Systemic Questionnaire Form - 3C

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Systemic Questionnaire and Attitudes

Name *

First

Last

What is your topic or concern?

I am physically healthy and even absolutely fit.

Selected Value: 0

I take full responsibility for all areas of my life. I lead a largely self-determined life.

Selected Value: 0

World events, job situation, family, etc. do not influence me at all (0) to extremely (5).

Selected Value: 0

I can also live alone for a longer period of time. I can cope well with myself.

Selected Value: 0

My financial situation allows me to live according to my needs and ideas without worries.

Selected Value: 0

I have siblings and I'm in umpteenth place.

Selected Value: 0

I live emotionally and spatially detached from my parents. I have forgiven and thanked them.

Selected Value: 0

My partnership relationship makes me happy.

Selected Value: 0

In the partnership I can allow closeness and give as well as take freedom. These are in a well-balanced relationship.

Selected Value: 0

I live out my intimacy and sexuality as I wish.

Selected Value: 0

I have children.

Selected Value: 0

Please indicate number of kids.

My children are an enrichment for me and I give them age-appropriate attention and time they deserve.

Selected Value: 0

0 = childlessness, 1-5 sensation and time together.

My work is my vocation and I am absorbed in it.

Selected Value: 0

I have a large circle of friends and meet them frequently.

Selected Value: 0

I have one or two very close friends with whom I can confide everything.

Selected Value: 0

I feel mentally and spiritually balanced and fulfilled.

Selected Value: 0

I can relax very well, find strength and balance through sports, meditation, nature, hobbies or similar and do this regularly.

Selected Value: 0

I react impulsively to stress and aggression, or suppressed feelings sometimes boil over in me.

Selected Value: 0

I observe myself avoiding unpleasant tasks and conflicts. Because that will also already so.

Selected Value: 0

I perform assigned or necessary tasks with the utmost care, because if it has to be done, it has to be done well.

Selected Value: 0

Small cause, big effect. Such stumbling blocks lurk everywhere and can sometimes even lead to disasters.

Selected Value: 0

I have been disappointed too many times and I know that I cannot rely on anyone 100%. So I have to check and be in the picture.

Selected Value: 0

The opinion of others about me is important to me. I enjoy pleasing others and I also have a hard time saying no.

Selected Value: 0

Success is important to me. I owe it to my hard work. I also want to be the best in my field.

Selected Value: 0

I often have the feeling that no one really understands me. If only someone would finally come to help me. And then these things always happen to me.

Selected Value: 0

I can work focused, but only as long as there is not something more exciting.

Selected Value: 0

Feelings are only a distraction. What have I developed expertise for? So I can assess things objectively and make informed decisions.

Selected Value: 0