Bridge Compass: The Introductory Questionnaire Step 1 of 6 0% A warm welcome. I realize that life may feel especially difficult for you right now. You are here because you have likely lost someone or something very important to you. This has changed your life – and it may stir you, weigh on you, or hold you back. By being here, you’re already taking a meaningful step toward seeking support and finding your way in this transformed life. You have my sincere respect for that! Perhaps you’re asking yourself: What could help me most right now? Where would be a good place to start? If you’d like, I invite you to answer a few questions. They may give us an initial sense of what could bring you relief at this moment. This questionnaire is like a gentle compass: it’s meant to carefully show how the loss is currently shaping your life – and where we could work together in coaching, if you choose that. We can of course talk through the results together, entirely at your pace. Please trust your feelings and only answer what feels right for you.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? What happened?Even though we don't know each other yet: I'm very sorry to hear that! What kind of job was it? What happened?Even though we don't know each other yet: I'm very sorry to hear that! What kind of business was it? What happened?Even though we don't know each other yet: I'm very sorry to hear that! Where is your homeland, your home? What happened?Even though we don't know each other yet: I'm very sorry to hear that! What was your life dream? In what way was it lost?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 Anxiousness Loneliness Longing Guilt 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.
