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How would you describe where you are emotionally right now?

A. I feel raw, overwhelmed, anxious, or emotionally all over the place.

B. I feel disconnected from myself and unsure who I am outside the relationship.

C. I feel ready to move forward, but I need help knowing what the next chapter looks like.

What feels hardest for you at the moment?

A. The emotional pain, overthinking, or missing them.

B. Feeling like I gave too much of myself away.

C. Knowing how to move forward without repeating the same patterns.

Which thought feels most familiar?

A. “I just want this pain to stop.”

B. “I don’t know who I am anymore.”

C. “I know I need to move forward, but I don’t know how.”

What do you find yourself doing most often?

A. Replaying conversations, checking your phone, hoping for a message, or feeling emotionally pulled back in.

B. Questioning yourself, doubting your worth, or wondering how you allowed things to get this far.

C. Trying to make plans, but feeling unsure, cautious, or afraid of making the wrong choice.

What would feel most helpful right now?

A. Calming my emotions and feeling more stable day to day.

B. Rebuilding my confidence, self-worth, and sense of who I am.

C. Getting clear direction and learning how to move forward properly.

How does the breakup or relationship situation affect your daily life?

A. It affects my emotions heavily and can take over my day.

B. It has changed how I see myself and what I believe about myself.

C. It affects my decisions and makes it hard to plan what comes next.

When you think about the relationship, what do you notice most?

A. I still feel emotionally attached, hurt, rejected, or unsettled.

B. I notice how much I changed, adapted, or lost parts of myself.

C. I notice that I do not want to carry this into my future.

Which outcome would feel most important to you?

A. Feeling calmer and less emotionally controlled by what happened.

B. Feeling like myself again and trusting my own needs, feelings, and boundaries.

C. Feeling clear, confident, and ready to build a healthier future.