express your feelings?
1----2----3----4----5----6----7----8----9----10
difficult to understand .........able to express feelings
and express my feelings
21. Do you find yourself repeating behavior patterns that are unhealthful or that are causing you distress?
1----2----3----4----5----6----7----8----9----10
often rarely ...............................................never
22. Do you have trouble staying in a committed relationship even though you desire intimacy?
1----2----3----4----5----6----7----8----9----10
trouble with intimacy .................not a problem
23. Do you find yourself losing your temper often?
1----2----3----4----5----6----7----8----9----10
often .......rarely ........................................never
24. Do you feel that eating is a major focus in your life?
1----2----3----4----5----6----7----8----9----10
eating and food are .....................its just eating
very important to me
25. Do you feel that you provide adequately for your family and/or for yourself?
1----2----3----4----5----6----7----8----9----10
no .......sometimes .........................................yes
26. Do you have problems with emotions changing in cyclical or unexplainable ways?
1----2----3----4----5----6----7----8----9----10
severe emotional changes ..............no problem
27. Have you ever been raped, physically abused, beaten, or otherwise sexually assaulted?
1----2----3----4----5----6----7----8----9----10
yes ...................................................................no
28. Would you like to learn more about yourself and why you are the way that you are?
1----2----3----4----5----6----7----8----9----10
interested ....................................not interested
that was the last question...
Look for future versions of the SES for couples, seniors, children and other groups.
Each of the above questions probes an area which signals that therapy can be of help. If you scored close to 10 on all of the questions then therapy is not likely to be of help to you at this time. Therapy is not just designed to help you through the tough times; it can also help you to understand yourself better and help you to grow as a person.
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