Check In Sheet

Hi! My name is: __________________________ and I’m in group because I am a

partner of: Sex Addict and/or Intimacy Anorexic and I am healing from:
Please try to keep your check in brief. This is your check-in so try to keep to the issues YOU are
working on, not your husbands, not your b/f, mother’s fathers etc. Words NOT to use during check-in
or feedback; ‘you’, ‘they’ and ‘he’.
Mothering
Spending/Shopping Codependency
Escaping Control/Avoidance
Low Self-esteem Eating Disorders
Other: ________ Dissociation

This week for recovery work I completed: Exercise #______Step #______

I am currently working on ________________boundary.

ACTING OUT AND ACTING IN

Spiritualizing Eating
Checking up on him Sleeping
Not being able to separate Negative Self-talk
Controlling Fantasy/Escaping
No Sex/ Hypersexual Self-Pity
Changing boundaries Isolation
Shaming Uglifying
Rages Avoidance
Scoping out women TV
Pretending in a perfect marriage Shopping
Sarcasm Dissociation
Hitting Him Stuffing Anger
Using his problems not to deal Seductive dress
with my feelings Romance/Erotica Novels
Reinforcing fears of abandonment Poor Choices
Spiritualizing or rationalizing Inflicting pain on self
staying when he’s not recovering Crying
Lying Passivity
Cursing Frumpifying
Alcohol Overworking/working longer
Focus on children Focus on the future
Internet relationships Over Entertaining
Reading Sports
Volunteering Porn/masturbation
Emotional Affair Outside sexual activity
Intimacy Anorexica Acting In
W/H love- affection
W/H praise and appreciation from partner
Control or create distance with silence and anger
Ongoing or ungrounded criticism
W/H sex or disconnected during sex
W/H spiritual connection
W/H authentic feelings
Staying Busy to avoid time with partner
Blame your spouse not taking responsibility for your part of conflict
Control or shame with money issues

This week or today I felt____________________________, I remember the first time I felt

___________________ was when __________________________________.

My 5 commandments this week (THESE ARE YOUR PERSONAL COMMANDMENTS)

Morning Prayer
Reading recovery material
Calls to others
Attending Group
Evening Prayer
My Spiritual self-care this was _____________________________________
My self-care this week was _______________________________________
What I like about myself today is ___________________________________

3 Dailies w/spouse ___/7

Date night agreement Y/N
Sex agreement Y/N