1. Basic Information

Full Name *

Phone Number (Optional)

Email *

Number of Teens and Their Ages *

Other (please specify)

2. Emotional Insights

A. Negative Emotions

Why do you feel these negative emotions? Check all that apply. *

I feel like I can’t communicate effectively with my teen.

It’s draining to keep up with their emotional highs and lows.

I feel out of control and unable to make things better for them.

Their mood swings disrupt our daily routine.

I worry about the impact of these behaviors on their future

Other (please specify)

2. Emotional Insights

B. Desired Positive Emotions

What is stopping you from feeling these positive emotions? Check all that apply. *

I get impatient wanting quick solutions that don’t exist

I find it hard to relate to their experiences and reactions sometimes.

The unpredictability of their mood swings keeps me on edge.

It’s hard to feel hopeful when I don’t see progress.

I feel unsure about my parenting decisions.

Other (please specify)

3. Experiences

A. Negative Experiences

What negative experiences are you having as a parent of a teen? Check all that apply. *

Frequent arguments and conflicts

Stressful mornings or evenings

Feeling like walking on eggshells around the house

Frequent disciplinary actions at school

Stressful interactions with neighbors or authorities

Emotional exhaustion

Other (please specify)

3. Experiences

A. Negative Experiences

What causes these negative experiences? Check all that apply. *

Consistent and peaceful family time

Enjoyable outings and events

Relaxed conversations and interactions

Positive bonding experiences

Feeling proud of their achievements

Other (please specify)

3. Experiences

B. Desired Positive Experiences

What positive experiences do you wish to have more often as a parent of a teen? Check all that apply. *

Consistent and peaceful family time

Enjoyable outings and events

Relaxed conversations and interactions

Positive bonding experiences

Feeling proud of their achievements

Other (please specify)

3. Experiences

B. Desired Positive Experiences

What prevents you from having these positive experiences? Check all that apply. *

It’s hard to feel relaxed when any moment could turn into a conflict.

Their mood can dominate the emotional climate of our home

Behavioral issues often lead to arguments.

Trust issues and frequent conflicts make it hard to develop a closer bond.

Their dependence on reminders means they aren’t learning to be self-reliant.

Other (please specify)

4. Actions

A. Current Behaviors:

What are you doing or not doing that’s stopping you from being the parent you want to be? Check all that apply. *

Reacting impulsively to their mood swings instead of responding calmly.

Not setting or consistently enforcing clear boundaries and consequences.

Avoiding discussions about their feelings due to fear of conflict.

Overlooking the need to praise or acknowledge positive behavior changes.

Stepping in too quickly to solve problems instead of letting them figure it out.

Other (please specify)

4. Actions

B. Desired Behaviors

What can you do to improve your parenting? Check all that apply. *

Practicing patience and taking a moment to breathe before responding.

Establishing and maintaining clear, consistent rules and consequences.

Encouraging open dialogue about emotions in a safe space

Actively looking for and reinforcing positive behaviors with praise.

Creating daily or weekly tasks that require them to apply specific life skills.

Other (please specify)

6. Outcomes

A. Past Attempts:

What have you tried and failed at when it comes to parenting teens? Check all that apply. *

Attempting to reason with them when they are highly emotional.

Setting strict rules to control their behavior during mood swings.

Implementing disciplinary measures that seemed to increase rebellion.

Seeking help from school counselors or teachers without seeing improvement.

Other (please specify)

6. Outcomes

B. Envy

What are you envious about when it comes to other parents who seem to have it all together? Check all that apply. *

Their ability to maintain calm and not take things personally.

Positive and open communication with their teen.

Balancing firmness and warmth to foster respect and cooperation.

Their teen’s ability to manage schoolwork, chores, and personal projects independently.

Other (please specify)

Other (please specify) - What are you envious

7. Thoughts

A. Reasons for Not Achieving

What do you believe are the reasons you haven't yet improved your parenting? Check all that apply. *

I’m often too emotionally involved and take their behavior personally

I'm unsure about distinguishing normal teenage moodiness from more serious issues

I sometimes react emotionally, which may escalate the situation.

I worry that being too strict could harm our relationship.

There’s inconsistency in how my spouse and I handle things.

Past attempts have failed, which has discouraged me.

Other (please specify)

7. Thoughts

B. Future Outcomes

What do you think would happen if you did manage to improve your parenting? Check all that apply. *

There would be a more peaceful and stable environment at home.

My teen might feel more understood and supported, strengthening our relationship.

It could lead to better communication, helping to resolve conflicts.

Successfully managing issues could boost my confidence in my parenting abilities.

Other (please specify)

Other (please specify) What do you think

8. Goals for the Clarity Coaching Call

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Preparing for Your Clarity Coaching Call

To get the most out of your clarity coaching call, please choose one area where you would like support. You will receive a .mp3 file by email along with a link to schedule the Coaching Call. Find a safe and comfortable place to relax (Not While Driving) and listen to the recording. Ideally, listen to it before our call, but you are welcome to use it at any time that works best for you. Feel free to revisit it whenever you need support.