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Social Networks Questionnaire
List the significant people in your life‚ those people that you currently feel a strong emotional tie to‚ regardless of whether that tie is positive‚ negative or mixed. List as many or as few people as you feel necessary. These individuals can be listed in any order. In addition‚ please fill in the other information requested about these individuals.
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Name/
Initials
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Relationship
(e.g. friend‚ brother)
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SexM/F
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Age
(yrs)
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Distance From You
1 = same house
2 = within 10 min drive
3 = within 1 hour drive
4 = within 1 day drive
5 = more than 1 day drive
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Frequency of Contact(visit‚ phone‚ write)
1 = daily/almost daily
2 = at least once/week
3 = at least once/month
4 = 3 to 4 times/year
5 = approx. once/year
6 = less than once/year
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Amount of Time
You Have Known
Each Other
(years)
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13.
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14.
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15.
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DO NOT TURN THE PAGE UNTIL THE EXPERIMENTER HAS INSTRUCTED YOU TO CONTINUE
RANKING QUESTIONS
- Whom would you want to go to‚ to help you feel better when something bad happens to you or you feel upset‚ whether or not you actually go to them?
- Whom do you actually go to‚ to help you feel better when something bad happens to you or you feel upset?
- Whom would you like to be able to count on to always be there for you and care about you no matter what?
- Whom do you feel you can actually count on to always be there for you and care about you no matter what?
- Whom is it important for you to see or talk with regularly?
- Whose death would have the greatest impact or effect on you‚ regardless of what the effect may be?
- Who can make you feel upset? (Remember that these are people with whom you have a personal relationship.)
- Rank order all of the people on your list in terms of who you feel most emotionally connected to‚ regardless of whether that connection is positive‚ negative‚ or mixed.
PLEASE RANK EVERYONE FOR THIS QUESTION.
RANKING FORM
REMINDER:
- For each question‚ only rank those individuals that apply.
- The individuals listed should be those with whom you have a personal relationship.
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Name/
Initial
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A.Want to
go to
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B.Actually
go to
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C.Like to
count on
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D.Actually
count on
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E.See/talk
regularly
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F.Impact
of death
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G.Makes
you upset
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H.Emotional
connection
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14.
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15.
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http://www.sfu.ca/psyc/faculty/bartholomew/attachnetworks1.htm
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