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"Survey for Women" by chaplains
Question Your Answer
These question are serious and will help in writing several articles and a book I am preparing.
1. Please rate the following statements by how you would apply them to yourself, and as honestly as possible.
You may choose more than one in each category
2. but answer as simply as possible.
3. If you would like to write an explanation for your answers, you may.
4. All responses will be kept confidential.
Self-Image:
5. I am a Hottie
6. I am Eye Candy
7. I am Beautiful
8. I am Good Looking
9. I am Okay
10. I am Not Attractive
11. I am Fat
12. I am a MILF
13. Other:___________
I Dress the Way I Do, Because:
14. I feel like it
15. I want to
16. I need to
17. I feel powerful when I do
18. I love what I wear
19. I like the response I get, even if it's not the response I want
20. Other:___________
I Like It When:
21. Men look at my Pictures on MySpace
22. Men get "excited" over my pictures on MySpace
23. Men relate to me as a desirable female
24. Men leave me messages about how "Hot" I am
25. Men pay any attention at all to me
26. Men leave me alone
27. Other:___________
It Bothers Me When:
28. I am posing in a way to illicit a response from men in pictures
29. I men judge me as an object
30. I am treated as less than special
31. People don't seem to see the "real me"
32. Other:___________
I am Happiest When:
33. I am appreciated
34. I am treated with respect
35. I am acknowledged
36. I am loved
37. I am sexy
38. I am shopping
39. I am successful
40. Other:___________
What I Need Most in Life to Feel Fulfilled is:
41. Love
42. Respect
43. Happiness
44. Sex
45. Money
46. Clothes
47. A Hug
48. Other:___________
The Biggest "Pain" I Deal With is Because I was/Have Been
49. Lied to
50. Hurt
51. Abandoned
52. Injured
53. Raped
54. Victimized as a Child
55. Heartbroken
56. Other:___________
I deal with the Following:
57. Addiction to medications/drugs (prescription or otherwise)
58. Alcohol
59. Over-eating
60. Temper/Anger
61. Depression
62. Other:___________
My Biggest Fear Is:
63. I won’t be a success
64. I won’t be taken seriously
65. I’ll go unnoticed
66. I won't be a good wife
67. I won't be a good mother
68. I will never find a partner in life
69. I made a mistake getting together with the one I'm with (married or not)
70. I will never get married
71. I will never find a partner who is "worthy of me"
72. I am not worthy of being loved by someone
73. My children will not be well adjusted
74. I am going to hurt my children
75. I am going to hurt myself (or hurt myself again)
76. I am a powerful person
77. I will be successful
78. I will not know how to handle success when it comes
79. I am afraid of people
80. I am afraid of going outside
81. I am afraid of speaking in public
82. I am afraid of being raped (or raped again)
83. Other:___________ (see this list for some examples: http://www.phobialist.com/reverse.html)
I Prefer the Company of:
84. Men
85. Women
86. Teens
87. Children
88. Girls
89. Boys
90. Elderly
91. Other:___________
I My Perfect World I Would Be:
92. A Model
93. A Singer/Musician
94. An Actor
95. A Director
96. A Manager
97. A Mother
98. A Bride
99. Loved by Anyone
100. Loved by Someone
101. Find love that was real and lasting
102. Other:___________
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