Self -Disclosure Questionnaire

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For Speech 210 (Interpersonal Communication) return to:  Syllabus   Daily Schedule

The response sheet at the end of these questions has columns with the headings "mother," "father," "male friend," " female friend."  You are to read each item on the questionnaire, and then indicate on the response sheet the extent to which you have talked about that item to each person; that is, how much have you have made yourself known to that person. 

The question fall into six groups:

Attitudes and Opinions

1. What I think and feel about religion; my personal religious views.

2. My views on the present government-- president, government, policies, etc.

3. My personal standards of beauty and attractiveness in women -- what I consider to be attractive in a woman.

4. The things that I regard as desirable for a man to be-- what I consider to be attractive in a man.

5. My feelings about how parents ought to deal with children.
    

Tastes and Interests

1. My favorite foods, the ways I like food prepared, and my food dislikes.

2. My likes and dislikes in music.

3. The kinds of movies that I like to see best; the TV shows that are my favorites.

4. My tastes in clothing.

5. My favorite ways of spending spare time, e.g. reading, cards, sports, video games, parties, dancing, etc.

Work (or Studies)

1. What I find to be the worst pressures and strains in my work.

2. What I enjoy most, and get the most satisfaction from in my present work.

3. What I feel are my special strong points and qualifications for my work.

4. How I feel about the choice of career that I have made--whether or not I'm satisfied with it.

5. How I really feel about the people that I work for, or work with, e.g. students, teachers, boss, etc.

Money

1. Whether or not I owe money; if so, how much.

2. Whether or not I have savings, and the amount.

3. Whether or not others owe me money; the amount, and who owes it to me.

4. All of my present sources of income--  wages, fees, allowances, dividends, etc.

5. How I budget my money-- the proportion that goes to necessities, luxuries, etc.

Personality

1. The aspects of my personality that I dislike, worry about, that I regard as a handicap to me.

2. Whether or not I feel that I am attractive to the opposite sex; same sex.  My problems if any, about getting
   favorable attention from the opposite sex; same sex.

3. Things in the past or present that I feel ashamed and guild about.

4. What it takes to get me feeling real depressed or blue.

5. The kinds of things that make me especially proud of myself, elated, full of self-esteem or self-respect.

Body

1. How I wish I looked; my ideals for overall appearance.

2. My feelings about different parts of my body -- legs, hips, waist, weight, chest, or bust, etc.

3. Any problems and worries that I had with my appearance in the past

4. My past record of illness and treatment.

5. Whether or not I now make special effort to keep fit, healthy, and attractive,  (e.g. diet, exercise)

Response Sheet

The self-disclosure rating scale:

0 = Have told the other person nothing about this aspect of me.
1 = Have talked in general terms about this item.  The other person has only a general idea about this aspect of me.
2 = Have talked in full and complete detail about this item to the other person.  He/she knows me fully in this respect, and could
        describe me accurately.
X = Have lied or misrepresented myself to the other person so that he/she has a false picture of me.

Directions:  Read each question and place one of the ratings above in the box for each person. (Example:  first question under
Attitudes and Opinions is: "What I think and feel about religion . . ."  Think about your mother and place a 0,1,2, or X in the box under
mother question 1.  This represents your level of disclosure to her on that item.  Do this for each person and each item.  When you
finish look for any trends.  Who do you disclose most to? least?  Which topics? etc.