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A Question/Answer Assignment, Questionnaire Example

Pages: 2

Words: 548

Questionnaire
  1. What emotional situations do you find yourself in over and over again? I find it very hard to connect with people of the opposite sex emotionally. Whenever someone gets close to me, I find ways to push them away out of fear of being hurt.
  2. What do you expect will happen in your relationships with friends? Lovers? Family members? Colleagues? Employers? I believe I will continually have difficulty in all aspects of my life where making a commitment is required.
  3. How much of your experience do you imagine is conditioned from the past? I believe all of my present day experience is somehow caused by past experiences.
  4. How would your life be different if you were free from this conditioning? If I were free from these restraints, I would be a much happier person. I am sure that other people would enjoy being around me more as well. I would be able to produce meaningful relationships.
  5. What is it like to think of jealousy, love, or ecstasy as a chemical? It was difficult to see those emotions as chemicals at first, but essentially that is all emotions are. Everything one feels begins in the brain.
  6. What is it like to think of your emotions as addictions? Since they are chemicals, it was easier to see them as addictions. Overtime, I believe one can get used to feeling a certain way and begin to strive to continually produce that feeling.
  7. What is the benefit of thinking about emotions this way? It helps one to understand that they can be controlled.
  8. Is anything lost with this way of thinking?I believe it can cause a person to lose that euphoric feeling of being in love.
  9. What motivates your desire to heal? I want to be a part of a meaningful relationship without the fear of rejection.
  10. What enables you to stay committed to the process? This has become a cycle for me. I am able to see how I cripple my relationships. I’m getting older and I desire commitment now.
  11. What have been the primary catalysts for your healing? Seeing all of my friends get married and start families has been my biggest motivator.
  12. What tends to block the process? Fear of rejection tends to make me want to give up some time.
  13. How would your life be different if you forgave those who caused you pain? Forgiving those who caused me pain would allow me to forgive myself and understand that it was not my fault.
  14. What do you have to lose by forgiving them? I would lose nothing by forgiving them, except for the sleepless nights of wondering why they hurt me.
  15. Except some minor pride, releasing negative energy from our body is in my opinion healthy for people.
  16. What do you have to gain? I would gain peace and serenity.
  17. What helps you forgive? Being a Christian is what has helped me to forgive.
  18. What makes healing possible? My faith in Christ makes my healing possible.
  19. What does your own intuition tell you about healing the past? I know that once I do that, my future will be much happier.
  20. What stands out for you from this chapter? I enjoyed this chapter must of all because it required one to self-reflect.
  21. What difference can what you have learned make in your life? I now know that forgiving is for me and not for the person who wronged me.
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