Name - Date
Name - Date
Name - Date
Name_____________________________________________ Date_______________
INSTRUCTIONS:
RATING SCALE:
1 = Completely untrue of me
2 = Mostly untrue of me
4 = Moderately true of me
5 = Mostly true of me
6 = Describes me perfectly
EXAMPLE:
I care about
A. __4__ I worry that people ^ will not like me.
3. _____ I show a lot of anger when people let me down or betray me.
7. _____ The visible trappings of success (e.g., expensive car, clothing, home)
are important to me.
10. _____ I often have fantasies of success, fame, wealth, power, or popularity.
13. _____ I put a lot of emphasis on having order in my life (e.g., organization,
structure, planning, routine).
14. _____ I expend a lot of effort trying to avoid having things go wrong.
17. _____ I like being in positions where I have control or authority over the
people around me.
18. _____ I dislike other people having any say over my life.
21. _____ It's crucial to me that I make my own decisions and support myself.
23. _____ I like to be a “free agent”, to have the freedom to do what I want.
24. _____ I have trouble limiting myself to one job or career; I like to keep my
options open.
26. _____ I am often demanding with other people -- I like everything to be “just
right”.
27. _____ I have to take care of myself first, the way other people do.
30. _____ I dislike rules and can get satisfaction from breaking them.
31. _____ I enjoy being unconventional, even if it's unpopular or I don't fit in.
34. _____ I'm a very private person; I don't like people knowing a lot about my
private life or feelings.
35. _____ I try to appear strong to other people, even if I feel vulnerable or
unsure of myself.
36. _____ I can be very possessive or clinging with the people I value.
38. _____ I often prefer indirect means of getting my way instead of directly
asking for what I want.
39. _____ I keep people at a distance so they only see the parts of myself I want
them to see.
41. _____ I feel I'm under a great deal of pressure to meet my own standards or
responsibilities.
43. _____ I try to be optimistic at all times; I don't let myself focus on the
negative.
44. _____ I believe it's important to “put on a happy face” regardless of what I
feel inside.
45. _____ I often feel envious or frustrated when others are more successful or
get more attention than I do.
46. _____ I will go to considerable lengths to be sure I get my fair share and am
not cheated.
.
47. _____ I look for ways to outsmart people, so they won't take advantage of
me or hurt me.
48. _____ I know just what to say or do to get other people to like me (e.g.,.
flattery, saying what they want to hear).
COPYRIGHT 2003 Jeffrey Young, Ph.D. Unauthorized reproduction without
written consent of the author is prohibited. For more information, write:
Cognitive Therapy Center of New York, 36 West 44th Street, Suite 1007,
New York, NY 10036