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HOW
READY AM I FOR MEDIATION?
When
a relationship is coming to an end or has ended, cooperating with the other
parent is not always easy. Sometimes
one parent believes the other has caused the feelings of disappointment, loss
and pain. This questionnaire will help you realize how ready you are to use
mediation to decide:
(1)
how you are to spend time with your child/ren.
(2)
how you can continue being an active and responsible parent.
Circle
the number closest to how you think and feel right now
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No
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Somewhat
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Yes
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1.
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Do I value our child/ren's
relationship with the other parent?
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1
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2
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3
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2.
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Am I willing
to consider our child/ren's needs above my own?
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1
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2
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3
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3.
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Can I share
our child/ren (and be separate from them) when they are with the other
parent?
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1
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2
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3
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4.
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Can I share
control, authority and decision-making regarding our children?
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1
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2
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3
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5.
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Am
I willing to protect our child/ren from my angry or hurt feelings and
complaints about the other parent?
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1
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2
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3
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6.
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Am I openly.
supportive of the child/ren's relationship with their other parent?
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1
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2
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3
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7.
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Is it really
OK with me for them to have a full relationship with their other parent?
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1
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2
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3
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8.
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Can I stick
to the issues about our child/ren when we communicate about them?
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1
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2
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3
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9.
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Can I accept
the differences in the other parents style of parenting?
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1
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2
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3
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10.
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Am I willing
to work with the other parent to find a way to handle the fact that we
have these differences?
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1
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2
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3
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11.
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Am I willing
to have open and honest communication with the other parent about our
child/ren?
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1
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2
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3
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12.
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Am l willing
that our child/ren spend time, on an overnight basis with their other
parent?
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1
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2
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3
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13.
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Am I ready,
to let go of some of my hopes, fears and disappointments?
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1
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2
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3
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14.
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Am I willing
to put aside my anger while dealing with the issues?
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1
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2
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3
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15.
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Do I really
want to resolve our issues fairly?
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1
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2
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3
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16.
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Where I
circled a 1 or 2, am I willing to discuss my needs around that issue?
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1
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2
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3
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Number 1 shows you
may not be ready to mediate this item, or have strong concerns or feelings about
it. Where you circled 1 or 2 please
describe your concerns on the other side.
~Adapted
from an instrument prepared by Portland mediator Lois Gold, ACSW, Ray Lowe. EdD
of the Universe of Oregon, Department of Counseling and Educational
Psychology
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