[ot] Stronger-After.org Is a Beautiful Glimpse of Freedom

[Karl Semich]

STRONGER AFTER

INTAKE FORM

In what areas did you experience coercive control?
- [ ] Group: Religious, Social, Recovery, Educational, Recreational,
Commercial, Political, etc.
- [ ] Romantic Relationship
- [ ] Family Relationship
- [ ] Friend
- [ ] Work
- [ ] Therapy, Coach, etc.
- [ ] Other: __________
[i think i selected “group” and “other”, and wrote in i was targeted
by an opposing political group]

How did you become involved in the group or relationship?
- ( ) I was born into it
- ( ) My parent(s) joined when I was a child or teenager
- ( ) I became involved as a minor, but on my own
- ( ) I became involved as an adult
- ( ) Other: _________
[i think i selected “became involved as an adult”]

- ( ) I am still in the group / relationship / situation
- ( ) I am going back and forth at the moment
- ( ) I have left
[i think i selected “going back and forth”]

If you answered "I have left," please specify how long ago:
_________________________

How did you leave?
- ( ) I left on my own
- ( ) Someone else left and I followed
- ( ) I was forced to leave by the group
- ( ) I am still in
[i think I selected “left on my own” although in retrospect i think my
other experiences profile to “forced to leave”]

Which types of abuse would you say you have experienced while in this
situation? (Check all that apply)
- [ ] verbal
- [ ] emotional
- [ ] physical
- [ ] neglect (medical / physical / ...)
- [ ] sexual abuse as a child
- [ ] sexual abuse or assault as an adult
- [ ] mind games / gas-lighting
- [ ] spiritual / religious
- [ ] financial
- [ ] domestic violence
- [ ] none that I am aware of
- [ ] Other: _____________
[i think i selected “verbal”, “emotional”, “neglect”, “mind games”,
“financial”, “other” and wrote in something like “digital systems
compromise including medical and telecommunications”.
note that if you experienced sexual abuse during an adult experience
this would be sexual abuse as an _adult_; it can be confusing if you
are called a child while an adult.
 it can also be really hard to perceive information around the word
abuse or phrase sexual abuse, at least for me, if you are working with
someone.]

How often are you bothered by the following experiences?  (Check each
column as it applies)*
 …… | never | sometimes | often | always | not sure what the question means
Thoughts keep circling in my head. I can't make them stop.
I don't think I am worthy of love
I have nightmares
I have fears about the world ending, hell, karma or other punishment
I fear making mistakes
I feel shame for having participated
I experience difficulty making decisions
I feel a sense of dread
I experience anxiety and panic
I feel guilt for leaving the situation
I feel guilty for leaving people behind
I feel guilty for living / enjoying life
I have an internal voice that criticizes me or polices me
I feel alone / miss my community
I have strong beliefs and inner convictions that I didn't choose
I feel responsible for others and their needs
I lack boundaries and don't feel sure when someone is violating mine
I have difficulty connecting with other people
I have difficulty with sexuality and physical closeness
I have difficulty trusting others
I have difficulty finding a job or being able to keep it
I have issues with authority in the workplace or elsewhere
I have difficulty speaking up and not letting others take advantage of me
I have suicidal thoughts
I sometimes hurt myself
I feel exhausted
I feel stress from family who are still in the group or situation
I have no sense of who I am, my identity outside the group or situation
I feel powerless, that I have no control
Sometimes I get triggered and have flashbacks (feeling stuck in a memory)
I am afraid someone will come after me. I feel watched.
I have difficulty talking about what happened or making sense of my experience
I feel depressed and find it difficult to function
I feel very angry. There is so much rage inside.
I have a hard time connecting to my emotions
I feel a sense of grief and loss
I question my reasoning, how I make decisions
I feel compelled to do certain things and find it hard to stop myself
I put myself down
I miss feeling chosen or special
It's all or nothing - I don't seem to find the middle ground
I feel like I have no future without them
I still think in us-versus-them terms, who is the enemy now?
I look for absolute truth and instant solutions to my troubles
I cannot let go of people, even when they hurt me or are toxic
I daydream or just drift off, disconnect from my feelings or where I am
I cannot feel my body
I feel overwhelmed by my emotions, like I am drowning
I feel like I have to be productive all the time, have difficulty relaxing
I flinch when someone is loud or yells
I don't feel safe
I feel stuck because I was not allowed to continue my education

[i think i selected “always” for the majority of these. there are a
lot, making it hard to go through the whole list. it’s helpful to
memorize that the last option is “i don’t know what the question
means.”]

