Childhood Questionnaire

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.

(ex. hard working, easy to talk to, honest)
(ex. lots of anger, perfectionist, rigid)
(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.)
(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.)
(For instance, he would hug me and tell me he loved me.)
(For instance, she would buy me things, clothes, toys and stuff.)
(Ex. Dad would _______ Mom would _______)
(Ex. Dad would _______ Mom would _______)
(For instance, they hugged and kissed a lot; they spoke kindly to each other; they laughed a lot together.)
Indicate either "Mom", "Dad", "both", or "neither" next to the following phrase to help describe your home life as a child.
Indicate either "Mom", "Dad", "both", or "neither" next to the following phrase to help describe your home life as a child.
Indicate either "Mom", "Dad", "both", or "neither" next to the following phrase to help describe your home life as a child.
Indicate either "Mom", "Dad", "both", or "neither" next to the following phrase to help describe your home life as a child.
Indicate either "Mom", "Dad", "both", or "neither" next to the following phrase to help describe your home life as a child.
Indicate either "Mom", "Dad", "both", or "neither" next to the following phrase to help describe your home life as a child.

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