Spring Adult Mid-Survey Name First Name Last Name What's working for you so far? What aren't you enjoying? What would you like less or more of? How have you enjoyed or not enjoyed Te'Von's facilitation? How did you enjoy Te'Von's services as a co-facilitator? 1-Very unsatisfied 2- Unsatisfied 3- Neutral 4- Satisfied 5- Very satisfied I pay careful attention when other people talk to me about their troubles. For the questions below, choose the response that best fits you, where 1 is almost never and 5 is almost always. 1 - Almost never 2 3 4 5 - Almost always I notice when people are upset, even if they don’t say anything 1 - Almost Never 2 3 4 5 - Almost Always When I’m sad, I feel like other people are probably happier than I am 1 - Almost Never 2 3 4 5 - Almost always When I fail at something, I feel alone in the failure 1 - Almost never 2 3 4 5 - Almost always I like to be there for others when they’re struggling 1 - Almost never 2 3 4 5 - Almost always I am good at noticing when people are upset, even if they don’t say anything 1 - Almost never 2 3 4 5 - Almost always In difficult situations, I can pause without immediately reacting 1 - Almost never 2 3 4 5 - Almost always I tell myself I shouldn’t be feeling the emotions that I feel 1 - Almost never 2 3 4 5 - Almost always I have trouble thinking of the right words to express how I feel things 1 - Almost never 2 3 4 5 - Almost always I can notice my feelings without reacting to them 1 - Almost never 2 3 4 5 - Almost always I make judgments about whether my own thoughts are good or bad 1 - Almost never 2 3 4 5 - Almost always My natural tendency is to describe my feelings in detail 1 - Almost never 2 3 4 5 - Almost always I could be experiencing some emotion and not be conscious of it until some time later For the remaining questions below, choose the option that best fits you, where 1 is "Almost never" and 6 is "Almost always." 1 - Almost never 2 3 4 5 6 - Almost always I tend not to notice feelings of physical tension or discomfort until they really grab my attention 1 - Almost never 2 3 4 5 6 - Almost always I find myself listening to someone with one ear and doing something else at the same time 1 - Almost never 2 3 4 5 6 - Almost always I find myself preoccupied with the future or the past 1 - Almost never 2 3 4 5 6 - Almost always I find myself doing things without paying attention 1 - Almost never 2 3 4 5 6 - Almost always Thank you! If you have any add’l questions please email lwolfthal@fwtransformation.org
