Survivor to Thriver Manual Personal Relationships Checklist

Personal Relationships Checklist

RECOMMENDATIONS: If you are being hit, forced to have sex, or criticized or verbally abused, you must take steps to stop this very real and potentially dangerous pattern. If you are being dominated in one or more destructive ways, you should seek professional help to figure out how to rectify or leave the relationship or insist that your partner get help to eliminate the abusive behavior. In more subtle instances, where you are unclear as to whether your perceptions of abuse are based on the past or on the present, you may also need professional help to understand fully the interpersonal dynamics that are being played out in your relationship(s). Again, your ASCA meeting Co-Secretaries might have local resource lists to help you find the assistance you need.

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Check "Yes" or "No" to each question that applies:
1.	Does your partner or spouse ever hit you?	Yes No
2.	Does your partner ever force you to have sex?	Yes No
3.	Does your partner verbally abuse or disrespect you by calling you names, belittling you or threatening you?	Yes No
4.	Does your partner try to restrict whom you spend time with or limit other choices in your life?	Yes No
5.	Does your partner consistently assign unfounded malicious intent to your actions and opinions?	Yes No
6.	Do you find yourself afraid of disagreeing with or opposing your partner?	Yes No
7.	Does this relationship make you feel the way you did as a child?	Yes No
8.	Do you feel dominated or controlled by your partner?	Yes No
SCORING: If you answered "YES" to any of the above questions, you will need to determine whether your childhood abuse history is shaping your perceptions of your current relationship(s) or whether the relationship is, in fact, abusive in some way. Print this checklist if you need your answers for reference. Your entries will be cleared once you leave this page. Clear Checklist \| Print Checklist