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Are You Ready to Mediate? |
A "download and print" version of this form is available
here.
When a marriage or a couple's relationship is coming to an
end, the willingness to
cooperate with the other
party often does not come easily. Sometimes, one party is of
the opinion that the other is responsible for the prevailing
loss and accompanying pain. The situation is more difficult
of resolution when the custody of children is an issue.
The purpose of this exercise is to assist you in realizing
the extent to which you are ready to pursue the mediation
process as a means of arranging how you are to spend your
time with your children, and further, how you can best
exercise your responsibilities. It is most important that
you consider carefully your thinking and feelings about each
item before responding.
 The
scale of 1 to 5 represents a range of thoughts and feelings.
Number 1 indicates that you are not ready or have strong
negative thoughts or feelings about the issue. Progressively
up to number 5, your thoughts and feelings are less negative
and less reluctant and a 5 indicates that you are quite
positive about the item, that, in fact, you're ready and
willing to discuss the matter toward a viable solution.
|
1 2 3 4 5 |
Do I really want to resolve the issues before us
equitably? |
|
1 2 3 4 5 |
Am I willing to put aside my anger and deal with the
issues in a rational manner? |
|
1 2 3 4 5 |
Am I willing to make some compromises and let go of
some of my hopes, fears and disappointments? |
|
1 2 3 4 5 |
Do I value the importance of the child(ren)'s
relationship with their other parent? |
|
1 2 3 4 5 |
Am I willing to work towards our most constructive
and fairest agreement? |
|
1 2 3 4 5 |
In regards to parenting, am I willing to consider
the child(ren)'s needs above my own? |
|
1 2 3 4 5 |
Can I share the children and be separate from them
when they are with the other parent? |
|
1 2 3 4 5 |
Can I share control, authority and decision-making
regarding the children? |
|
1 2 3 4 5 |
Can I keep the children protected from my angry or
hurt feelings and complaints about the other parent? |
|
1 2 3 4 5 |
Am I openly supportive of the child(ren)'s
relationship with their other parent? |
|
1 2 3 4 5 |
Do I really believe that it is okay with me for them
to have a full relationship with that parent? |
|
1 2 3 4 5 |
Can I stick to the issues regarding the child(ren)
when we must communicate about them? |
|
1 2 3 4 5 |
Can I accept the differences that exist in the other
parent's style of parenting? |
|
1 2 3 4 5 |
Am I willing to work with the other parent to find a
way to handle the fact that we have these
differences? |
|
1 2 3 4 5 |
Am I willing to have open and forthright
communication with the other parent in order to
communicate important events/information? |
|
1 2 3 4 5 |
Am I willing that the child(ren) spend time, on an
overnight basis, with their other parent? |
|
1 2 3 4 5 |
Am I willing that the child(ren) spend time, on an
overnight basis, with their other parent's parents
(i.e., their grandparents)? |
|
1 2 3 4 5 |
Can I accept the possibility that at some point in
the future my child(ren) may well have a step-
mother or stepfather? |
|
1 2 3 4 5 |
Where I have indicated a 1 or 2 (negative) level of
thoughts or feelings, am I prepared to discuss what
my needs and interests are around that issue? |
|
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