Emotional Questions (Discovery)

Name:______

Emotional questions (Discovery)

1. Salvation/Religion------John1:12-13 (NKJV) But as many as received Him, to them He gave the right to become children of God, to those who believe in His name:13 who were born, not of blood, nor of the will of the flesh, nor of the will of man, but of God.

Please explain all questions

• Are your parents Christians? __Father ______Mother______how long?___/____Church?______
• When did you receive Christ as your Savior? Age____ by whom ______
• Do you speak in tongues?______
• What events led up to your salvation?______
• What motivated you to receive the Lord?______
• Did you publicly accept the Lord?______
• Were you baptized as a believer?______
• Have you received the baptism of the Holy Spirit?______
• What happened to you before and after the experience of accepting the Lord?______
• How has this changed your life?______
• Have you had any spiritual experiences?______
• What do you have to look forward to as a Christian?______
• How do you know you received Christ as your Savior?______
• Where do you struggle to live a Christian life daily?______
• Is there increasing fruit in your Christian life?______
• Is praying to Jesus and your heavenly Father difficult?______
• Do you attend church on a regular basis?______
• Are you a member and under church authority?______
• Do you tithe on a regular basis to God's work?______
• What things are most important to you in your daily life?______
• Who is Jesus to you and how do you see Him?______
• How do you see and relate to your heavenly Father?______
• Do you have a good relationship with Holy Spirit, Jesus and our heavenly father? ______
• What are your talents and gifting? ______
• Are you equipped to meet your destiny? ______
• What do you want Jesus Christ to do for you?______

2. Abuse: Please explain if not on pages 1-6 ______

______

3. Fear /Trauma (dreams/nightmares/torment)

fear/ trauma (dreams/nightmares/torment) what is real from what is not

God/Jesus interacts with you and come to you

Sleep disorders with reoccurring nightmares and disturbances
Sexual and spiritual violations

A heavy presence around you

Something is stalking you in your bedroom and/or when you go out

cannot talk or breath and feel like you're suffocating
Seems like someone has a hold on your throat

Cannot talk

Unusual noises and moving objects

Voices audible or otherwise including thoughts and words

Soul captured, tormented and/or removed from your body

4. Relationships/rejection, love and forgiveness

Circle Y for yes/ N for no. Please explain!

Y – N Do you know your biological father?______Alive _____

Y – N Do you have a godly relationship with your biological father/stepfather?______

Y – N Do you know your biological mother?______Alive______

Y – N Do you have a godly relationship with your biological mother/stepmother?______

Y – N Did your parents treat each other in a ungodly way?______

______

Y – N Was the home a safe environment? If No why______

Y – N Was there divorce/divorces in the family? ______Who?______# of times_____

Y – N What was your age/ages at the time of divorce(s)______

Y – N Are you adopted?______What are the circumstances?______
Y – N Did one or both parents want you?(The timing, boy or girl issues, financial issues) ______

Y – N Did parents exhibit favoritism to your siblings ______
Y – N Who raised you?______

Y – N Was the relationship: Good _____Bad_____ Explain:______
What is your birth order? ______

Y – N Were you conceived in adultery and or fornication?

Y – N Do you believe conception/ womb / birth has issues in your life?
Y – N Did you have a father’s love and acceptance in your life? ______Age?______
Y – N Was the correct father's love demonstrated?______
Y – N Did you have a mother’s love and acceptance in your life? ______Age?______
Y – N Were your parents and grandparents emotionally supportive to you in times of trauma?______
Y – N Were either parent/grandparents involved in secret organizations(Masons, Satanism, occult, etc.?

Explain ______

Y – N Was a root of bitterness in either of your parents/ grandparents?______
Y – N Were their times in your life that you had special problems with your parents?______
Y – N Would you consider your parents as friends?______
Y – N Has the family gave you financial help and gifts on a regular basis?______
Y – N Do you support yourself financially without any help?______

Y – N Would you change the way your parents treated you? ______HOW?______
Y – N Are you repeating the same patterns that you disliked in your mother and/or father? Identify: ______

______
Y – N Have you judged your father and mother for the way they raised you?______

Y – N Have you judged others and compared them to yourself?______

Y – N Do you like yourself?______

Y – N Can you give unconditional love? Explain: ______

Y – N Have you done things that are so bad that you had never shared them with Christians?______

Y – N Are you scared(afraid) of what people will think of you?______

Y – N Did you become sexually active before marriage? ______Age______

Y – N Were you involved in many sexual partners?______#'s ______

Y – N Did you become involved with illegal drugs/ prescription drugs? ______Age______

What drugs/medications? ______
Y – N Did you change after the involvement with sex and illegal drugs?______

Y – N If married how would you describe the relationship as healthy?______

Y – N Are you in a sexual relationship outside of the covenant of marriage?______
Y – N Do you have a good relationship with family siblings?______

Y – N Did you raise your sibling in your childhood and/or teen years?______

Y – N Do you have a good relationship with your spouse and your children?______

Y – N If you are not married would you like to be or would you get married again? ______

Y – N Describe what you would expect from your spouse or future spouse?______

Y – N Do you have a good relationship with your friends and in your work environment?______

Y – N Have you ever made a promise to God and not performed it? Explain: ______

Please explain (if possible) any in the womb experience: ______

Please explain if there is someone you cannot forgive and why you cannot. ______

______

Check how you see yourself? Circle how you think others see you. You may do both

Please describe the relationship you would like to develop with;

Jesus and your heavenly Father______

______

Parents______

Spouse______

Children/Grandchildren______

Extended Family and Siblings______

______

Yourself (kind and benevolent, to be well-liked, to have integrity, to be accepted, to be at peace, to be a servant of the Lord, etc.)______

