Symptoms Checklist


It can be difficult to determine when to go to therapy. The Symptoms Checklist is intended as a guideline for you to clarify what you are currently experiencing and may wish to work on.Please check the boxes that indicate any of the areas that are currently problems for you.
Place TWO check marks to indicate the most important reason(s).To download a printer friendly version CLICK HERE.
_____ Feeling nervous or anxious _____ Use/abuse of alcohol and/or drugs
_____ Feelings of panic _____ Difficulty with school or work
_____ Under pressure and feeling stressed _____ Concerns about finances
_____ Needing to learn to relax _____ Having difficulty being honest/open
_____ Afraid of being on your own _____ Having difficulty communicating
_____ Feeling angry much of the time _____ Having a hard time making friends
_____ Concerns about your violence _____ Having a hard time keeping friends
_____ Difficulty expressing emotions _____ Wishing you were more social
_____ Feeling inferior to others _____ Feeling pressured by others
_____ Lacking in self-confidence _____ Feeling controlled/manipulated
_____ Feeling down or unhappy _____ Marital or couple problems
_____ Feeling lonely and/or isolated _____ Family difficulties
_____ Guilty feelings _____ Difficulties with children
_____ Feeling down on yourself _____ Break-up of a relationship
_____ Thoughts of taking your own life _____ Difficulties in sexual relationships
_____ Recent trauma or loss in your life _____ Feeling guilty about sexual activities
_____ Concerns about emotional stability _____ Feelings related to molestation or rape
_____ Feeling cut off from your emotions _____ Concerns about childhood abuse
_____ Wondering “Who I am” _____ Concerns about your weight
_____ Difficulty making decisions _____ Difficulties with weight control
_____ Feeling confused much of the time _____ Concerns about your physical health
_____ Difficulty controlling your thoughts _____ Concerns about your appearance
_____ Difficulty controlling your actions _____ Performing ritualistic behaviors
_____ Being suspicious of others _____ Fear of losing control

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