Question Title

* 1. Client Name

Question Title

* 2. Which of the following is the best definition of Coercive-Controlling Domestic Violence?

Question Title

* 3. Regarding anger, are the following statements True or False?

  True False
Anger is an unhealthy, unnatural human emotion and it should be repressed at all costs.
Anger is often a secondary emotion meaning that anger is sometimes a cover-up for another
emotion such as hurt, fear, or insecurity.
Anger is a signal that something is not right, that something needs to change.
If others are angry at us, we must have done something wrong.

Question Title

* 4. For each of the things listed below, indicate if the behavior is an example of Power and Control or Equality in a relationship:

  Power and Control Equality
Emotional abuse- verbal or emotional put downs, name calling, humiliation.
Shared responsibility- mutually agreeing on fair distribution of work, making family decisions
together.
Using intimidation- making one’s partner afraid by using looks, actions, gestures: smashing
things, destroying your partner’s property, displaying weapons.
Minimizing, denying, and blaming- making light of abuse, denying it happened, blaming
her/him for your behavior (“you made me hit you”).
Trust and support- supporting each other’s goals, respecting each other’s opinions, feelings and
choice of friends, interests and activities.
Accepting responsibility for yourself and your behavior, admitting being wrong,
communicating openly and truthfully.
Isolation – controlling where your partner goes, who he or she sees, limiting access to friends
and family.

Question Title

* 5. Of the three following behaviors, which is the most desirable?

Question Title

* 6. A person with good boundaries…

  True False
Has trouble saying “no”
Can express healthy anger and refuse to be victimized.
Is able to feel clear and decisive.
Is focused more on her partner’s problems, needs and emotions than on her own.
Is secure, grounded and able to cope.

Question Title

* 7. List two ways in which you can increase your self-esteem.

Question Title

* 8. List two ways helpful ways to handle stress.

Question Title

* 9. True or False?

  True False
Alcohol causes domestic abuse.
It is okay to hit one’s partner when angry.
Taking a time out is a good idea if emotions become too intense during an argument.
Extreme possessiveness and jealousy early in a relationship may be an indicator of an abuser and/or
power and control.
The following are reasons a woman may find herself in an abusive relationship: a family history of
abuse, low self-esteem and feeling trapped because she made a commitment to the relationship before
finding out he is abusive.
The best way to ensure a positive self-esteem in our children is to offer frequent praise, gentle
constructive criticism, and unconditional acceptance and love.
A partner refusing to let you spend time with your friends or family is a form of
psychological/emotional abuse.
If you can’t reach an agreement in a conflict, it is a good idea to ask family or friends to get involved.
It is possible to change another person if you work really hard at it and don’t give up.

T