Instructions:	Participant #_______

This form lists various attitudes and behaviors of parents and caretakers. As you remember your MOTHER (or the person most like a mother to you) over the years, please circle the most appropriate number next to each question.

Very likely	Moderately

likely	Moderately

unlikely	Very unlikely
1. Spoke to me with a warm and

friendly voice	1	2	3	4	(32)

2. Did not help me as much as I needed	1	2	3	4	(33)
3. Let me do things I like doing	1	2	3	4	(34)
4. Seemed emotionally cold to me	1	2	3	4	(35)
5. Appeared to understand my problems

and worries	1	2	3	4	(36)
6. Was affectionate to me	1	2	3	4	(37)
7. Liked me to make my own decisions	1	2	3	4	(38)
8. Did not want me to grow up	1	2	3	4	(39)
9. Tried to control everything I did	1	2	3	4	(40)
10. Invaded my privacy	1	2	3	4	(41)
11. Enjoyed talking things over with me	1	2	3	4	(42)
12. Frequently smiled at me	1	2	3	4	(43)
13. Tended to baby me	1	2	3	4	(44)
14. Did not seem to understand what I

needed or wanted	1	2	3	4	(45)
15. Let me decide things for myself	1	2	3	4	(46)
16. Made me feel I wasn't wanted	1	2	3	4	(47)
17. Could make me feel better when I

was upset	1	2	3	4	(48)
18. Did not talk with me very much	1	2	3	4	(49)
19. Tried to make me dependent on her	1	2	3	4	(50)
20. Felt I could not look after myself

unless she was around	1	2	3	4	(51)
21. Gave me as much freedom as I

wanted	1	2	3	4	(52)
22. Let me go out as often as I wanted	1	2	3	4	(53)
23. Was overprotective of me	1	2	3	4	(54)
24. Did not praise me	1	2	3	4	(55)
25. Let me dress in anyway I pleased	1	2	3	4	(56)

The person I just described is: (Circle one)

1 = My natural, biological mother

2 = My adopted mother

3 = My step-mother	(57)

4 = My foster mother

5 = Someone else (please give name and relationship to you) _________________________