After each appropriate answer ask the question: "Did you intend that?" or "Was it intentional?"

Name: ______________________________

Date: ______________________________

01. Is there anything that you feel guilty about? ________

02. Have you done anything wrong? ________

03. Have you ever harmed anybody? ________

04. Have you taken an unfair advantage over somebody? ________

05. Have you ever convinced anyone that something they wanted
to do was impossible? ________

06. Have you made anyone feel hopeless? ________

07. Have you ever betrayed anyone's trust in you? ________

08. Is there something you've done that you are restraining
yourself from ever doing again? ________

09. Have you ever shocked or startled somebody? ________

10. Have you ever nagged anybody? ________

11. Did anyone deserve what you did to them? ________

12. Have you done something to somebody that they didn't
deserve? ________

13. Have you worried somebody? ________

14. Have you upset somebody? ________

15. Is there somebody that you feel you didn't do enough to? ________

16. Is there anyone that you've tried to get revenge on? ________

17. Have you ever tortured anybody? ________

18. Have you ever really wanted to do anybody in? ________

19. Have you ever hunted anybody? ________

20. Have you ever murdered anyone? or tried to? ________

21. Have you made somebody's life miserable? ________

22. Have you punished somebody? ________

23. Have you ever screamed or yelled at somebody? ________

24. Have you hit somebody? ________

25. Have you tried to control somebody? ________

26. How have you tried to stop another? ________

27. Is there any overt that you feel you should have committed? ________

28. Do you feel you have been too lenient? ________

29. Have you enforced your opinion on somebody? ________

30. Have you convinced somebody that he or she was wrong? How? ________

31. Have you made anyone feel that he or she was no good? ________

32. Have you been mean to others? ________

33. Have you done anything that was cruel? ________

34. Have you had to be hard on somebody for their own good? ________

35. Is there somebody that you tried to dominate? How? ________

36. Is there something that you have had to restrain yourself
from doing? ________

37. Have you prevented another from talking? ________

38. Have you cut somebody's comm? ________

39. Have you lied to somebody? ________

40. Have you attacked somebody? ________

41. Do you feel you have been unjust? ________

42. Is there any time when you thought that you had been
too weak? ________

43. Have you ever accused somebody of something they didn't do? ________

44. Have you ever pronounced somebody guilty? ________

45. Is there somebody you have criticized to others? ________

46. Have you talked about somebody behind their back? ________

47. Have you invalidated somebody? ________

48. Is there somebody you have wanted to destroy? ________

49. Have you tried to destroy somebody? ________

50. Is there somebody you would like to teach a lesson to? ________

51. Is there somebody you would like to harm? ________

52. Is there somebody who deserves to suffer a little? ________

53. Do you know anyone that you consider yourself too good for? ________

54. Is there something you could do that would really
show them? Have you done that? ________

55. Have you ever had to point out somebody' faults? ________

56. Have you ever beaten somebody up? ________

57. Do you think that you might have killed somebody? ________

58. Have you ever shattered somebody's hopes and aspirations? ________

59. Have you ever blunted somebody's goal? ________

60. Is there any overt that you have committed that you feel
you will never be able to make up for? ________

61. Have you ever stopped another? or tried to? ________

62. Have you betrayed anybody? ________

63. Have you ever been too mean to anybody? ________

64. Have you hurt somebody that you loved? ________

65. Have you rejected anybody that you loved? ________

66. Have you failed to thank or acknowledge somebody who
helped you? ________

67. Have you ever made somebody give up? ________

68. Have you ever destroyed another's hopes? ________

69. Have you ever made another go unconscious? ________

70. Have you ever drugged anybody? ________

71. Have you ever hypnotized somebody? ________

72. Have you ever implanted another? ________

73. Is there somebody that you led astray? ________

74. Have you ever rendered another unconscious and then told
them to do bad things? ________

75. Have you ever tried to control another's mind? ________

76. Have you ever tried to destroy another's mind? ________

77. Have you ever tried to totally wipe out another being? ________

78. Have you ever been negligent of somebody you were
looking after? ________

79. Have you wounded anybody? ________

80. Have you ever mistreated anybody? ________

81. Have you ever destroyed another's possessions? ________

82. Have you ever tried to wipe out another's memory? ________

83. Have you ever punished somebody for telling something? ________

84. Have you ever forced another to keep a secret? ________

85. Have you ever passed on something that somebody told you confidentially? ________

86. Have you ever forced another to keep their mouth shut? ________

87. Have you ever prevented another from revealing something? ________

88. Have you ever coerced another into doing bad things? ________

89. Have you ever put somebody to sleep and then done bad
things to them? ________

90. Have you ever jailed somebody? ________

91. Have you ever trapped another? ________

92. Have you ever scarred another's body? ________

93. Have you ever dismembered somebody? ________

94. Have you ever disfigured somebody? ________

95. Have you ever tried to possess or control another? ________

96. Have you ever undermined another's position? ________

97. Have you ever undermined another's authority? ________

98. Have you ever destroyed another's morals? ________

99. Have you ever destroyed another's mind? ________

100. Have you ever destroyed another's memory? ________

101. Have you ever run a can't have on somebody? ________

102. Have you ever forced another into a contract or agreement? ________

103. Is there somebody that you really hate? ________

104. Is there somebody that you used to hate? ________

105. Have you ever tried to get rid of somebody? ________

106. Have you ever been rude or discourteous? ________

107. Have you ever dominated somebody else? ________

108. Is there somebody you think would be better off dead? ________

109. Is there somebody you should have gotten rid of? ________

110. Do you know of anybody who got too powerful? ________

111. Is there somebody whose opinions you sought to invalidate? ________

112. Have you ever forced somebody to do something against
their will? ________

113. Have you ever ridiculed another? ________

114. Have you ever held another up to contempt? ________

115. Have you ever made someone feel unwanted? ________

116. Is there some temptation you haven't been able to resist? ________

117. Is there a time when you were too good? ________

118. Is there somebody whom you neglected? ________

119. Is there somebody who deserved everything they got? ________

120. Is there somebody who deserved more than you did to them? ________

121. Is there somebody whom you prevented from doing things
that they wanted to do? ________

122. Is there somebody whom you took for granted? ________

123. Have you ever failed to keep your exchange in with others? ________

124. Have you ever stolen anything? ________

125. Have you ever borrowed another's possessions and not
returned them? ________

126. Have you ever failed to repay a loan? ________

127. Have you ever taken advantage of somebody? ________

128. Is there somebody whom you exploited? ________

129. Is there somebody whom you tried to make less of? ________

130. Have you ever disappointed somebody? ________

131. Have you ever tried to get even? ________

132. Is there some overt you haven't committed but should have? ________

133. Have you ever treated somebody badly? ________

134. Have you ever hurt somebody's feelings? ________

135. Is there anyone that you tricked? ________

136. Is there somebody whom you feel guilty around? ________

137. How do you think you have erred? ________

138. Do you think that you are evil in any way? ________

139. Is there anything that you have done that we haven't
covered? ________

140. Tell me your opinion of yourself now. ________