Case Study 00232 – 24 March 2026 – 30 Questions a Hypnotherapist might ask to Customize a Healing Program for you to address your Self-love, Self-worth, Self-system, Focus, Discipline, Anxiety, Stress, Depression, Low Mood, Bad Habits using Hypnotherapy.

Case Study 00232 – 24 March 2026 – Customized Hypnotherapy Healing Program Intake

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Client Discovery & Assessment Questionnaire

Purpose: To gather deep insight into the client’s emotional, mental, and behavioural patterns in order to design a personalized hypnotherapy program.

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Section 1: Personal Awareness & Self-Perception

1. How would you currently describe your relationship with yourself?
2. What thoughts do you most frequently have about yourself?
3. In what areas of your life do you feel “not good enough”?
4. When did you first start feeling this way about yourself?
5. What does self-love mean to you personally?

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Section 2: Self-Worth & Identity

6. Do you feel deserving of success, happiness, and love? Why or why not?
7. What internal beliefs might be limiting your growth?
8. How do you handle criticism or rejection?
9. What roles or identities do you feel pressured to maintain?
10. If you could redefine yourself, who would you become?

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Section 3: Emotional & Mental State

11. How often do you experience anxiety, stress, or low mood?
12. What are your most common emotional triggers?
13. How do you typically cope with overwhelming emotions?
14. Have you experienced any past trauma or unresolved emotional pain?
15. What emotions do you find hardest to express or process?

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Section 4: Habits & Behaviour Patterns

16. What habits do you feel are holding you back?
17. When do these habits usually occur (time, situation, emotional state)?
18. What do you gain (emotionally or mentally) from these habits?
19. What habits would you like to build instead?
20. Have you tried to change these habits before? What happened?

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Section 5: Focus, Discipline & Motivation

21. How would you rate your current level of focus and discipline?
22. What tends to distract you the most?
23. Do you procrastinate? If so, what are you avoiding?
24. What motivates you when you feel aligned and productive?
25. What does your ideal daily routine look like?

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Section 6: Stress, Anxiety & Depression

26. What situations cause you the most stress or anxiety?
27. How does stress show up in your body and thoughts?
28. Have you experienced periods of depression or emotional numbness?
29. What support systems (if any) do you currently have?
30. What would “healing” look like for you at the end of this program?

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Practitioner Notes (Optional Add-On)

• Emotional intensity scale (1–10)
• Dominant limiting beliefs identified
• Core triggers and behavioural loops
• Suggested hypnotherapy techniques:
  • Regression therapy
  • Inner child healing
  • Suggestion therapy
  • Cognitive restructuring
  • Habit reprogramming

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Outcome Intention Statement (Client-Focused)

“By the end of this hypnotherapy program, I want to feel… (confident, calm, in control, disciplined, self-loving, etc.)”