Assertive Communication Questionnaire

Learn how your client communicates by issuing the Assertive Communication Questionnaire to see if they are passive, manipulative, aggressive, or assertive.

By Matt Olivares on Jun 20, 2024.

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Assertive Communication Questionnaire PDF Example
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What is Assertive Communication?

Before we discuss what the Assertive Communication Questionnaire is all about, let’s briefly talk about Assertive Communication.

Assertive Communication is a type of communication that takes into account a person’s feelings, thoughts, boundaries, and needs. Assertive communicators show confidence with no hint of aggression or condescension while also taking into account the same things on the part of the other party or parties involved in the conversation.

This type of communication is healthy and helpful, and learning this skill will help people find a sense of self-esteem and self-worth to prevent them from being undermined or invalidated when conversing with others. It is a way for people to step up and respond to others confidently and honestly but with the amount of empathy that they, too, would like to be shown when being conversed with. This will lead them to more fruitful and positive conversations.

Before a therapist puts their client under assertive communication training, they must first assess the client for communication issues, as well as how they communicate in the first place. One way of doing that is to issue the Assertive Communication Questionnaire, which can give the therapist an idea of what the patient is like in conversations.

Printable Assertive Communication Questionnaire

Download this Assertive Communication Questionnaire to better learn how your clients communicate.

How the Assertive Communication Questionnaire works

The Assertive Communication Questionnaire is a sixty-item questionnaire that can be conducted in two ways.

The first one would be to conduct it like an interview. If you’re going to conduct it this way, you will simply tell the patient to answer with “Rather True” or “Rather False” after reading aloud each statement on the questionnaire.

The other way of doing it is to issue the questionnaire to your client and have them answer it on the spot. They simply need to tick either one of the answers for each statement.

The upside to the first one is that you will have the opportunity to have them explain themselves and expound on their answers. You might cover more ground quickly by doing that. Either way works, though, so it’s up to what you believe suits your style the most.

Some of the questionnaire’s items include:

  • I often say “yes”, when I really want to say “no” 
  • I’m sometimes accused of contradicting myself
  • I’m not afraid to criticize and tell people what I think
  • It is hard for me to listen to others
  • I communicate with others based on trust rather than domination or calculation
  • I’m talkative and I tend to interrupt others without noticing it in time
  • I’m not afraid to express what I’m feeling

If they answer “Rather True,” that will count as 1 point. “Rather False” is 0.

You will tally the scores based on the following communication styles:

  • Passive (flight) = Items 1, 7, 15-17, 25-26, 35-37, 50-52, and 59-60
  • Aggressive (attack) = Items 4, 6, 10-11, 20-21, 28-30, 39-40, 48-49, and 55-56
  • Manipulation = Items 3, 5, 9, 12-13, 19, 22, 31-32, 41-42, 46-47, 54, and 57
  • Assertive = 2, 8, 14, 18, 23-24, 27, 33-34, 38, 43-45, 53, and 58

There are no directives for the results, but you, the therapist, would like to focus on making them more assertive. If they score high on Passive, Aggressive, and Manipulation, you might want to look into helping them unlearn these, so they become healthier when it comes to communicating with others.

Assertive Communication Questionnaire Example

Now you know what Assertive Communication is and how the Assertive Communication Questionnaire can be conducted, what clients need to do to answer it, and how to interpret the scores, it’s time for you to see what it looks like. We adapted this questionnaire from the version created by Pro Mind Consulting SA back in 2012, which they adapted from the book Assertiveness (D. Chalvin, Editions ESF, 1981).

If you like what you see and believe this is a good way to gauge how your clients communicate with others, then feel free to download it – it’s free! You can print it and fill it out with a pen, or you can go paperless! The free Assertive Communication Questionnaire PDF template has tickable checkboxes and fields to indicate your scores.

Download this Assertive Communication Questionnaire Example:

Assertive Communication Questionnaire Example

When is it best to use the Assertive Communication Questionnaire?

Before using the Assertive Communication Questionnaire, you must first determine if your client has a communication problem and if it has impacted their mental health. Once you have surmised that this is a problem for them, then let them know that you will issue the Assertive Communication Questionnaire. Explain what this questionnaire is and why you are issuing it. Ask them if they are ready to answer the questionnaire, then either conduct it like an interview or hand them a copy of the sheet to answer independently.

