On paper, please describe in as much detail as possible:

• Tell why you are seeking help at this time of your life and why you are particularly seeking a Deep Feeling type of therapy.
• Describe yourself, your family and present life situation.
• Give as much detail as you can concerning the circumstances surrounding childhood: birth (emotional and physical dynamics; early and present day medical issues; where you were born and raised; relationships with your parents, siblings, grandparents, etc. Described key events (both positive and traumatic) that impacted you and how.
• Include your childhood, teenage and adult years - with its love relationships, engagements, marriages, breakups, divorces, deaths, losses and gains.
• If difficulties concern a minor or significant other living at home with you, please include as much information about that individual too. When did the behavior begin? Were there any events in his/her life that triggered its onset?
• Give a brief occupational history and include descriptions concerning moods, anxiety and personality. Also include data concerning alcohol and substance abuse, smoking, and medications that you are presently taking.
• Give a description of your cultural and spiritual background and history, if any. What religious or spiritual methods have you practiced or used?