Childhood Questionnaire

Drawing from your memories of childhood, list one word or one phrase for each of your parents (both strengths and weaknesses.) Describe step-parents if appropriate.

Father - Strengths *

(ex. hard working, easy to talk to, honest)

Father - Weaknesses *

(ex. lots of anger, perfectionist, rigid)

Mother - Strengths *

Mother - Weaknesses *

What things did you most like about yourself when you were a child? *

(For instance, I liked that I was so creative. I liked being the best swimmer in my neighborhood. I liked the way I could talk easily with adults.)

What things did you like least about yourself when you were a child? *

(For instance, I felt like a klutz around my friends. I was afraid to stand up for myself. I didn't get good grades like the other kids.)

When you were a child, how would Dad praise you? *

When you were a child, how would Dad criticize you? *

When you were a child, how would Mom praise you? *

When you were a child, how would Mom criticize you? *

As you grew up, how did you know that Dad loved you? *

(For instance, he would hug me and tell me he loved me.)

As you grew up, how did you know that Mom loved you? *

(For instance, she would buy me things, clothes, toys and stuff.)

How did Mom and Dad deal with conflict between themselves? *

(Ex. Dad would _______ Mom would _______)

How did Mom and Dad handle conflict with you? *

(Ex. Dad would _______ Mom would _______)

How did you know that your parents loved each other as you were growing up? How did they show it? *

(For instance, they hugged and kissed a lot; they spoke kindly to each other; they laughed a lot together.)

Family leader *