Life Transition Assessment

Please read each statement and select the number that best represents your experience over the past 2-4 weeks. There are no right or wrong answers.

Scale Key

0 = Not at all

1= Slightly

2 = Moderately

3 = Very much

4 = Extremely

Life Transition Impact

1. The life change I am experiencing feels overwhelming

2. This transition has disrupted my sense of stability or routine.

3. I feel unprepared for the demands of this transition.

4. I frequently think about this transition in a stressful or negative way.

Section 1 Subtotal: ____/16

Emotional Distress

5. I feel anxious or worried more than usual.

6. I experience sadness or low mood related to this change.

7. I feel emotionally overwhelmed or unable to cope at times.

8. My emotions feel difficult to control or manage.

Section 2 Subtotal: ___/16

Daily Functioning

9. My sleep has been negatively affected.

10. I have difficulty concentrating or staying focused.

11. My motivation to complete daily responsibilities has decreased.

12. This transition has impacted my performance at school, work or home.

Section 3 Subtotal: __/16

Adjustment and Self-Perception

17. This transition has negatively affected how I see myself.

18. I feel uncertain about my direction or future.

19. I feel confident in my ability to adapt to this change. (reverse scored)

20. I feel emotionally balanced overall. (reversed scored)

Section 5 Subtotal: __/16

Total Score Calculation

Total Possible Score: 80

Client Total Score: ____/80

Score Interpretation

0-20: Minimal Distress (Therapy not indicated. Monitor as needed)

21-40: Mild Distress (Supportive or short-term therapy recommended)

41-60: Moderate Distress (Therapy indicated to support adjustment)

61-80: Significant Distress (Strong recommendation for therapeutic intervention)