(copyright 2013 Amy Banks MD,  Do not reprint without permission)

The C.A.R.E. Relational Assessment

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Answer the questions on a 1-to-5 scale:


1=None or never

2=Rarely or minimal

3=Some of the time

4=More often than not; medium high

5=Usually; very high

#1

#2

#3

#4

#5

Total statement score

C.A.R.E. code

1. I trust this person with my feelings.

Calm

2. This person trusts me with his/her feelings.

Calm

3. I feel safe being in conflict with this person.

Calm

4. This person treats me with respect.

Calm

5. In this relationship I feel calm.

Calm

Accepted

6. I can count on this person to help me out in an emergency.

Calm

Accepted

7. In this relationship, it's safe to acknowledge out differences.

Calm

Accepted

8. When I am with this person, I feel a sense of belonging.

Accepted

9. Despite out different roles, we treat each other as equals.

Accepted

10. I feel valued in this relationship.

Accepted

11. There is give and take in this relationship.

Accepted

12. This person is able to sense how I feel.

Resonant

13. I am able to sense how this person feels.

Resonant

14. With this person I have more clarity about who I am.

Resonant

15. I feel that we "get" each other.

Resonant

16. I am able to sense that my feelings impact this person.

Resonant

17. This relationship helps me be more productive in my life.

Energetic

18.I enjoy the time I spend with this person.

Energetic

19. Laughter is a part of this job.

Energetic

20. In this relationship, I feel more energetic.

Energetic

Safety group score

C.A.R.E. Score Results


Calm


Your score is 0


135 - 175 : High
100 - 134 : Moderate
below 100 : Low

Accepted


Your score is 0


135 - 175 : High
100 - 134 : Moderate
below 100 : Low

Resonant


Your score is 0


95 - 125 : High
70 - 94 : Moderate
below 70 : Low

Energetic


Your score is 0


75 - 100 : High
55 - 74 : Moderate
below 54 : Low