change questionnaire

i am currently playing with an adaptation of the readiness for change questionnaire for personal changes.  there are 50-odd questions (i’ll probably pare it down to about 35, 40 – less, hopefully, with your help!).  as i’m doing this i’m interested in all the different angles change can be looked at, and am also thinking of maybe turning this into a little research project.  after all, this blog is called change therapy!

i would love to have your thoughts.  are these useful questions?  what do they make you think of?  how might they help YOU make changes?

ok, here starts the adaptation  (in capital letters, of all things!  jan, are you reading this?)

The questionnaire is comprehensive and is intended to provide a way for people

desiring change to scan and evaluate the many factors that may influence

change readiness. It can be used to identify the factors that will support

and facilitate a given change, as well as to flag possible pitfalls and difficulties.

Some of the questions may not apply to you: leave them blank.  Some may seem to apply, but they seem “off” in some way, not phrased just right for your situation. Please answer these questions, but make a note as to how the question should be rephrased to apply to your situation.

A. This questionnaire assumes that you either see a need for change, or that someone else has proposed a change. Whichever is the case, take a moment to define for yourself what change you have in mind as you go through this questionnaire, and describe it very briefly below.

___________________________

___________________________

1. What is your likely relationship to the change? Check as many items as apply to you.

a. I want to change.

b. I think I should change but I am not 100% enthusiastic about it.

c. I have been told it would be good to change, or that I should change.

d. I have been forced to change.

e. I think there is some change happening in the future, and I think I should/want to prepare for it.

2. How much information do you have about the proposed change?

a) I am fully informed.

b) I have some information.

c) I have little information.

d) I have no information.

0) No change has yet been proposed.

B. The need for change.

3. Is there a need for change?

a) Yes, definitely.

b) Probably; I think so.

c) I’m not sure; I don’t know.

d) No, not at this time.

4. What circumstances tell you that there is or might be a need to change?

________________________________

________________________________

5. What are your personal experiences, thoughts or feelings that tell you there is or might be a need to change?

________________________________

________________________________

6. In relationship to the needed or proposed changes, which statement best reflects the current situation?

a) I know exactly what to do, have a plan for doing it, and am currently

implementing the plan.

b) I know exactly what to do, have a plan for doing it and haven’t begun to

implement the plan.

c) I know exactly what to do and have no plan for doing it yet.

d) I have a general idea of what to do, have a plan for doing it, and am currently

implementing the plan.

e) I have a general idea of what to do, have a plan for doing it and haven’t begun to implement the plan.

f) I have a general idea of what to do and have no plan for doing it yet.

g) I don’t know what to do but am experimenting with some things anyway, such as ___________________

h) I don’t know what to do.

i) Even if I knew what to do, I wouldn’t know how to plan or implement it.

C. The Approach to Change

7. How do you think you might go about making the needed changes?

________________________________

________________________________

D. The Urgency of Change

8. How urgent is the need for change?

a) It is imperative that I change now.

b) I need to change soon.

c) I will need to change in the foreseeable future.

d) The need is not urgent.

9. How long can the change be put off before it gets intolerable for me?

a) The current situation already has seriously impacted me

b) ___ Weeks.

c)____  Months.

d) A year or more.

10. How long can the change be put off before it gets intolerable for my family?

a) The current situation already has seriously impacted my family

b) ___ Weeks.

c)____  Months.

d) A year or more

e) It doesn’t matter because ______________________________________

E. Magnitude of Change Required:

11. What is the magnitude of change needed to make a substantial improvement in the current situation? (Check as many as apply.)

a. A small/medium/large amount of change in finances, most importantly from __________ to ____________

b. A small/medium/large amount of change in some/many/all of my relationships, most importantly from _________________ to ______________________

c. A small/medium/large amount of change at work, from __________ to ____________

d. A small/medium/large amount of change in my behaviour, most importantly from __________ to ____________

e.  A small/medium/large amount of change in my thoughts, most importantly from __________ to ____________

f.  A small/medium/large amount of change in my feelings, most importantly from __________ to ____________

g.  A small/medium/large amount of change in my motivation, most importantly from __________ to ____________

h.  A small/medium/large amount of change in my spiritual life, most importantly from __________ to ____________

i.  A small/medium/large amount of change in my physical health, most importantly from __________ to ____________

j.  A small/medium/large amount of change in  ___________________________, most importantly from __________ to ____________

F. Criteria of Successful Change

12. How will you know that the needed change has occurred? (Please give as concrete examples and indicators as you can.)

a. I will know ___________________________________________ has changed when ___________________________, _____________________________, and _______________________

G. Resources

Change sometimes requires extra resources. How available are the following resources for carrying out the change?

13. Support from people:

a) People who and are already supporting me or have indicated they are eager to support me, e.g. ____________________________________________  ________________________________________(list as many as you can think of)

b) People who I think are willing to support me, e.g.  ______________________  ________________________________________(list as many as you can think of)

c) People who could possibly support me, e.g.  ______________________  ________________________________________(list as many as you can think of)

d) No-one

14. Information

a) I have all the information I need.

b) I still need to find out more about ___________________ and I can get it from  ___________________________

b) I still need to find out more about ___________________ and don’t know where I can get it

c) I’m not sure whether I have all the information.  However, I do know ______________________________________________________________

d) There’s lots I don’t know and I have no idea where to start.

15. Skills

a) I have all the skills I need.

b) I need to beef up on  ___________________ and am already committed to doing  ___________________________________________________ about it

c) I need to beef up on  ___________________ and could do  _________________________________________________________ about it

d) I need to beef up on   ___________________and don’t know how to go about it

e) I need to learn how to   ___________________ and am already committed to doing  ___________________________________________________ about it

f) I need to learn how to   ___________________ and could do  _________________________________________________________ about it

g) I need to learn how to  ___________________and don’t know how to go about it

h) I don’t have a lot of skills to deal with the change.  One skill I DO have is ________________________________________________________________

i) I have no skills whatsoever to deal with the change.

j) I have a feeling there is/are skills that I need to deal with the change but I have no idea what it is/they are.

16. Money

a) Readily available.

b) Available if I work on it a bit

c) Pretty tight.

d) None whatsoever.

***

I will post part 2 very soon.

3 thoughts on “change questionnaire

  1. Evan

    Hi Isabella, how picky do you want us to be? For instance I would change 1.a. to “I want this change”. And for Q4. what if they answered “No” for Q3? Do you want this kind of stuff?

  2. Pingback: change questionnaire, part 2 – change therapy

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