Center for Holistic Therapies
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info@centerforholistictherapies.com
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"I achieved more this year of working with Vernon than I have in the previous 10 years of consistent drug therapy, psychiatric assessments and therapy with other clinicians, and that's the honest to God truth. I feel good." --M.S.
15. I find it difficult to hear criticism about myself. Yes___ No___

16. It makes me really angry when someone disrespects me. Yes___ No___

17. I often compare myself to others. Yes___ No___

18. I am easily embarrassed. Yes___ No___

19. I've been told I am too sensitive. Yes___ No___

20. I often procrastinate. Yes___ No___

21. I feel uncomfortable saying no. Yes___ No___

22. I've been involved in several abusive relationships, either verbal, emotional or physical.  Yes___ No___

23. People take advantage of me. Yes___ No___

24. I felt inferior or inadequate as a child. Yes__ No___

25. I try to avoid conflict or confrontation. Yes___ No___

26. I like conflict or confrontation. Yes___ No___

27. I was bullied as a child or was a bully growing up. Yes___ No___

28. I experience anxiety and fear whenever I think about doing anything new. Yes___ No___

"Oh my goodness! I went up to say my speech and was a ball of nerves. I did exactly what Vernon told me to do...and I did great. It was incredible!" --S.H.
29. I'm a people pleaser (nice guy/sweetheart) and have no identity of my own. Yes___ No___

30. I'm a hoarder; I have trouble letting go of things. Yes___ No___

31. I feel guilty when I stand up for myself and would rather give in to others. Yes___ No___

32. I have trouble starting things. Yes___ No___

33. I have trouble finishing things. Yes___ No___

34. I feel I never measure up; never get anything right. Yes___ No___

35. It's hard for me to relax. Yes___ No___

36. I am afraid I'll be rejected and abandoned if I'm not a good lover. Yes___ No___

37. I often have sex when I don't want to. Yes___ No___

38. My life is empty; I feel depressed a lot of the time. Yes___ No___

39. I feel ashamed when I get mad. Yes___ No___

40. I rarely get mad, but when I do, I become rageful. Yes___No___
"I had a lot of reservations about seeing a counselor. People were telling me I may have to go through several to find the right fit. For me, finding Vernon--it was lucky #1!" --N.M.
41. I almost never express unpleasant emotions. Yes___ No___

42. I am not always aware of my feelings. Yes___ No___

43. I do what I think others expect of me. Yes___ No___

44. I have an overdeveloped sense of responsibility. It's easier for me to be concerned with another than with myself. Yes___ No___

45. I often don't say no directly and then refuse to do what others ask in a variety of indirect and passive ways. Yes___ No___

46. I don't know how to resolve conflicts with others. I either overpower my opponent or completely withdraw from them. Yes___ No___

47. I frequently guess at what another's statement means and respond to it based on my guess.  Yes___ No___

48. I am fiercely competitive and a poor loser. Yes___ No___

49. I am easily frustrated. Yes___ No___

50. I am leading a 'productive' life but still feel unfulfilled. Yes___ No___
Your YES answers are powerful clues to areas where you may
be 'stuck' and can benefit from caring and supportive assistance.

If you are ready to take the next step on your journey towards resolution and growth

CALL: 301-588-2474
or
EMAIL: info@centerforholistictherapies.com

for a FREE 15 min. consultation or to make an appointment.

  1. I rely heavily on the opinion of others when making decisions. Yes___ No___

  2. I become discouraged easily. Yes___ No___

  3. I often refrain from sharing my opinions, my ideas, my feelings in groups. Yes___ No___

  4. I sometimes lie when I feel the truth would result in criticism or rejection. Yes___ No___

  5. I'm afraid that I will say or do something that will make me look stupid or incompetent. Yes__ No__

  6. I don't set goals for the future. Yes___ No___

  7. I find myself needing to look perfect and do things perfectly. Yes___ No___

  8. I'm too embarrassed to eat out alone or to attend movies and other activities by myself. Yes___ No___

  9. I don't want anyone to see me cry. Yes___ No___

10. I doubt I will ever be rich. Yes___ No___

11. I grew up in a home with addiction problems. Yes___ No___

12. I have been or am now married to an addict. Yes___ No___

13. I often feel hurt or angry by the words or behavior of others. Yes___ No___

14. At times I get so anxious and upset that I experience one or more of the following: heart racing or pounding,     sweating, tears, blushing, difficulty swallowing or lump in my throat, shaking; poor concentration; dizziness, nausea or diarrhea, butterflies. Yes___ No___

Is this your time to
discover yourself?
Use the questionnaire below to help determine areas in your life that
may be denying you your full potential.

Think about and answer according to how you feel most of the time.
Counseling & Coaching
Center for Holistic Therapies products and services are not to be considered a substitute for professional, medical or psychological diagnosis and/or treatment. Participation in all Center for Holistic Therapies programs is considered voluntary and should not replace, supersede or conflict with treatment and/or advice of a health professional. Any and all payments to Center for Holistic Therapies are non-refundable. Workshop dates and times are subject to change. Results may vary.