Clarity Assessment "*" indicates required fields 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. Take a deep breath- here we go.First Name*Last Name*Email* Phone* Let’s begin by finding out where you are currently with your mother… 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 eachHow 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 MomWhen 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?Boundary SettingIf you don’t set boundaries why is this? Would you like to?When you try and set boundaries with your mother – how does it go? What do you do and how does she respond?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? Please prove you are human by selecting the key. CAPTCHANameThis field is for validation purposes and should be left unchanged.
