NICHD SECCYDWisconsin

MY RELATIONSHIP WITH MY FATHER

1 MONTH

Please circle one: Father Stepfather

The following questions are designed to learn more about your current relationship with your father. Please
circle the number that best characterizes your father today.

Not Very
at all much

1. My father and I enjoy spending time together. 1 2 3 4 5

2. My father believes that mothers should stay home with their
1 2 3 4 5
children rather than work.
3. If I have a problem, I can go to my father and talk about it. 1 2 3 4 5
4. Assuming that circumstances permitted it, I would feel comfortable
1 2 3 4 5
having my father care for my child/children for a week.
5. I am closer to my father now than I was as a child. 1 2 3 4 5
6. The most important aspect of my fathers life is his family. 1 2 3 4 5
7. My father is critical of my choice of a spouse/partner. 1 2 3 4 5
8. Its easy for my father to tell me what he is thinking. 1 2 3 4 5
9. I wish my father and I had a better relationship. 1 2 3 4 5
10. If I needed financial help and he was able to provide it, I would not
1 2 3 4 5
hesitate to ask my father for help.
11. I wish I had a different father. 1 2 3 4 5
12. My father is critical of how I raise my children. 1 2 3 4 5
13. I wonder if my father loves me. 1 2 3 4 5
14. My father is quiet and distant. 1 2 3 4 5
15. My father is critical of my career choice. 1 2 3 4 5
16. My father is comfortable with physical affection. 1 2 3 4 5
17. I am very close to my father. 1 2 3 4 5
18. My father doesnt approve of how I live my life. 1 2 3 4 5
19. I have not lived up to my fathers expectations. 1 2 3 4 5
20. My father admires how I handle my finances. 1 2 3 4 5
21. The most important aspect of my fathers life is his work. 1 2 3 4 5
 NICHD SECCYDWisconsin

MY RELATIONSHIP WITH MY FATHER

36 MONTHS

Please circle one: Father Stepfather

Please circle the number that best describes your relationship with your father today.

Not Very
at all much

1. My father and I enjoy spending time together. 1 2 3 4 5

2. If I have a problem, I can go to my father and talk about it. 1 2 3 4 5

3. Assuming that circumstances permitted it, I would feel comfortable

1 2 3 4 5
having my father care for my child/children for a week.

4. The most important aspect of my fathers life is his family. 1 2 3 4 5

5. My father is critical of my choice of a spouse/partner. 1 2 3 4 5

6. Its easy for my father to tell me what he is thinking. 1 2 3 4 5

7. I wish my father and I had a better relationship. 1 2 3 4 5

8. If I needed financial help and he was able to provide it, I would not
1 2 3 4 5
hesitate to ask my father for help.

9. I wish I had a different father. 1 2 3 4 5

10. My father is critical of how I raise my children. 1 2 3 4 5

11. I wonder if my father loves me. 1 2 3 4 5

12. My father is quiet and distant. 1 2 3 4 5

13. My father is critical of my career choice. 1 2 3 4 5

14. My father is comfortable with physical affection. 1 2 3 4 5

15. I am very close to my father. 1 2 3 4 5

16. My father doesnt approve of how I live my life. 1 2 3 4 5

17. I have not lived up to my fathers expectations. 1 2 3 4 5