Clarity Assessment Phone Thank you for booking the Clarity Session. This questionnaire will help me help you with your difficult mother. This is essentially your backstory. And it’s very important. We are going to dive deep and wide, travel back in time, and delve into your psyche in this questionnaire. Please give yourself plenty of time to go through it as it is part of your journey to clarity and change. ( skip any question you have already answered on the application form) Take a deep breath- here we go. First Name * Last Name * Email * Phone * How many of these describe your relationship dynamic with your mother? (please check all that apply) 1. No matter how hard you work for Mom’s approval, it’s never good enough. Try as you might, whatever you do, Mom weighs in with criticism or “helpful suggestions,” or finds other, subtle ways to make her disapproval known. 2. Mom gives you unsolicited advice. She micromanages you and tries to control your life, continuing to act like she’s responsible for and in charge of you long into adulthood. She expects you to answer to her and take her advice even when you haven’t asked for it. 3. Mom is never wrong and never sorry. You won’t hear, “I was wrong, and you were right.” She just can’t give it to you. Nor can she give you a genuine apology. It’s not in her DNA. 4. Boundaries, what boundaries? When it comes to your mother, you have a hard time setting them, and an even harder time sticking to them. In fact, setting a boundary feels like you are breaking a rule you never knew existed. 5. You wish it were different, but you feel responsible for Mom’s happiness. Deep down, you feel like it’s your job to make your mother happy. If she isn’t happy, you worry it is somehow your fault. 6. Mom takes any pushback as a rejection of her. Typical reactions include comments like, “I was just trying to help,” or, “I guess I’m just a horrible mother.” She gets so defensive and upset if you bring up even a tiny issue that it’s almost impossible to have a reasonable conversation with her. You feel like it isn’t even worth trying. 7. Mom thinks she knows what is best for you. Always. It goes without question, at least in her mind. You live by an unstated rule: Mother knows best. 8. Although not explicitly stated, making Mom look good and feel good is your job. Whether you are picking out an outfit for a holiday meal, or choosing a profession or mate, you suspect Mom will regard your choice as a reflection on her. 9. Standing up to Mom is hard for you. Your mother’s mood sets the tone. You don’t want to mess with that. You don’t want to rock the boat. You know the phrase, “If momma ain’t happy, ain’t nobody happy” all too well. It’s been your internal mantra for as long as you can remember. 10. Plagued by self-doubt, you frequently feel guilty and second-guess yourself. It is hard for you to make decisions and feel confident about them. You don’t feel like you can rely solely on your own judgment and often seek external approval to feel okay about things. I imagine your wheels are turning if you see yourself in any of the statements above. Don’t worry -we will take it slow and give you a chance to tell your story. Let’s begin by finding out where you are currently with your… Level of Contact Are you in contact with your mother? If so, is it too much, too little? If not, are you considering reinitiating contact? If you are in contact- what would be your ideal level of contact if you are not experiencing it now? If you are not in contact- how is that for you? If you are considering reinitiating contact, what is your fear- if any- in doing so? Please summarize your answer to the Level of Contact questions here. Now that we have a starting place let’s zero in on how you see your mother. About Mom How would you describe your mother? (Below is a list of descriptors to choose from.) Loving, judgmental, empathetic, controlling, easy going, thoughtful, critical, forgiving, supportive, kind, cruel, harsh, soft, needy, arrogant, humble, steady, unbalanced, easily hurt, mature, immature, other? Please fill-in your description of your mother here. Take the top three and give examples of each How do you think she got this way? What do you know about her childhood, religious or cultural upbringing that would influence her attitudes toward you or be a source of trauma that makes her personality difficult? About you- how would you describe yourself – or how would your best friend describe you? Examples- Loving, judgmental, empathetic, controlling, easy going, thoughtful, critical, forgiving, supportive, kind, cruel, harsh, soft, needy, arrogant, humble, steady, unbalanced, easily hurt, mature, immature, other? Fill-in description about yourself here. If there were one thing you would want me to know about you (in order to help you) what would that be? If there were one thing you wish you mother got about you what would that be? If there were one thing you’d like to change about yourself what would that be? After an encounter with your mother, which best describes how you feel and why? Give your own example of each descriptor you resonate with. Examples- Not good enough/ feeling like you just can’t get it right/ low confidence/ low self-esteem Guilty/ feeling like you are selfish if you put yourself first Self-doubt/ second guessing yourself or being unable to make a decision Ashamed/ feeling like something is wrong with you Fill-in your examples here. Do you have a spiritual, religious, yoga or consciousness/ethical code or practice that guides your values? You and Mom When Mom does hurtful things to you how do you typically respond? How do you feel inside? When/if you tell her what she has done is hurtful, how do you say it and how does she respond? What percentage of the time does Mom get her way? Taking a developmental history During your childhood there are pivotal times when daughters make a separation from their mothers- Keeping this in mind, how did they go for you? Kindergarten – separating from Mom and going off to school, did you experience school phobias or separation anxiety? Elementary school- were you allowed to choose your own friends or did Mom choose for you? Teen Years- Make up, music, boys, friends- were you allowed to choose, experiment (within reason) or were you micromanaged? College and profession- Were you free to make your own educational and vocational choices or did mom weigh in, pressure you and micromanage your choices? Choosing a partner and the wedding- were you free to make your own choices about whom to love or how to plan your wedding or were you heavily influenced by Mom? Your children and family- are you free to make decisions for your family and raise your children the way you want or does Mom give your unwanted advice? Boundary Setting When you try and set boundaries with your mother – how does it go? What do you do and how does she respond? If you don’t set boundaries why is this? Would you like to? Finish these sentences- I would set better boundaries with my mother if only she would _______________ I would set better boundaries with my mother if only I could _______________ Have you had therapy for your mother issues? What did you get out of it and, if so, where was it lacking? Is there anything else you would like me to know? What would you want to get clear on in order to feel like your clarity session was successful?
