Suggestibility Questionnaire 1

The following is a conditioned response test designed to help your Hypnotherapist assist you more rapidly with
your program. It is important that you answer these questions truthfully, keeping in mind there are no “right” or
“wrong” answers. Go with the first answer that comes to mind after you read the question. Try not to dwell on
any question. Simply check “Yes” or “No” beside each question. Complete both suggestibility questionnaires
1&2. Follow instructions on score sheet below. Score sexuality suggestibility separately.

QUESTION YES NO
1 Have you ever walked in your sleep during your adult life?
2 As a teenager, did you feel comfortable expressing your feelings to one or both of your Maternal
and Paternal figures?
3 Do you have a tendency to look directly into people's eyes and/or move close to them when
discussing an interesting subject?
4 Do you feel that most people you meet for the first time are uncritical of your appearance?
5 In a group situation with people you have just met, would you feel comfortable drawing attention
to yourself by initiating a conversation?
6 Do you feel comfortable holding hands or hugging someone you are in a relationship with while
other people are present?
7 When someone talks about feeling warm physically, do you begin to feel warm also?
8 Do you occasionally have a tendency to tune out when someone is talking to you, and at times
not even hear what the other person is saying, because you are anxious to come up with your
side of it?
9 Do you feel that you learn and comprehend better by seeing and/or reading than by hearing?
10 In a new class or lecture situation, do you usually feel comfortable asking questions in front of
the group?
11 When expressing your ideas, do you find it important to relate all the details leading up to the
subject so the other person can understand it completely?
12 Do you enjoy relating to children?
13 Do you find it easy to be at ease and comfortable with your body movements, even when faced
with unfamiliar people and circumstances?
14 Do you prefer reading fiction rather than non-fiction?
15 If you were to imagine sucking on a sour, juicy, yellow lemon, would your mouth water?
16 If you feel that you deserve to be complemented for something well done, do you feel
comfortable if the compliment is given to you in front of other people?
17 Do you feel that you are a good conversationalist?
18 Do you feel comfortable when complimentary attention is drawn to your physical body or
appearance?
TOTAL
Suggestibility Questionnaire 2
The following is a conditioned response test designed to help your Hypnotherapist assist you more rapidly with
your program. It is important that you answer these questions truthfully, keeping in mind there are no “right” or
“wrong” answers. Go with the first answer that comes to mind after you read the question. Try not to dwell on
any question. Simply check “Yes” or “No” beside each question. Complete both 1 & 2.

QUESTION YES NO
1 Have you ever awakened in the middle of the night and felt you could not move your body
and/or could not talk?
2 As a child, did you feel that you were more affected by the tone of voice of your Maternal and
Paternal figures than by what they actually said?
3 If someone you are associated with talks about a fear that you too have experienced, do you
have a tendency to have an apprehensive or fearful feeling also?
4 If you are involved in an argument with someone, after the argument is over do you have a
tendency to dwell on what you could or should have said?
5 Do you have a tendency to tune out occasionally when someone is talking to you, perhaps not
even hear what was said, because your mind has drifted to something totally unrelated?
6 Do you sometimes desire to be complemented for a job well done, but feel embarrassed or
uncomfortable when complemented?
7 Do you often have a fear or dread of not being able to carry on a conversation with someone
you have just met?
8 Do you feel self-conscious when attention is drawn to your physical body or appearance?
9 If you have your choice, would you rather avoid being around children most of the time?
10 Do you feel that you are not relaxed or loose in body movements, especially when faced with
unfamiliar people or circumstances?
11 Do you prefer reading non-fiction rather than fiction?
12 If someone describes a very bitter taste, do you have difficulty experiencing the physical feeling
of it?
13 Do you generally feel that you see yourself less favourably than others see you?
14 Do you tend to feel awkward or self-conscious initiating touch (holding hands, kissing, etc...)
with someone you are in a relationship with while other people are present?
15 In a new class or lecture situation, do you usually feel uncomfortable asking questions in front of
the group even though you may desire further explanation?
16 Do you feel uneasy if someone you have just met looks you directly in the eyes when talking to
you, especially if the conversation is about you?
17 In a group situation with people you have just met, would you feel uncomfortable drawing
attention to yourself by initiating a conversation?
18 If you are in a relationship or are very close to someone, do you find it difficult or embarrassing
to verbalize your love for him or her?
TOTAL
Sexuality Questionnaire 1
Go with the first answer that comes to mind after you read the question. It is important that you answer these
questions truthfully, keeping in mind there are no “right” or “wrong” answers. Avoid dwelling on any question.
Simply check “Yes” or “No” beside each question. The term “Paternal or Maternal Figure” is used to designate
the primary role model who had the most influence upon you and your life. Complete both sexuality
questionnaires 1&2. Follow instructions on score sheet below.