Which one of the following areas were influenced by the rules of the
group or relationship? (Check all that apply)
- [ ] Behavior
- [ ] Diet
- [ ] Finances
- [ ] Health Care
- [ ] Information
- [ ] Pets
- [ ] Emotions
- [ ] Education
- [ ] Thoughts
- [ ] Reading
- [ ] Sexuality / Birth Control
- [ ] Entertainment
- [ ] Sexual Identity
- [ ] Partner Choice
- [ ] Work
- [ ] Parenting
- [ ] Free Time
- [ ] Vacation
- [ ] Creativity/Hobbies
- [ ] No Rules
- [ ] Other: _____________
[by this question my dissociation against silence was pretty taxed
from the preceding question. i might have checked “behavior”, “diet”,
“finances”, “health care”, “information”, “emotions”, “education”,
“thoughts”, “reading”, “sexuality”, “entertainment”, “sexual
identity”, “partner choice”, “work”, “free time”, “hobbies”; by this
point it’s highly likely i was interpreting the options in personal
ways rather than comprehending how the form author might have intended
them.]

In what ways do you feel like you were manipulated in the group or by
an individual? (Check all that apply)
- [ ] Fears
- [ ] Guilt
- [ ] Mind-games/gaslighting
- [ ] Dependency
- [ ] Promises
- [ ] Threats
- [ ] Punishment
- [ ] Sense of responsibility
- [ ] Through family / children
- [ ] Isolation
- [ ] Lack of sleep
- [ ] Lack of privacy
- [ ] Lack of outside resources
- [ ] Financial dependency
- [ ] Housing
- [ ] Not at all
[i might have checked “fears”, “guilt”, “mind games”, “dependency”,
“threats”, “punishment”, “responsibility”, “family”, “isolation”,
“sleep”, “privacy”, “resources”, “financial dependency”, “housing”. i
think i unchecked “promises” while thinking about guilt and amnesia.]

Are any of these currently impacting your life? (Check all that apply)
- [ ] Homelessness
- [ ] Financial difficulty
- [ ] Mental Health problems
- [ ] Lack of education
- [ ] Lack of Employment
- [ ] Physical Health problems
- [ ] No Identification documents
- [ ] Lack of support system
- [ ] Parental alienation
- [ ] Difficulty finding a therapist
- [ ] Not at all
[i might have checked “homelessness”, “financial difficulty”, “mental
health”, “education”, “employment”, “identification documents”,
“support system”, “finding a therapist”: although financially i think
i was awarded some social security recently, and i spent years trying
to get and keep a passport and now actually have one, my dissociated
part just keeps this concept away from me, so at least those two may
have been in error and/or overstatement.]

If you were in a group what kind of group was it? (Check all that apply)
- [ ] Christian
- [ ] Judaic
- [ ] Islamic
- [ ] Therapeutic
- [ ] Alternative Medicine
- [ ] New Age
- [ ] Eastern
- [ ] Political
- [ ] Multi-marketing
- [ ] Personal development/Psychological
- [ ] Conspiracy
- [ ] Satanic
- [ ] White Supremacy
- [ ] Sex trade
- [ ] Human Trafficking
- [ ] Sports
- [ ] School/Educational
- [ ] Addiction/Recovery/Detention
- [ ] Other: _____________
[i think i selected “political”, “sex trade”, “human trafficking”, and
then also “conspiracy” and “white supremacy”, possibly confusing my
experience with those in the news a little, maybe to help get near it
via overlap.]

If you are comfortable, share a few sentences about what you
experienced and how it has affected you.
_________________
[i think i used this space to thank them for their beautiful website
and apologize that i could fail to follow up on the form due to my
email struggles]

I recognize Stronger After is a form of coaching and is in no way to
be construed or substituted as psychological counseling or any other
type of therapy or medical advice.
- [ ] Yes

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