Healing Questionnaire

Self-Discovery Questionnaire: Uncovering Hidden Wounds and Limiting Beliefs

Before you begin:

Find a quiet, safe space where you won’t be interrupted
This is for your eyes only – be completely honest
If you feel overwhelmed at any point, take a break
Awareness is the first step toward healing
Consider having a trusted friend, counselor, or pastor available for support

Scoring Guide:

1 = Never true
2 = Rarely true
3 = Sometimes true
4 = Often true
5 = Always true

If you’ve experienced trauma, some questions may be triggering. Trust your instincts about what feels safe to explore right now.

PART A: PSYCHOLOGICAL PATTERNS

Section 1: Self-Worth and Identity

1. I feel like I have to earn love and acceptance through my performance or achievements. 2. I believe that if people really knew me, they would reject or abandon me. 3. I find it difficult to accept compliments or believe positive things about myself. 4. I feel responsible for other people’s emotions and try to fix their problems. 5. I struggle with imposter syndrome and fear being “found out” as inadequate.

Section 2: Trust and Relationships

6. I have difficulty trusting people and expect to be disappointed or betrayed. 7. I either become overly dependent in relationships or remain completely independent. 8. I attract or stay in relationships where I’m taken for granted or mistreated. 9. I have difficulty saying no and setting healthy boundaries. 10. I fear abandonment and will do almost anything to avoid being left alone.

Section 3: Control and Safety

11. I need to control situations and people to feel safe and secure. 12. I avoid taking risks or trying new things because I fear failure or judgment. 13. I have difficulty relaxing and always feel like I need to be “on guard.” 14. I catastrophize situations and assume the worst possible outcome. 15. I feel like I must be perfect to be acceptable to others.

Section 4: Emotions and Expression

16. I suppress or deny my emotions because they feel dangerous or unacceptable. 17. I feel overwhelmed by emotions and struggle to regulate them. 18. I use substances, work, or other behaviors to numb painful feelings. 19. I feel guilty or selfish when I prioritize my own needs and desires. 20. I struggle with expressing anger in healthy ways.

Section 5: Achievement and Success

21. I believe I must achieve certain things to be worthy of love and respect. 22. I procrastinate on important goals because I fear not meeting my own high standards. 23. I downplay my achievements and have difficulty celebrating successes. 24. I compare myself constantly to others and usually feel inferior. 25. I abandon goals at the first sign of difficulty or setback.

Section 6: Family and Cultural Patterns

26. I carry heavy expectations about family loyalty that prevent me from setting boundaries. 27. I feel torn between my individual desires and what my family/community expects. 28. I struggle with internalized messages about my racial, cultural, or economic identity. 29. I have difficulty expressing needs because “asking for help” was seen as weakness in my family. 30. I repeat unhealthy patterns I witnessed in my family, despite wanting to be different.

PART B: PHYSICAL PATTERNS

31. I experience unexplained physical symptoms (headaches, stomach issues, tension) during stress. 32. I have difficulty feeling safe and comfortable in my own body. 33. I startle easily or feel hypervigilant in certain environments. 34. I hold tension in specific parts of my body (shoulders, jaw, stomach). 35. I have sleep disturbances or nightmares related to past experiences. 36. I struggle with eating patterns related to emotions or control. 37. I feel disconnected from or uncomfortable with my sexuality/sensuality. 38. I have difficulty breathing deeply or feel short of breath during emotional moments. 39. I experience fatigue that doesn’t match my physical activity level. 40. I notice my body “shutting down” or going numb during overwhelming situations.

PART C: SPIRITUAL AND RELIGIOUS PATTERNS

41. I fear God’s punishment or rejection and struggle to believe in His unconditional love. 42. I have been hurt by church leaders or trusted Christians who abused their position. 43. I struggle with shame about my humanity and feel like faith means suppressing all negative emotions. 44. I have experienced judgment, gossip, or rejection from church communities. 45. I feel pressure to maintain a “perfect Christian image” that doesn’t match my real experience. 46. I have difficulty trusting church leadership or being vulnerable in Christian community. 47. I struggle with teachings that were used to control, manipulate, or shame me. 48. I feel like I have to choose between my authentic self and my faith community. 49. I experience spiritual dryness or disconnection that may be related to past church hurt. 50. I carry guilt or shame about past mistakes that I struggle to believe God has truly forgiven.

Self-Discovery Questionnaire: Uncovering Hidden Wounds and Limiting Beliefs

PART A: PSYCHOLOGICAL PATTERNS

Section 1: Self-Worth and Identity

Section 2: Trust and Relationships

Section 3: Control and Safety

Section 4: Emotions and Expression

Section 5: Achievement and Success

Section 6: Family and Cultural Patterns

PART B: PHYSICAL PATTERNS

PART C: SPIRITUAL AND RELIGIOUS PATTERNS

Thank you for filling in the Healing Questionnaire