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Stage of Change Assessment

Each statement below describes how a person may feel when approaching problems in their life. Please indicate the degree to which you agree or disagree with each statement below. In each item, select how you feel RIGHT NOW, not how you have felt in the past or how you would like to feel. For all statements that refer to a “problem”, answer in terms of problems or issues related to why you are wanting to join this program. Any words such as “here” or “this place” refer to the program.

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Question 1 of 32

As far as I’m concerned, I don’t have any problems that need changing.

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

Question 2 of 32

I think I might be ready for some self-improvement.

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

Question 3 of 32

I am doing something about the problems that had been bothering me.

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

Question 4 of 32

It might be worthwhile to work on my problem.

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

Question 5 of 32

It doesn’t make much sense for me to be here.

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

Question 6 of 32

It worries me that I might slip back on a problem I have already changed, so I am here to seek help.

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

Question 7 of 32

I am finally doing some work on my problems.

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

Question 8 of 32

I’ve been thinking that I might want to change something about myself.

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

Question 9 of 32

I have been successful in working on my problem, but I’m not sure I can keep up the effort on my own.

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

Question 10 of 32

At times my problem is difficult, but I’m working on it.

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

Question 11 of 32

Trying to change is pretty much a waste of time for me because the problem doesn’t have to do with me.

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

Question 12 of 32

I’m hoping this place will help me to better understand myself.

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

Question 13 of 32

I guess I have faults, but there’s nothing that I really need to change.

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

Question 14 of 32

I am really working hard to change.

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

Question 15 of 32

I have a problem, and I really think I should work on it.

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

Question 16 of 32

I’m not following through with what I had already changed as well as I had hoped, and I’m here to prevent a relapse of the problem.

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

Question 17 of 32

Even though I’m not always successful in changing, I am at least working on my problem.

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

Question 18 of 32

I thought once I had resolved the problem, I would be free of it, but sometimes I still find myself struggling with it.

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

Question 19 of 32

I wish I had more ideas on how to solve my problem.

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

Question 20 of 32

I have started working on my problems, but I would like help.

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

Question 21 of 32

Maybe this place will be able to help me.

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

Question 22 of 32

I may need a boost right now to help me maintain the changes I’ve already made.

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

Question 23 of 32

I may be part of the problem, but I don’t really think I am.

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

Question 24 of 32

I hope that someone here will have some good advice for me.

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

Question 25 of 32

Anyone can talk about changing; I’m actually doing something about it.

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

Question 26 of 32

All this talk about change is boring. Why can’t people just forget about their problems?

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

Question 27 of 32

I’m here to prevent myself from having a relapse of my problem.

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

Question 28 of 32

It is frustrating, but I feel I might be having a recurrence of a problem I thought I had resolved.

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

Question 29 of 32

I have worries but so does the next person. Why spend time thinking about them?

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

Question 30 of 32

I am actively working on my problem.

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

Question 31 of 32

I would rather cope with my faults than try to change them.

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

Question 32 of 32

After all I had done to try and change my problem, every now and then it comes back to haunt me.

A

Strongly Disagree

B

Disagree

C

Undecided

D

Agree

E

Strongly Agree

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