| MAKE CHECK MARK (√) IN APPROPRIATE COLUMN | LITTLE OF THE TIME 1-pt/each √ | SOME OF THE TIME 2-pt/each √ | A LOT OF THE TIME 3-pt/each √ | MOST OF THE TIME 4-pt/each √ |
| I am open-minded when making decisions with my loved ones. | | | | |
| I feel good about myself and treat myself kindly. | | | | |
| I have a friend I can count on when the chips are down. | | | | |
| I treat others the way I like to be treated. | | | | |
| Relationships with my family give me pleasure. | | | | |
| I accept my limitations and deficiencies. | | | | |
| I have an intimate and trusting relationship with someone I love. | | | | |
| I assert myself without being aggressive even when my opinions may be unpopular. | | | | |
| I feel empathy for those less fortunate than I am. | | | | |
| I keep my promises to others and myself. | | | | |
| Multiply √ by the value given in each column | | | | |
Add the total for each column to get the GRAND TOTAL = ________
Scoring
10-14 points = Lonely and insecure
15-24 points = Few friends and little influence
25-34 points = Likable and understanding
34-40 points = ˜˜˜˜˜ confident friend and lover
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