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 children, and (2) how you can continue being an active and responsible parent.
Circle the number closest to how you think and feel right now:
|Do I value our child/ren’s relationship with their other parent?||1||2||3|
|Am I willing to consider our child/ren’s needs above my own?||1||2||3|
|Can I share our child/ren (and be separate from them) when they are with the other parent?||1||2||3|
|Can I share control, authority and decision-making regarding our child/ren?||1||2||3|
|Am I willing to protect our child/ren from my anger or hurt feelings and complaints about the other parent?||1||2||3|
|Am I openly supportive of the child/ren’s relationship with the other parent?||1||2||3|
|Is it really okay with me for them to have a full relationship with their other parent?||1||2||3|
|Can I stick to the issues about our child/ren when we are in communicate about them?||1||2||3|
|Can I accept the differences in the other parent’s style of parenting?||1||2||3|
|Am I willing to work with the other parent to find a way to handle the fact that we have these differences?||1||2||3|
|Am I willing to have open and honest communication with the other parent about our child/ren?||1||2||3|
|Am I willing to have our child/ren spent time, on an overnight basis with their other parent?||1||2||3|
|Am I ready to let go of some of my hopes, fears, and disappointments?||1||2||3|
|Am I willing to put aside my anger while dealing with the issues?||1||2||3|
|Do I really want to resolve our issues fairly?||1||2||3|
|Where I circled a 1 or 2, am I willing to discuss my needs around that issue?||1||2||3|
Number 1 shows you may not be ready to mediate at this time or have strong concerns or feelings about it.
Adapted from an instrument prepared by Portland mediator, Lois Gold, ACSW, Ray Lowe, Ed.D., of the University of Oregon, Department of Counseling and Educational Psychology.