Where Does it Hurt?
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Question 1 of 12
1. Question
Take your time over this assignment and be really honest with yourself. Don’t hold anything back. It’s for your eyes only, so let it all out. That said, though, be careful to keep it private. When you have completed it, you have the option to print it out. If you do, put somewhere safe where other won’t find it. The information will stay on the computer until you click the link to clear it. When you do that, everything is gone, so that’s safe.
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1. For Whom Do You Grieve? (Enter the person’s name.)
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Question 2 of 12
2. Question
2. How were you related to him or her?
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Question 3 of 12
3. Question
3. What were the circumstances of the death?
(Write as much as you wish, but please be kind to yourself as you might feel that you’re opening Pandora’s box.)-
This response will be reviewed and graded after submission.
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Question 4 of 12
4. Question
4. How long ago did the death occur?
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Question 5 of 12
5. Question
5. Was the death: (check all that apply)
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Question 6 of 12
6. Question
6. What were your main reactions at the time of the person’s passing?
(check all that apply) -
Question 7 of 12
7. Question
Write down all your feelings, reactions, thoughts, judgements in addition to the above, if any.
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This response will be reviewed and graded after submission.
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Question 8 of 12
8. Question
7. What feelings were present in you at the time or when you first learned of the death?
(check all that apply)
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Grief
Sadness
Abandonment
Fear
Anger
Numbness
Rage
Betrayal
Loneliness
Relief
Other
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Question 9 of 12
9. Question
8. Indicate whether these feelings have changed since the death — less intense, more intense, or the same?
Type ‘YES’ next to your answer
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Grief
Less Intense More Intense The Same
Sadness
Less Intense More Intense The Same
Abandonment
Less Intense More Intense The Same
Fear
Less Intense More Intense The Same
Anger
Less Intense More Intense The Same
Numbness
Less Intense More Intense The Same
Rage
Less Intense More Intense The Same
Betrayal
Less Intense More Intense The Same
Loneliness
Less Intense More Intense The Same
Relief
Less Intense More Intense The Same
Other
Less Intense More Intense The Same
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Question 10 of 12
10. Question
9. Who do you blame (if anyone), and why?
Write down their name and explain.
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This response will be reviewed and graded after submission.
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Question 11 of 12
11. Question
10. On a Scale of 1-10. How Angry/Bitter Do You Feel Toward The Person or People You Blame?
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Question 12 of 12
12. Question
11. What would you like to say to those you blame? Write it here and take as much room as you need to say all that you would want to say:
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This response will be reviewed and graded after submission.
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