Schema Therapy


SAMPLE ITEMS FROM THE YPI


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Name______________________________________________     Date____________________________


INSTRUCTIONS:  

Listed below are statements that you might use to describe your parents. Please read each statement and decide how well it describes your parents.  Choose the highest rating from 1 to 6 that describes your mother, then your father, when you were a child and write the number in the spaces before each statement.  If someone substituted as your mother or father, please rate the scale for that person.  If you did not have a mother or a father, leave the appropriate column blank.


RATING SCALE:

1  =  Completely untrue                              
2  =  Mostly untrue                                   
3  =  Slightly more true than untrue                    
4  =  Moderately true
5  =  Mostly true
6  =  Describes him/her perfectly


MOTHER
FATHER
     DESCRIPTION               
__________
__________
1.  Loved me, treated me as someone special.
__________
__________
2.  Spent time with and paid attention to me.
__________
__________
3.  Gave me helpful guidance and direction.
__________
__________
4.  Listened to me, understood me, shared feelings with me.
__________
__________
5.  Was warm and physically affectionate.
*ed
__________
__________
6.  Died or left the house permanently when I was a child.
__________
__________
7.  Was moody, unpredictable, or an alcoholic.
__________
__________
8.  Preferred my brother(s) or sister(s) to me.
__________
__________
9.  Withdrew or left me alone for extended periods.
*ab
__________
__________
10.  Lied to me, deceived me, or betrayed me.
__________
__________
11.  Abused me physically, emotionally, or sexually.
__________
__________
12.  Used me to satisfy his/her needs.
__________
__________
13.  Seemed to get pleasure from hurting people.
*ma
__________
__________
14.  Worried excessively that I would get hurt.
__________
__________
15.  Worried excessively that I would get sick.
__________
__________
16.  Was a fearful or phobic person.
__________
__________
17.  Overprotected me.
*vh
__________
__________
18.  Made me feel I couldn't rely on my decisions or judgment.
__________
__________
19.  Did too many things for me instead of letting me do things on my own.
_________
__________
20.  Treated me as if I were younger than I really was.
*di
__________
__________
21.  Criticized me a lot.
__________
__________
22.  Made me feel unloved or rejected.
__________
__________
23.  Treated me as if there was something wrong with me.

THE REMAINING ITEMS ARE NOT REPRINTED HERE.

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                                                     COPYRIGHT 2014  Jeffrey Young, Ph.D.  Unauthorized reproduction without written consent of the author is prohibited.