SPIRITUAL WELLNESS SELF ASSESSMENT QUESTIONNAIRE


Using 1 as low and 10 as high, indicate to what degree you presently receive nurture, energy, support, or fulfillment from the following:

1. A satisfying. long term romantic love relationship?

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2. At least one mutually supportive, sometimes challenging, enduring friendship?

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3. A parenting relationship with at least one of your own offspring or another child for whom you have
    been a primary "parenting one"?

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4. A consistently nurtured sense of wonder at the beauty, rhythms and miracles of nature?

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5. A relationship with a personal God as a life partner, who is "on your side", likes you, cares about
    your feelings / experiences, is  fairly consistently close to you?

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6. Harmony with non-personal forces of the universe, e.g. through meditation, scientific exploration,
    philosophy?

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7. A productive relationship with a personal helper, e.g. a spiritual director, therapist, clinical
    supervisor, counselor, addiction sponsor?

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8. Success in an art of giving help to others, e.g. as a therapist, minister, health care practitioner,
    counselor?

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9. An individuated, mutually supportive and understanding relationship with at least one of your parents?

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10. Effective physical self care, including maintaining healthy weight, moderate if any drinking, no
    smoking, adequate rest, sound diet?

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11. Habitual, effective emotional self care, including affective awareness, assertiveness, and sharing
    or otherwise dealing with your own feelings?

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12. Success in your primary chosen way of dealing with the urges of sexual expression, e.g. through
    regular enough sexual activity, satisfying celibacy, etc.?

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13. Finding your best work satisfying and appreciated by key others?

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14. Athletic accomplishment satisfying to you?

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15. Regular, active involvement in a hobby that delights you?

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16. Consistent, enriching involvement in a faith community including regular use of religious writings,
    symbols, traditions, and practices?

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17. Making a (to you) satisfying contribution to the human community as a whole, through e.g. political
    activity to improve world living conditions, involvement in social action causes, writing for
    others' benefit, etc.?

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18. Integrating losses into your life, e.g. deaths of close people, your own disability, divorce?

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19. Confronting your mortality, facing your own death with wisdom rather than heavy denial, bitterness,
     depression?

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20. Accomplishment in or appreciation of creative endeavors, i.e. the arts, e.g. in music, theater,
    painting, literature?

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21. Encountering "the new" in educational partnership with teachers / learners e.g. delight in your
    own learning, teaching, being a mentor?

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22. Adjusting for and appreciating the limitations or your own aging e.g. diminished health, vigor
    and appearance along with increased wisdom, magnanimity, and insight?

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23. Cultural background enrichment?

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24. Feeling validated and mentored by the elder men / women?

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25. Communing with your family of origin as a whole?

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26. Patriotic activity for the good of your homeland?

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27. Neighboring with people who live near you?

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28. Tuning in to your treasuring of your own person?

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29. Nesting, i.e. arranging, maintaining, and enjoying the ambiance of your own living space?   

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30. Viewing your earning, having, and spending of money as personally enriching and "enough"?

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31. Fellowship or sisterhood with your gender peers?

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32. Connectedness with any siblings who shared the same family of origin?

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33. Acceptance, respect and validation from your chronological, employment, professional or athletic
    peers?

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