Bridge Compass: The Introductory Questionnaire (optional) Step 1 of 6 0% I know that many things may not feel easy right now. You’re probably here because you’ve lost someone – or something – deeply important to you. That loss has changed your life, and it may feel heavy. The fact that you’re here, actively seeking support and ways to move forward, says something important about your strength! You might be wondering: What could help me most right now? Where do I even begin? In my experience, it can be easier for some people to start by answering a few questions on their own. If that sounds like you, I’d like to offer you the Bridge Compass. If you’d prefer to speak with me directly, please feel free to choose a time here! This questionnaire works like a gentle compass: it helps reveal how the loss is affecting your life right now. This will give you an initial sense of which of these four focus areas might offer you the most relief right now. If you’d like, this can also be the starting point for our work together later on. Please trust your feelings and answer only what feels right to you. Whether you choose to share your responses with me is entirely up to you at the very end. Who or what have you lost?(Required)Please choose the option that best describes your loss.A dear person has died.I lost an important person through separation or in another way.I lost my job.I was self-employed and lost my business.My life dream has vanished.I lost my homeland, my home.My pet has died.I have experienced another devastating loss.Even though we don't know each other yet: I'm very sorry to hear that! Who died?Even though we don't know each other yet: I'm very sorry to hear that! Who did you lose? Even though we don't know each other yet: I'm very sorry to hear that! What kind of job was it? Even though we don't know each other yet: I'm very sorry to hear that! What kind of business was it?Even though we don't know each other yet: I'm very sorry to hear that! Where is your homeland, your home?Even though we don't know each other yet: I'm very sorry to hear that! What was your life dream?Even though we don't know each other yet: I'm very sorry to hear that! Was it a dog, a cat, or another pet? And what was his or her name?Even though we don't know each other yet: I'm sorry for your loss. Please briefly describe who or what you have lost.Would you like to tell me how much time has passed since her/his death?Would you like to tell me how much time has passed since then?Would you like to tell me how much time has passed since the death of this important animal family member?If you'd like, there's space here to briefly describe what happened.Please decide whether it would be helpful for you to share this with me here in advance. How often do you think about the loss?Please choose what fits best right now.Almost constantly.Several times a day.Several times a week.Less often.How often do you talk to others about your loss? Is there an opportunity for that?Please choose what fits best right now.Very often.Often.Sometimes.Rarely.Never – I have decided against it.Never – there is no possibility for that.Loss can bring up many different emotions. Which feelings are you experiencing most strongly? Please choose three to five. Love Grief Anger Despair Powerlessness Gratitude Anxiety Loneliness Longing Guilt Disappointment Emptiness Hope Hopelessness Pain Defiance Optional: I'm experiencing another feeling that's not on the list, namely: Please indicate how strongly the following 12 statements apply to you. Move the slider to the appropriate position between 0 and 10: 0 = doesn’t apply at all 10 = applies completely1. I feel a great sense of powerlessness, as if I'm at the mercy of fate.2. My thoughts often circle around the day, the moment, when it happened.3. A very important part of me is now missing – I no longer recognize myself.4. I'm afraid of forgetting my beloved person who has died.4. I'm afraid of forgetting my beloved pet.4. I'm afraid of forgetting what I can do professionally and what I've already accomplished.4. I'm afraid of forgetting how I can be happy in a relationship.4. I'm afraid of forgetting what I've lost.5. I keep asking myself whether I couldn't have done something/more to prevent the death.5. I keep asking myself whether I couldn't have done something/more to prevent the separation.5. I keep asking myself whether I couldn't have done something/more to prevent the termination.5. I keep asking myself whether I couldn't have done something/more to prevent this terrible loss.6. My old identity is a thing of the past after this loss. But who am I now?7. I feel paralyzed, stuck in my grief.8. Others advise me to let go – but I'm looking for ways to maintain our connection.9. I want to continue living our love and wonder how that can succeed.10. Inside, I feel tired and empty.11. It's hard for me to think about the moment of death. I'm afraid that my feelings will overwhelm me.11. It's very difficult for me to think about the moment of separation. I'm afraid that my feelings will overwhelm me.11. It's very difficult for me to think about the moment I was fired. I'm afraid that my feelings will overwhelm me.11. It's very difficult for me to think about the moment when it became clear that I had lost my business / my self-employment. I'm afraid that my feelings will overwhelm me.11. It's very difficult for me to think about the moment when it became clear that my life dream was lost. I'm afraid that my feelings will overwhelm me.11. It's very difficult for me to think about the moment when it became clear that I had lost my homeland / my home. I'm afraid that my feelings will overwhelm me.11. It's very difficult for me to think about the moment of loss. I'm afraid that my feelings will overwhelm me.12. My life story has a deep break in it. I don't know how I can continue telling it.This field is hidden when viewing the formEventThis field is hidden when viewing the formIdentityThis field is hidden when viewing the formPowerlessnessThis field is hidden when viewing the formConnection Initial insights from the CompassWhen it comes to finding your own path in dealing with a new reality after a devastating loss, most people find that the following key areas play an important role. Your responses suggest that these might be weighted in this way for you – does that seem accurate to you? Event: What happened? 0/10 Identity: Who am I now? 0/10 Powerlessness: How do I get out of this? 0/10 Connection: How can I maintain it beyond death? 0/10 (only relevant if you are grieving someone who has died) Optional informationWould you like to receive the results by email? If so, please leave your email address.Email address Opportunity to talkWould you like to discuss the results with me? If you’re comfortable with me calling you, please leave your name and phone number. Or you can directly schedule a free initial consultation (ideally after submitting this form through the menu at the top of the website).Your nameYour phone numberIs there anything else about your loss that's on your mind or that you'd like to share with me?Here is space for your questions and comments…Privacy Notice(Required) The information you provide will only be used to address your concerns and will be stored solely for this purpose. You can find additional information and details about your right to object in my privacy policy. Important: Please click “Submit” now. Only then will your responses from this questionnaire be sent.
