0| Constantly | Often | Rarely | ||
| 1 | Do I interrupt? | 0 | 5 | 10 |
| 2 | Do I pretend I am interested, even when I am not? | |||
| 3 | Do I listen to words but not to feelings? | |||
| 4 | Do I ignore a speaker who is critical or emotional? | |||
| 5 | Do I get angry at the speaker? | |||
| 6 | Do I think about my response while I am listening? | |||
| 7 | Do I avoid asking questions even when I am not sure what the speaker is saying? | |||
| 8 | Do I allow uncomfortable pauses to continue rather than prompt a reluctant continue rather than prompt a reluctant speaker? | |||
| 9 | Do I avoid acknowledging or paraphrasing what the speaker says? | |||
| 10 | Do I daydream while the speaker is talking? |
