Name: ______________________________

Date: ______________________________

01. Do things look hopeless? ________

02. Is life grim? ________

03. Are people mean to each other? ________

04. Has the future ever looked black? ________

05. Has anyone betrayed you? ________

06. Do you feel you deserved what happened to you? ________

07. Do you know anyone who is really nasty? ________

08. Have your feelings been hurt? ________

09. Has life been unfair? ________

10. Do you feel that you have had bad luck? ________

11. Have you been treated unkindly? ________

12. Do you have any enemies? ________

13. Is there someone who doesn't like you? ________

14. Have you been treated badly? ________

15. Has anyone talked about you behind your back? ________

16. Has anyone ever lied to you? ________

17. Has anyone ever lied about you? ________

18. Has anyone ever played a dirty trick on you? ________

19. Do you feel trapped? ________

20. Tell me some things that are unfair. ________

21. Do you feel that someone has taken advantage of you? ________

22. Has anyone profited as a result of your labors? ________

23. Have you had to work against obstacles? ________

24. Are there any stops in your life? ________

25. Are there any barriers to your goals? ________

26. Has anyone thwarted you? ________

27. Are there some things that you have had to give up? ________

28. Have you ever had to go without things that you wanted? ________

29. Has anyone done something really rotten to you? ________

30. Have you been misled? ________

31. Has anyone led you astray? ________

32. Has anyone persuaded you to do bad things? ________

33. Have you been robbed? ________

34. Has anyone borrowed money from you and not paid it back? ________

35. Has anyone misused your possessions? ________

36. Have you ever felt that you have been used by others? ________

37. Do you feel that you have been exploited? ________

38. Do you feel that you have been taken for granted? ________

39. Is there anyone who didn't acknowledge you? ________

40. Have you ever felt that somebody didn't recognize you for what you were? ________

41. Has anyone made less of you? ________

42. Is there somebody who made you wrong? ________

43. Is there somebody who wouldn't let you have anything? ________

44. Did anyone run a can't have on you? ________

45. Were you prevented from doing certain things until you grew up? ________

46. Have you been told that you weren't old enough to do something? ________

47. Has anyone implied or said that you were too old? ________

48. Has anyone excluded you? ________

49. Have you been kicked out? ________

50. Did anyone beat you physically? ________

51. Has anyone hit you or pushed you around? ________

52. Has anyone been impolite to you? ________

53. Have you been called names? ________

54. Have you been forced to do something that you didn't want to do? ________

55. Have you been made to sign a contract or agreement that you didn't want to? ________

56. Have you been forced to sign anything against your will? ________

57. Do you feel that you have been forced to agree to anything? ________

58. Is there somebody who dominated you? ________

59. Is there somebody who is trying to get even with you? ________

60. Do you suspect that somebody wants to get rid of you? ________

61. Do you know of anybody that hates you? ________

62. Has anyone usurped your authority? ________

63. Is there somebody who has undermined you? ________

64. Is there somebody who wants to destroy you? ________

65. Has somebody tried to destroy you? ________

66. Has somebody tried to control you through your emotions? ________

67. Has somebody tried to control your mind? ________

68. Has anyone tried to possess you? ________

69. Have you ever been captured? ________

70. Have you ever been imprisoned? ________

71. Have you ever been convicted? ________

72. Have you ever been sent to jail? ________

73. Have you been mistreated? ________

74. Has anyone coerced you into doing bad things? ________

75. Has anyone ever hypnotized you? ________

76. Have you been implanted with bad purposes? ________

77. Has anyone drugged you? ________

78. Is there anything that happened after which you were never the same again? ________

79. Have you ever been wounded? ________

80. Have you been scarred for life? ________

81. Has anyone ever tried to destroy your memory? ________

82. Did anyone insist that there were certain things that you must forget? ________

83. Did anyone ever force you to keep your mouth shut? ________

84. Have you been threatened with consequences if you talked? ________

85. Have you been punished for revealing a secret? ________

86. Have you ever told somebody something in confidence and then been betrayed? ________

87. Has life ever seemed unreal? ________

88. Has anything that happened to you seemed unbelievable? ________

89. Is there anything that happened to you that is too incredible for anyone to believe? ________

90. Have you been outraged? ________

91. Were you ever driven to desparation? ________

92. Were you ever driven to suicide? ________

93. Have you ever experienced things being so bad that you just wanted to forget? ________

94. Have you ever experienced anything so bad that you knew you couldn't
live through it? ________

95. Have things ever seemed so bad that you just wanted oblivion? ________

96. Have you ever wished that you didn't exist? ________

97. Have you ever tried to take your own life? ________

98. Have you ever wished that you could go unconscious? ________

99. Have things gotten so tough that you decided to quit? ________

100. Have you ever given up? ________

101. Have things gotten so bad that you felt completely stopped? ________

102. Have you ever felt that somebody had you thwarted? ________

103. Have you ever felt dirty? ________

104. Did anyone or anything make you feel slimy or unclean? ________

105. Did anyone ruin you for life? ________

106. Did anyone or anything ruin you forever? ________

107. Did anyone ever do anything to you that was so bad that you felt you would
never recover from it? ________

108. Were your hopes and aspirations shattered? ________

109. Is there somebody who dampened your enthusiasm? ________

110. Do you know somebody who keeps picking on little faults? ________

111. Have you been criticized? ________

112. Have you been attacked? ________

113. Have you ever been accused of things you haven't done? ________

114. Were you falsely found guilty? ________

115. Have your intentions been misinterpreted? ________

116. Has anyone given you false reasons for things? ________

117. Do you know someone who made it hard for you to talk? ________

119. Has anyone sucked you into their viewpoint? ________

120. Is there somebody that you felt dirty after associating with? ________

121. Has anyone convinced you that you were wrong? ________

122. Is there somebody that you had to resist going into agreement with? ________

123. Is there anybody who seemed to have a strange power over you? ________

124. Did somebody scream and yell at you? ________

125. Were you punished? ________

126. Have you been hunted? ________

127. Are you wanted anywhere? ________

128. Has anyone made life miserable for you? ________

129. Has anyone cast a spell over you? ________

130. Have you ever been tortured? ________

131. Did anyone cause you stress? ________

132. Did somebody nag you a lot? ________

133. Have you ever been shocked? ________

134. Have you been startled so severely that you wondered what was happening? ________

135. Do you feel that you have been abused? ________

136. Has anyone scorned you? ________

137. Has anyone taken unfair advantage over you? ________

138. Do things seem hopeless? ________

139. Have you ever been harmed? ________

140. Is there something that you don't want to ever have happen to you again? ________

141. Do you like flowers? ________

142. Is there anything that you feel uncomfortable about? ________

143. How do you feel you have been treated? ________