What Is Assertiveness Worksheet Template Page 7
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9--------------------------------------------------------------------------------------------------------------ASSERT YOURSELF!
may find giving compliments to strangers relatively easy and rate themselves at 0 in this cell,
but have a lot of difficulty giving compliments to authority figures such as their boss and so
rate this cell at 4.
Exercise. Rating your assertiveness in different situations
Fill in each cell using a scale from 0 to 5. A rating of “0” means you can assert yourself with no
problem. A rating of 5 means that you cannot assert yourself at all in this situation.
Friends
Friends of
Authority
Strangers
Work
Intimate
Shop
of the
different
figures
colleagues
relations
assistants
same
gender
or spouse
gender
Saying No
Giving
compliments
Expressing
your opinion
Asking for help
Expressing
anger
Expressing
affection
Stating your
right and
needs
Giving
criticism
Being criticised
Starting and
keeping a
conversation
going
Keep a copy of your responses to this exercise as you will use it in Module 10 when you
create your own assertiveness plan. You will also be able to complete it again once you have
finished all the modules to see if you have improved your assertiveness.
C
entre for
C I
linical
Module 1: What is Assertiveness
Page 7
nterventions
• Psychotherapy • Research • Training
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