Trauma Therapy Modality Fit Screening

Name

Phone Number (I will contact you via the number provided)

What type of trauma have you experienced?
A single traumatic event (e.g., accident, assault)Multiple or long-term traumatic experiences (e.g., childhood abuse, domestic violence)

Do you experience dissociation (feeling detached, spaced out, or ‘not in your body’)?
Rarely or NeverOften or Easily Triggered

Are you comfortable describing your trauma out loud in some detail?
YesNo

Do you prefer a structured, multi-stage approach to therapy?
YesNo or Unsure

Do you have trouble using your imagination or mental imagery (e.g., daydreams/visualization)?
YesNo or Unsure

Are you looking for therapy that helps you reframe negative beliefs about yourself?
YesNo, I just want to stop distressing reactions/emotions

When thinking about past trauma, do you feel emotionally overwhelmed?
OftenRarely

Would you prefer a therapy that is often shorter in duration (1-5 sessions lasting 50-60 minutes each)?
YesNo, I'm open to long-term work

Do you find emotional release (e.g., crying) healing or helpful?
YesNot Really

How soon are you hoping to feel relief from symptoms?
As quickly as possibleI'm okay with gradual improvement