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Solutions to improve Your Life
Online Questionnaire
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QUESTION 10 - Family Phrases

Please give a short description of your job, ex job if retired or daily activities
When finished, please click “Submit”

QUESTION 7 - List of  Events

QUESTION 6 - Initial Cause

QUESTION 11 - Anything else

Please give a  short description of your family situation.
What would you like out of our session together?
Or if you prefer, how will you know the session has worked?
Please be as specific as possible, the clearer the outcome, the easier it is to recognize when you have reached it.

Start with: “I want to be able to..”
What are the ‘symptoms’ that something is not right. How do you know something has to change? Ie Panic Attacks, avoiding situations, negative thoughts, nightmares.
What are the Triggers?
How long have you been aware of this disturbance? When did it start?
Has it evolved over time?
Are you aware of why you might be like this? Was there a specific trigger? Or if you could guess a reason, what would it be?
What EMOTIONS do these points bring up? Fear, guilt, helplessness.....
Click here for a non exhaustive list of emotions, which might help you
What particular situation/s, event/s, person/s, in your life that you would like to skip / change if you could live your life again:

Make a list of SEVERAL POINTS/ EVENTS (if appropriate) and scale them on the ‘emotional scale’
1 to 10 (10 being very high). You are scaling how you feel NOW about the event.. not how you felt then.

Just few descriptive words would do ie
1. Day dog bit me 7/10 - 2. Going for walks near a park 6/10- Seeing a dog on tv 4/10 etc
This might be too emotional to attempt at home. Don’t do anything that could bring
emotions at  uncomfortable levels. We can do this together in the session.

QUESTION 8 - Emotions

What BELIEFS about yourself have those events brought? Ie’ I am not safe’ - I ‘m helpless...’ I’m guilty, unloveable etc
Try starting with ‘I am...’ Or ‘I cannot...’   Click here for help
What phrases/beliefs/fears did you keep hearing during childhood? Ie Money does not grow on trees, be seen not heard, the world is a dangerous place....
Please tell me anything else you feel might be useful to know for our sessions together

Please fill in these 11  questions (or as many as you wish)  and click  “Submit” at bottom of page, when ready.

This will help me find the best approach to suit your specific needs, so I can provide you with fast and effective help without delay.
Answer as much as you can but do not worry if you get “stuck”, we will discuss all this face to face anyway.

Some of these questions will be less relevant to you than others. Some might be too emotional to attempt at home. Don’t do anything that could bring emotions at  uncomfortable levels.
If you are unsure at any time, you can also contact me directly:

Christine Pirrie

Mobile: 07769 571853