Case Study 00434 – Intake Questions for Customized Hypnotherapy Healing Program
Section 1: Identity & Sense of Self
- Who do you believe you are when no one else is around?
- Do you often feel disconnected from your true self or unsure of your identity?
- Have there been periods in your life where you felt you “lost yourself”? What happened then?
- What words would you currently use to describe yourself? Are these words positive or negative?
- Do you feel you live authentically, or do you often hide parts of yourself from others?
Section 2: Personal Transparency & Emotional Honesty
- How easy or difficult is it for you to express what you truly feel?
- Do you often hide your emotions, thoughts, or needs out of fear of rejection or conflict?
- When someone asks how you are, do you answer honestly? Why or why not?
- Are there parts of your life, past, or emotions that you feel unable to talk about?
- What would happen if people really knew what you feel inside?
Section 3: Fearful-Avoidant Attachment & Relationship Safety
- Do you desire closeness in relationships but become afraid when intimacy increases?
- Do you tend to pull away from people when you begin to care deeply?
- Have you experienced abandonment, betrayal, rejection, or emotional inconsistency in close relationships?
- Do you struggle to trust people even when they appear trustworthy?
- What fears come up when someone loves you, gets too close, or depends on you?
Section 4: Confusion, Mental Fog & Memory
- Do you experience mental confusion, emotional overwhelm, or difficulty making decisions?
- Have you noticed problems with memory, concentration, or recalling important events?
- Are there traumatic, painful, or emotionally loaded memories you avoid thinking about?
- Do you feel your mind is often “foggy,” distracted, or disconnected from the present?
- When confusion appears, what emotions usually accompany it (fear, panic, sadness, numbness, anger)?
Section 5: Insecurity, Self-Worth & Fear of the Future
- What are your deepest insecurities about yourself?
- Do you often feel “not good enough,” unwanted, unsafe, or unlovable?
- How do you imagine your future right now—hopeful, uncertain, empty, frightening?
- Have you lost motivation, direction, or belief that life can improve?
- What fears come up when you think about tomorrow, next year, or your future relationships?
Section 6: Relationships, Grief & Emotional Healing
- Are you grieving a person, relationship, version of yourself, or a life you hoped to have?
- Do you feel emotionally stuck in pain, loss, regret, or longing?
- How have past relationships shaped the way you love, trust, or protect yourself today?
- Is there someone you need to forgive, release, or emotionally separate from?
- If healing were possible, what would you want your life, identity, and relationships to feel like?
Hypnotherapist Clinical Follow-Up Themes
A hypnotherapist may use the answers to identify:
- Core wounds around identity formation
- Attachment trauma and relational fear patterns
- Hidden grief and unresolved loss
- Internalized beliefs of rejection, shame, or unworthiness
- Emotional avoidance and self-protection mechanisms
- Cognitive overload linked to stress or trauma
- Lack of future orientation and hopelessness patterns
- Areas for ego-strengthening, inner child healing, regression work, grief release, and confidence restoration
This type of intake helps build a customized hypnotherapy healing program rather than a one-size-fits-all script.