The Move Beyond Conflict Survey

Name

First Name

Last Name

The situation that I'm concerned about relates to:

A work situation

My primary partner

An ex-partner

A family situation

A friend

A neighbor

A service person (plumber, contractor, etc.)

A person who I am unable to have contact with. This leaves things very unresolved for me.

With this person in mind, rate how true the statements below are for you on a scale of 1-10. Depending on the situation, some statements may not apply.

1=Highly disagree 5=Neutral 10=strongly agree

1. I don’t feel heard and understood at all by this person.

2. I have no idea what this person needs from me about this.

3. The other person speaks to me in critical and condescending ways.

4. I am 100% right about my point of view. I don’t care how it impacts the other person.

5. I need the other person to get that I am right about this. That’s what matters most to me here.

6. I may not win the argument, but I get even in other ways.

7. I speak my mind quickly without much of a filter.

8. I sometimes regret some of the things I’ve said.

9. I usually need time to think before I speak. The other person talks over me before I can get my thoughts out.

10. I’d rather keep the peace and avoid conflict by not engaging.

11. I feel like there’s nothing I can say without it being taken wrong so I just stopped trying.

12. I wish I would never have to see or deal with this person again.

13. I am ready to leave the relationship or this job in order to avoid this situation or person.

14. Unfortunately, I have to deal with this person (because she/he is an ex-partner, family member, boss or co-worker), so I need to figure out how to protect my heart, emotional safety or job. I would like support in how to do this.

15. I care about this relationship. I’m motivated to work through it.

16. I care more about being respectful more than being “right.” I am willing to look at what might be causing my own reactions.

17. If I knew there was a way for me to actually be heard and understood and work towards a better outcome, I would be willing to get the support for that to happen.

18. I am aware that different personality types and different styles of communicating can sometimes contribute to conflict. I am open to learning about how this might be impacting me so I can handle difficult personalities and challenges better.

19. In an ideal world, if I could waive a magic wand so we both could be heard and understand AND have a better outcome, I’d like to know more about how to make that happen.

20. I’m normally a good communicator, but this situation triggers me. I’d like to be able to communicate without being triggered.