Shame Assessment

Required Fields *

Name*

Email*

Mailing Address*

City*

State

Zip Code

Country*


Assessment Questions:




1. How does shame interfere with accountability and healing because of the following five shame impacts?*
a. isolation, withdrawal and avoidance
b. loss of resources
c. hopelessness and lack of self-worth
d. inability to self-assess or reality check
e. outward or inward rage


2. How does shame affect the nervous system?*


3. What is the difference between guilt and shame?*


4. Name four things needed to de-activate shame?*


Feedback




1. Please rate in terms of value: 1 (lowest) …………… 5 (highest)

Professional:  1 2 3 4 5
Personal:  1 2 3 4 5
Reading:  1 2 3 4 5
Self-study:  1 2 3 4 5
Questions:  1 2 3 4 5


2. Please rate from 1 (lowest)……….5 (highest)

What was the degree of ease, if needed, in communicating with me:  1 2 3 4 5
What is the quality of reading materials (ie professional in appearance,
accurate information, free of typos):		  1 2 3 4 5
Was there adequate support for the content questions:  1 2 3 4 5
Were the unit objectives supported by the home study materials:  1 2 3 4 5
Were assignments carried out in a private and secure manner:  1 2 3 4 5
Did the content lend itself to a home study format:  1 2 3 4 5


3. How many hours/minutes did the following pieces take you?

Reading:
Self-study:
Questions:


4. Anything else you’d like to say?


5. Your Helping Profession:


6. Organization Requiring CEUs:


Like you, we don't like spam. Please help us cut down on spam by entering the text you see below in the box before clicking on the "Send" button.*
captcha


page bottom effect