QUESTION YES NO
1 When you were between the ages of 9 and 14, was your Paternal figure more possessive
of you and/or more physically and verbally expressive of affection for you than your
Maternal figure was?
2 If your partner ends a relationship that you wish to continue, do you find your thoughts
drifting back to your partner, and your energies turning toward restoring the relationship, to
the point where you find it difficult to concentrate on other things?
3 Is your relationship the “number one priority" in your life?
4 Do you enjoy selecting and giving gifts to your partner?
5 Do you feel that you demonstrate more outward affection and love toward your partner
than he/she does toward you?
6 Are you comfortable when your partner shows you attention or flatters you when others are
present?
7 If you suspected your partner of cheating on you, would you lay more blame on the third
party who led him/her astray than you would on your partner for being led astray?
8 Is it easier for you to express intimate feelings and attitudes than it is for your partner to do
so?
9 Would you find it easy to accept your partner's children from a previous marriage or
relationship?
10 Are you more jealous, and/or possessive of your partner then he/she is of you?
11 When you and your partner are having sex, do you desire to prolong the act as long as
possible, or to repeat the act at once or following a short rest?
12 Would you like your partner to approach you sexually more than he/she does at present?
13 Looking back to a previous relationship, were you ever rejected so badly that you
experienced tremendous physical and/or emotional pain as a result?
14 In a past relationship where you felt you had been rejected, were you capable of extreme
anger, tantrums, vindictive behaviour toward your partner, or violence? Answer "yes" if you
felt capable of one or more of these behaviours.
15 When you first meet a person to whom you are sexually attracted, is your attention initially
drawn to the area of the body below the waist, rather than above the waist?
16 Are you more socially outgoing and extroverted than your partner?
17 When there is a problem in your relationship, do you feel that, rather than just lettings
things "blow over," you need to "talk it out" with your partner before you can again feel
secure in the relationship?
18 In a relationship, do you have a need for your partner to tell you "where you stand" with
him/her?
19 Do you want to have sex more often than your partner does?
20 Would you like your partner to talk about what he/she is feeling and experiencing while you
are making love?
TOTAL
Sexuality Questionnaire 2
Simply check “Yes” or “No” beside each question. The term “Paternal or Maternal Figure” is used to designate
the primary role model who had the most influence upon you and your life.

QUESTION YES NO

1 When you were between the ages of 9 and 14, was your Paternal figure less possessive
of you and/or, less physically and verbally expressive of affection for you than your
Maternal figure was?
2 Does your anticipation of the pleasure you will receive from sex often exceed the
pleasure you actually experience from the act itself?
3 During sex with your partner, do you often fantasize about a different partner or sexual
act in order to become or remain sexually aroused?
4 Do you often find yourself wanting to hurry up and end the sex act before your partner
does?
5 During sex with your partner, is it more of a turn off than a turn on if your partner kisses
you heavily?
6 During a single evening or session of lovemaking, after you and your partner have had
sex, does he/she usually want to have sex again before you do?
7 Shortly after you complete the sexual act do you feel a desire to fall asleep, move away
from your partner, or to engage in some non-sexual activity (reading, watching
television, taking a shower, etc.) rather than "cuddle" with your partner? Answer yes if
you feel the desire, whether or not you actually do engage in the other activity.
8 After the newness of a relationship wears off do you find that your sex drive diminishes
to a level where it is appreciably lower than your partner's?
9 Thinking back to the end of a previous relationship, did you already have a new partner
in mind, or were you already involved with someone else, before the relationship
ended?
10 If your partner talks about the sex act while you are having intercourse do you find it
harder to concentrate on your sexual feelings?
11 Do you feel comfortable if your partner touches, kisses, or handles you in public?
12 Do you find excuses not to have sex with your partner more often than your partner
makes excuses not to have sex with you?
13 After you and your partner have resolved an argument or disagreement, does it usually
take you a longer time than your partner to "forgive and forget" and get back into the
mood to have sex with him/her?
14 Does it bother or annoy you to have to give your partner frequent reassurances and
compliments?
15 Do you seem to need more "alone time" away from your partner than he or she needs
away from you?
16 Instead of talking about your relationship, do you usually take the attitude that as long as
you don't complain, everything is OK?
17 When you and your partner are making love, does it make you uncomfortable if your
partner talks explicitly about what he or she is feeling or doing, or asks you to talk about
what you are feeling or doing?
18 When you first meet a person to whom you are sexually attracted, is your attention
initially drawn to the area of the body above the waist, rather from the waist down?
19 Do you think you are capable of being in love with more than one person at the same
time?
20 Does your partner want sex more often than you do?

Total
 Scoring Chart for BOTH Suggestibility & Sexuality
(based on the work of Dr John Kappas)

SCORING INSTRUCTIONS - Count only YES answers on all Questionnaires

1 SUGGESTIBILITY: the FIRST 2 questions score 10 points each if answered YES, on both
Questionnaires. Each remaining YES scores 5 points.

2 Total each Questionnaire separately for both the applicable '10' and '5' YES scores.

3 Add the totals of both Questionnaires to find the COMBINED Total.

4 Go to Chart to find suggestibility, locating Questionnaire 1's Total on the Vertical axis, and the
Combined Total on the Horizontal axis.

5 Follow chart to where the two Totals INTERSECT to find the client's suggestibility score.

6 SEXUALITY: ONLY the 1st question scores 10 points if answered YES, on both Questionnaires.
Each remaining YES scores 5 points. Total each Questionnaire separately for both the
applicable '10' and '5' YES scores.

7 Add the totals of both Questionnaires to find the COMBINED Total.

8 Go to Chart to find suggestibility, locating Questionnaire 1's Total on the Vertical axis, and the
Combined Total on the Horizontal axis.

9 Follow chart to where the two Totals INTERSECT to find the client's suggestibility score.