Meaningful Material Objects
A SA SD D NA
1. I am satisfied with my current housing situation.
2. I am satisfied with the furnishings in my home.
3. I am satisfied with my wardrobe.
4. I am satisfied with my access to reliable transportation.
5. I am satisfied with the electronic devices which provide
entertainment or save time and effort.
6. I am satisfied with my access to stores where I can find an
adequate variety of reasonably priced products which I
consider essential to my quality of life.
Money
A SA SD D NA
1. I have sufficient money to acquire and maintain those
material objects that make my life satisfying.
2. My level of income and/or assets are sufficient to secure the
respect and perhaps admiration of those people who are
important to me.
3. I have enough money to engage in the interpersonal
activities that interest me.
4. Money does not block me from participating in close and
revealing interpersonal interactions.
5. I can afford to participate in activities that enhance my health
and prevent illness.
6. I have sufficient money to obtain quality healthcare when I
need it.
7. My level of compensation is fair and reasonable for the work
I do.
8. I can afford to participate in a sufficient variety of renewing
recreational activities.
9. My income and/or assets are sufficient to provide me with
an adequate number of options in everyday living.
10. My income or assets are sufficiently reliable to make me feel
safe.
Affirmation
A SA SD D NA
1. I am satisfied with the affirmation I get from people in my
community.
2. I am satisfied with the affirmation I get from coworkers.
3. I am satisfied with the affirmation I get from my superiors.
4. I am satisfied with the affirmation I get from friends.
5. I am satisfied with the affirmation I get from my children.
6. I am satisfied with the affirmation I get from my parents.
7. I am satisfied with the affirmation I get from my extended
family.
8. I am satisfied with the affirmation I get from my spouse or
romantic partner.
9. I am satisfied with the affirmation I receive from my pet.
10. I am satisfied with the affirmation I get from God.
Companionship
A SA SD D NA
1. I am satisfied with the level of companionship I receive from
the people in my community.
2. I am satisfied with the level of companionship I receive from
coworkers.
3. I am satisfied with the level of companionship I receive from
my friends.
4. I am satisfied with the level of companionship I receive from
my children.
5. I am satisfied with the level of companionship I receive from
my parents.
6. I am satisfied with the level of companionship I receive from
my spouse or romantic partner.
7. I am satisfied with the level of companionship I receive from
my extended family.
8. I am satisfied with the level of companionship I receive from
my pet.
9. I am satisfied with the level of companionship I receive
through my relationship with God.
Intimacy
A SA SD D NA
1. I am satisfied with the intimacy I have with friends.
2. I am satisfied with the intimacy I have with my children.
3. I am satisfied with the intimacy I have with my parents.
4. I am satisfied with the intimacy I have with my extended
family.
5. I am satisfied with the intimacy I have with my spouse or
romantic partner.
6. I am satisfied with the intimacy I have within a professional
relationship, such as a pastor, rabbi or mental health
practitioner.
7. I am satisfied with the intimacy I have with God.
Health
A SA SD D NA
1. I have a general sense of physical well being.
2. I rarely feel physical pain or discomfort.
3. I rarely feel depressed.
4. I rarely feel anxious or worried.
5. I am confident that I will continue to experience physical and
emotional well being.
Rewarding Occupation
If you are a full-time homemaker or a full-time student, answer the items in this section in terms of the tasks involved in the work of a homemaker or a student )
A SA SD D NA
1. I have mastered the skills required to successfully complete
the tasks of my occupation.
2. I enjoy performing the tasks required by my occupation.
3. Completing the tasks required by my occupation gives me a
sense of accomplishment.
Renewing Recreation
A SA SD D NA
1. I have sufficient opportunity to engage in activities which have
have the primary purpose of pleasing me in some way.
2. The recreational activities I choose send me back to the tasks
of living with a sense of being refreshed and renewed.
3. I look forward to my recreational activities when I am involved
in the tasks of living.
Freedom
A SA SD D NA
1. Any constraints that restrict my actions are reasonable,
appropriate and acceptable.
2. I can express my thoughts and feelings without fearing I will
be rejected, ridiculed or punished in some way by people in
my community.
3. At work, constraints on my actions and the expression of my
thoughts and feelings are reasonable, appropriate and
acceptable.
4. Among friends, I can express my thoughts and feelings
without fear I will jeopardize the relationship in some way.
5. With my parents, I can express my thoughts and feelings
without fear I will jeopardize the relationship in some way.
6. With my spouse or romantic partner, I can express my
thoughts and feelings without fear I will jeopardize the
relationship in some way.
Security
A SA SD D NA
1. In the future I will be able to maintain possession of or access
to those material objects which I currently enjoy.
2. In the future I will enough money to maintain a reasonably
satisfying quality of life.
3. I will be able to maintain those interpersonal relationships
which provide affirmation.
4. I will be able to maintain those interpersonal relationships
which provide companionship.
5. I will be able to maintain those interpersonal relationships
which provide intimacy.
6. I am confident I will continue to have the degree of health and
emotional well-being I currently enjoy.
7. In the future I will continue to experience at least the degree
of occupational satisfaction I currently enjoy.
8. In the future I will be able to continue at least the degree of
enjoyment that my recreational activities currently provide.
9. I am confident future constraints on my actions will be
reasonable and appropriate and I will be able to express my
thoughts and feelings with members of my community,
workplace and family as well as with friends and my romantic partner without fear of jeopardizing those relationships as a result.
