Relationship Readiness Review after Your Divorce
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Name______________________________________Date______________________Address ___________________________Telephone Numbers___________E-mail Address: _________________
Please fill in the circle that most closely matches your reaction to the question and mail to Sat Tara Kaur Khalsa, MS, LPC, P.O. Box 20874, Boulder, CO 80308
1. I seek the company of other people frequently.
2. I am able to trust a member of the opposite sex.
3. I feel reasonably ready to go on a date.
4. I maintain my sense of self in a relationship.
5. I feel ready to work on a long-term relationship.
6. I can relate to my ex in a reasonable manner.
7. I can usually reveal secrets easily to the right person.
8. I am a loner.
9. My parents had a healthy relationship.
10. I feel ready to be sexual in a relationship with someone I trust.
11. I have some fears about being with someone sexually.
12. I have many close friends.
13. I handle criticism well.
14. I have had a healthy sexual relationship in the past.
15. I am usually comfortable when anger or disagreements first arise in a relationship.
16. I can go 24 hours without a thought about my past relationship.
17. I am comfortable with my body.
18. I have abused substances for a period of time in the past 5 years.
19. I am comfortable if I realize someone is attracted to me.
20. I experienced physical or sexual abuse as a child.
21. I experienced a good level of intimacy in my last relationship.
22. My parents were easy to open up to.
23. When I meet a person, they usually like me.
24. I know my own relationship patterns.
25. I think I could be ready for an exclusive relationship six months from now.R
ELATIONSHIP READINESS REVIEWI am currently offering a 3-session personal package I call RELATIONSHIP READINESS REVIEW to help you better asses your readiness to have a healthy, fulfilling long-term relationship.
Areas of focus include:
The ability to deal with fear, rejection, shyness, and isolation
Assessing if a potential partner is a good candidate for intimacy
Learning how to stop working against yourself in intimate relationships
What to look for in a partner so they suit your individual strengths and weaknesses
Gaining confidence in dating, choosing a partner and in relationships
Focused work on the specific areas that hold you back from having a healthy, happy, healing relationship
This process can be educational, empowering, and deeply healing. You can give me a call at 303-530-7080. I look forward to hearing from you!