1- These are my good qualities (list all you can think of and ask for input from people who know you well):
2- These are qualities about myself which I do not like:
3- I am passionately interested in:
4- This is what is most important to me:
5- This is what I am good at (talents, skills and aptitudes):
6- My job utilizes these of my good qualities, interests, talents, skills and aptitudes:
7- These are the aspects of my job that do not match my qualities, interests, talents, skills and aptitudes:
8- This is what I want to accomplish professionally:
9- This is what I want to accomplish personally:
10- If I learned I had one week to live, this is what I would regret:
11- If I died today, this is how I would be remembered by my family:
12- If I died today, this is how I would be remembered by friends and co-workers:
13- This is how someone observing all of my behaviors over the last two months would describe what I believe is right and wrong:
14- This is how someone observing all of my behaviors in the last two months would describe my priorities (for example, children, spouse, work, recreation, friends, exercise, self-nurturing, financial, tv, computer, etc.):
15- I thrive on these aspects of my life (for example, children, career, socializing, entertaining, deadlines, athletics, etc.): 16- These aspects of my life make me function less efficiently (e.g., disorganization, ill health, emotional upsets, fatigue, excess, bad relationships, etc.)? 17- This is what I have been putting up with: 18- This is what makes me laugh: I laugh ____ times a day. 19- These leisure activities make me feel most “in the moment”: How much opportunity do I create for doing these activities? 20- If I could do anything at all with my life, regardless of training, money or obligations, this is what I would do: 21- I enjoy my job _____% of the time. Is this an acceptable percentage? 22- I feel glad to begin a new day _______% of the time. Is this an acceptable percentage? 23- I feel most my true self in this kind of clothing: How often do I wear that kind of clothing? 24- In whose company am I my best self? Do I spend enough time with these people? 25- In whose company am I not my best self? 26- How can I improve my part those interactions? 27- How can I spend a more acceptable amount of time with these people? (This assumes that to limit time spent would not be dishonoring a commitment, for example, to a spouse or child. This assumes that I have given my best effort to improving my part in the interactions, taking responsibility for my part in the difficulties, learning better relationship skills, forgiving when appropriate. ) 28- This would be my ideal day: 29- This would be my day from hell: 30- Do I promote my health with good nutrition? 31- Do I promote my health with exercise? 32- Do I promote my health by getting proper rest? 33- Do I promote my health by managing the stress in my life? 34- What do I use as distractions from being fully present in my relationships and endeavors? Alcohol, drugs, sex, being “in love” (as opposed to loving), dieting, overeating, soda, caffeine, computer, TV, reading, etc. 35- In 1999, how did the things I use as distractions impair my being fully present in my relationships and in my endeavors? 36- Do I always honor commitments and promises I have made? 37- How often do I make large or small commitments, then realize I hadn’t thought out the consequences? 38- Do my thoughts contribute to my sense of well being, or diminish it? 39- Do I take responsibility for my failures and bad choices, or do I tend to blame my parents, spouse, children, boss, or others?
40- My primary relationships meet my needs in these ways:
41- I would like to get more of this in my primary relationships: 42- I give of myself in my primary relationships in these ways: 43- I would like to give more of myself in my primary relationships in these ways: 44- Do I have enough fun? 45- How can I rearrange my life to have more fun? 46- Am I satisfied with the sexual intimacy in my life? 47- What can I do to enhance it? 48- I seem to function best when I spend about ____% of my time in company of others and about _____% of my time alone. 49- Where am I happiest living? (Country or city? Climate? Close to neighbors or private?) 50- How closely does my home match my ideal? 51- Am I organized enough (not too little or too much) for efficiency? 52- On a scale of 1 to 10, I would rate my mental/emotional health as a _____. 53- I need these material things to live well (using my own definition of “well”)? 54- I need this much income to live well: 55- I waste my money on these kinds of things: 56- I skimp on these kinds of things: 57- I am grateful for: 58- How well does my life match my core self? Based on what I’ve learned above, Ø These are the ways my life is in sync with my core self: Ø These are the ways my life is out of sync with my core self: Ø One year from now, this is how I want my life to be: 3 things I want to be doing: 5 things I am no longer willing to tolerate: 5 standards I am willing to hold myself to, with no exceptions: 5 characteristics I am willing to create in my relationships: 10 daily habits I am willing to create: Other: These are people, places and things I need to support my goals:
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