______

Other______

5. Sexual/ self-image related to gender issues

Please Mark the ones that you struggle with;

Answer Yes/No - Please Explain

_____ Have you had a abortion?______# Times______

_____ Have you been involved in and approved of abortion (even by your silence) ______

_____ Have you paid for and/or contributed money for an abortion?______# Times ______

_____ Do you have guilt and shame associated with abortion?______

_____ Have you confessed, received forgiveness and release from abortion?______

_____ Have you been a victim of incest (family member)?______# Years_____# Times______

_____ Have you sexually victimized family members, cousins etc.?______

_____ Have you been molested? Ages______# Times______

_____ Have you been raped? Ages______# Times______

_____ Have you had sexual experiences in night dreams?______Does this still happen?______

_____ Do you like being who you are as a male/female?______

_____ Are you confused about your sexual gender?______

_____ Do you have guilt or shame associated with sexual intercourse?______

_____ Is a child secure with you (sexually)?______

_____ Are you in any type of physical abusive sex?______

_____ Have you ever been attracted to the same-sex with thoughts and desires?______

_____ Are you a homosexual /lesbian?______

_____ Have you ever had a homosexual/lesbian experience?______

_____ Are you currently having or recently have had an affair (Fornication-Adultery)?______

_____ Have you had a baby or fathered a baby out of wedlock ?______# Times______

_____ Do you know where these babies are?______Do you stay in touch?______

_____ Did you have sex with your spouse before marriage?______

_____ Did you conceived your first child in wedlock?______

6. Confusion/ mental and emotional/secrets

Expressing your Emotions

____ Readily express my emotions

____ Express only some of my emotions, but not all

____ Tendency to suppress my emotions

____ Feel it is safer not to express how I feel

____ I have never been able to be myself

____ I have not reached my destiny because of others

____ Tendency to disregard how I feel emotionally because I do not trust my feelings

____ I deny my emotions because it is too painful to deal with them

Please Explain or answer yes/no

____ Can you be totally honest with yourself?______

____ Can you be totally honest with your best friend?______

____ Can you be honest with Jesus Christ and your heavenly Father?______

____ Do you have addictions?______describe ______

____ Trauma induced memories (reliving as though it happened today)?______

____ Did you have children to play with as a child?______

____ Do you or have you had an imaginary friend/playmate? Name______age______

____ Do you now interact with this friend/playmate?______

____ Does this friend/playmate and you do ungodly things?______

____ Do you hear voices/words in your head?______

____ Are you tormented by your mind?______

____ Does your mind ever rest?______

____ The you have a fear of cracking up (losing control)?______

____ Do you have invasive thoughts that deal with evil (swearing, blaspheming, obscenities, sexual defilement, etc.)

____ Do you daydream and fantasize?______# times per week______

____ Do you wish you were someone else in your daydreams?______whom?______

____ Would you like to live in a different time?______

____ Would you like to live in a different place?______

____ How would you change the circumstances around your life?______

Dreams and Visions

____ Do you have godly and /or ungodly?______

____ Are your dreams vivid and exacting in detail?______

____ Is there a repeated theme in your dreams?______how often?______

Memory (missing blocks of time)...... Can you recall any trauma?

What is your earliest memory?______age______Do you have any disturbing memories?______

Loss of memory related to events______Loss of memory related to time______

Radical changes in ordering and eating food______Radical changes in clothing (type, design and modesty)______

Radical behavior in your living patterns of life?______ages ______Can you reveal all emotions of the heart?______

Where do you go to escape pain, suffering and rejection? ______

Have you or do you wish to die?______ages______Have you had psychiatric counseling? ______Are you still in counseling? ______

Have you been diagnosed with emotional and /or behavioral disorders? Describe______

______age(s)______

Do you feel that everyone is equally guilty when you compare yourself to others?______

Confusion

Is it hard to concentrate on one task or event?______at what age did you notice this?

Are you scattered in your thinking?______

Are you spontaneous in your decision-making and daily activities? ______

Can you complete your duties/obligations in a timely manner?______

Do you over commit?______# times per week? ______

Do others see you as irresponsible/disorganized?______

Do you get lost when going to shopping areas, etc. that you know? ______

Do you make a lot of wrong decisions that should be easy?______describe ______

Is simple decisions sometimes very hard to make?______

Fear/Afraid (also see section # 3 Fear)

Are you timid? ______Are you a coward? ______

Do you have any phobias?______Describe ______

Are you afraid of insects, snakes, spiders, and animals?______

Afraid of losing mind?______

Afraid of committing suicide?______

Afraid of hurting loved ones?______of death?______

Circle what you fear the most; Failure, burnout, future events, death, work, responsibility, darkness, other people, talking, divine judgment, hearing God evil behavior, pain, other ______

Compulsive Behavior

Have you been diagnosed with obsessive compulsive disorder?______When?______Do you have obsessive spending, hording, overachieving, competitiveness, proving yourself better than others, numerous pets, etc. Explain: ______

Miscellaneous questions that apply to your past or present

Y – N Can you receive correction from trusted friends, Christians and church leaders etc. What emotions will you experience?

Y – N Can you describe how you will react to correction and criticism?

Y – N Have you been singled out, and set aside, without justifiable reasons?

Y – N Do you feel and have you ever said "everyone else is sinning why am I held more accountable than anyone else"?

P.O. Box 14126 Arlington, TX 76013 817-642-9772 or 817-642-8014 Personal Ministry Profile

Copyright © Larry Pollard All rights reserved may not be reproduced without permission. Rev.7-5-2013