New Assessment

1. Do you sometimes feel lost or alone and not sure where you are in your life right now?*

2. Are you experiencing bouts of sadness or feelings of loss that scare you?*

3. Do you shut down your emotions because they feel so big right now?*

4. Do you feel overwhelmed with taking care of others right now that you can’t even think about yourself?*

5. Do you feel like you are a little lost and depression has become a way of coping for you?*

6. Do you wake up at night with fears?*

7. Are you unable to make decisions in your life right now?*

8. Do you feel alone and cut off from your friends/family/loved ones right now?*

9. Do you cry a lot and worry about why you are so emotional right now?*

10. Do you feel so busy that it you don’t have time to feel or think about yourself and your needs?*

11. Do you feel anger arises in you in unpredictable ways and takes you over when you don’t want it to?*

12. Do you feel shameful and try to keep your struggles to yourself?*

13. Do you feel fearful or confused about what direction you should take in your life right now?*

14. Do you feel ugly or out of touch with your body right now?*

15. Do you criticize yourself and your decisions that got you to this challenging place in your life right now?*

16. Do you feel anxiety in your chest or body when you think about the future?*

17. Do you avoid family and friends because you don’t want to break down in front of them?*

18. Is your mind going on overdrive every day to solve your current crisis?*

19. Do you keep feeling panic or anxiety when you try to move on in your life?*

20. Do you just push aside those feelings of resentment and frustration about the past thinking you can’t do anything about them?*

Name*

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