Once they finish answering the questionnaire, tally the scores and see how much they scored for each communication type. Once you have the results, explain the scoring to your client.

If they scored low for Assertive, then ideally, you want them to score higher next time. If they score high for the other three, well, that might be a problem. If they score high for Passive, then they are likely to be susceptible to being undermined or talked over during conversations, and they won’t do anything about it. If they score high for Aggressive, they might be prone to start fights and even burn bridges. If they score high for Manipulative, well, that’s problematic.

Once you have determined their communication styles based on the results, you must tailor-fit your assertive communication training to help them become more Assertive and unlearn being Passive, Aggressive, and/or Manipulative.

What are the benefits of using the Assertive Communication Questionnaire?

It can help therapists understand their clients’ communication styles.

The great thing about the Assertive Communication Questionnaire is that it is an easy way for the therapist to get to know the client better regarding how they communicate with others. Are they passive? Are they aggressive or manipulative? Or are they assertive? Their self-ratings for each statement will elucidate what they are like, or at least what they tend to be like in conversations. Based on the results, the therapist will be able to determine what they need to focus on when teaching them assertive communication skills.

It can help clients become self-aware about how they communicate.

Given that clients will be the ones rating themselves based on the statements on the questionnaire, this assessment has the chance to instill a sense of self-awareness in them and make them realize what they are like when communicating with others. There are people who are actually unaware of what they’re like when conversing with others unless it’s pointed out to them, so by discussing the results with them, they might realize where they might be problematic and what they need to focus on. The first step to self-improvement is to first be self-aware.

It can be used to track a client’s progress.

If you have been giving your client exercises throughout your program and they’ve learned how to be more assertive and have unlearned problematic traits related to passive, aggressive, and manipulative communication, then you can issue this to your client again and see how they fare this time. If they get better scores than the first time they’ve answered the questionnaire, then it’s fair to say that what you’ve taught them worked, and they’ve been constantly applying what they’ve learned to the point that their communication has taken a positive turn.

Why use Carepatron for therapy-related work?

If you’re a therapist or an adjacent mental health professional looking to help clients work through their mental health troubles, especially if these troubles have something to do with their communication skills or the lack thereof, then we’d like to ask you to set some time aside to explore the Carepatron platform.

We have numerous features that will help you with your work. One that we believe will make the most impact for you is our library of clinical resources. It’s one of the features that we’re most proud of.

This library houses a massive collection of worksheets (we have an Assertive Communication Worksheet that you might want to add to your roster), assessments (including this questionnaire and other things like depression scales), survey templates, form templates, general treatment plans, progress note templates, and much more! It even covers various therapy types like Cognitive Behavioral Therapy, Dialectical Behavior Therapy, Family Therapy, Art Therapy, and more! Download as many resources as you want and nee. If it helps you cover more ground with your work and gauge your clients better, then we’re happy.

If you subscribe to Carepatron, you’ll gain access to our awesome and secure storage system. This storage system will allow you to store your clinical files with us in a HIPAA-compliant manner, which means that not even we can access them because only you can set the access permissions. You can even store filled-out copies of the Assertive Communication Questionnaire if you want. Storing files with us is the same as creating backups for your files. If ever you lose physical copies, your work device gets destroyed, or you somehow lose your Dropbox or Google account, you can grab your files from the storage and reprint them and create copies on a new work device or another personal cloud storage of yours.

Not only will Carepatron help you streamline your workflow, but we can also help preserve your work by securing them!

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How long does it take to answer the Assertive Communication Questionnaire?
How long does it take to answer the Assertive Communication Questionnaire?

Commonly asked questions

How long does it take to answer the Assertive Communication Questionnaire?

It depends on the person answering. The instructions are simple enough that it’s possible to complete within 10 to 15 minutes (including thinking about answers) but don’t be surprised if it takes longer, especially if you conduct it as an interview.

What do I do after calculating the scores of this worksheet?

Shape the assertive communication training program of your patient to accommodate their current strengths and weaknesses based on the results. If they are aggressive and/or manipulative, then you must create a program that will help them unlearn those communication styles.

What if I’m not a therapist or a person taking therapy? Can I answer this questionnaire for personal reasons?

Yes. But please don’t consider this as a substitute for therapy. If you have problems with communication and it is severely impacting your mental health, we recommend seeing a therapist who can teach you assertive communication.

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