Questionaire (2 copies, to be filled out by safe guard and offender separately)

Power and control takes on many forms, some more apparent than others. Often power and control is intergenerational and it's forms passed down from grandparents, to parents and eventually continued generation by generation without thought or question. On the following questionaire please check all items where this has occurred at least once. If you have seen your parents use any of these forms place a "P" in the column; if you have on any occasion used one of the following forms place a "S" in the column.

Using Intimidation:

Making him/her afraid by using looks, actions, gestures

Smashing things

Destroying his/her property

Abusing pets

Displaying weapons

Using Emotional Abuse:

Putting him/her down

Making him/her feel bad about himself/herself

Calling him/her names

Making him/her think he/she is crazy

Playing mind games

Humiliating him/her

Making him/her feel guilty

Using Isolation:

Controlling what he/she does, who he/she sees and talks to,What he/she reads, where he/she goes

Limiting his/her outside involvement

Using jealousy to justify actions

Minimizing, Denying and Blaming:

Making light of the abuse and not taking his/her concerns about it seriously

Saying the abuse didn't happen

Shifting responsibility for abusive behavior

Saying he/she caused it

Using Children:

Making him/her feel guilty about the children

Using the children to relay messages

Using visitation to harass him/her

Threatening to take the children away

Using Male Privilege (where male is the abuser)

Treating her/him like a servant

Making all the big decisions

Acting like the "master of the castle"

Being the one to define men's and women's roles

Using Economic Abuse:

Preventing him/her from getting or keeping a job

Making him/her ask for money

Giving him/her an allowance

Taking his/her money

Using Coercion and Threats:

Making and/or carrying out threats to do something to hurt him/her

Threatening to leave him/her

Threatening to commit suicide

Threatening to report him/her to welfare

Making him/her drop charges

Making him/her do illegal things

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