1. What was the most significant challenge you faced in maintaining a consistent meditation practice in last 12 months?
A. My schedule was full, and practice sometimes got edged out by other responsibilities.
B. My mind was very active, and I wasn't always sure how to work skillfully with thoughts.
C. I knew practice would help, but I struggled with motivation or emotional resistance.
D. I felt disconnected from practice or unsure how to re-enter after time away.
E. I was practicing consistently, but felt ready for more depth or refinement.
2. When you think about engaging more deeply with mindfulness, what feels most compelling right now?
A. Being more effective and less reactive in daily life by applying mindfulness more skillfully
B. Gaining clearer insight into my thoughts, emotions, and inner patterns — and understanding how they shape my experience
C. Learning what mindfulness actually is and how to practice effectively
D. Finding emotional safety, kindness, and self-compassion through mindfulness practice
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3. What has been the most noticeable benefit of your mindfulness practice during the last 12 months?
A. A greater sense of calm and reduced stress in daily life
B. Improved focus, clarity, or concentration
C. More emotional regulation and less reactivity
D. Better sleep, physical ease, or overall well-being
E. None of the above
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4. How often do you successfully integrate a "mindful moment" (like a deep breath or a pause) into a high-stress or emotionally challenging situation?
A. Nearly every time; it has become a default response
B. Often; I remembered to pause in most situations
C. Sometimes; I usually remembered only after the moment had passed
D. Rarely or never; I still react automatically
E. I'm very aware of what's happening internally, but I often stay in my head and don't pause until I've had time to reflect later
F. I am still learning about mindfulness and would like to have mindful moments
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5. Have you noticed repetitive patterns of behavior that you would like to better understand or transform?
A. Yes — I clearly recognize patterns and feel ready to work with them
B. I'm beginning to notice patterns and would like support understanding them
C. I sense patterns are there, but approaching them feels tender or emotionally charged
D. I'm not very aware of patterns yet and would appreciate foundational guidance
E. I notice patterns mostly through reflection and analysis, but struggle to shift them in the moment
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6. When reflecting on moments of discomfort or difficult emotions over the last 12 months, which approach did you most often take?
A. I was usually able to acknowledge the emotion with some steadiness, allowing it to move through without needing to fix it
B. I noticed the emotion and tried to manage it, though I sometimes needed reminders or structure to stay present
C. I often analyzed the emotion to understand it, but stayed more in my head than in my body
D. I tended to distract myself or push the feeling away because it felt overwhelming or uncomfortable
E. I frequently judged myself for having the emotion or felt stuck in self-criticism around it
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7. When you hear the phrase "inner child," which response feels closest to your experience right now?
A. I'm familiar with inner child work and feel ready to explore it more deeply and intentionally
B. I'm curious about inner child work and would like gentle guidance to explore it
C. I feel cautious or unsure about inner child work and would want strong emotional safety and pacing
D. I'm not very familiar with inner child work, but I'm open to learning what it means and how it works
E. I understand inner child work conceptually, but would like help embodying it rather than staying in my head
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8. Through your mindfulness practice over the last 12 months, what have you learned most clearly about yourself?
A. That I need more rest, gentleness, or balance than I used to allow
B. That many of my reactions follow familiar patterns, and awareness gives me more choice
C. That how I show up matters to me, even in small, everyday moments
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9. Part 1 - Take a deep breath and visualize the last 12 months as a river. In some places it flowed freely, in other cases it met a dam. Where did any blockages to moving forward show up most in your life?
A. Relationships / communication
B. Work / purpose / direction
C. Body / health / energy
D. Money / stability / resources
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9. Part 2 - Take another deep breath. What was the dam mostly made of?
A. Fear or self-doubt
B. Overthinking / staying in the head
C. Habitual patterns that kept repeating
D. Overwhelm / exhaustion
E. Not sure — I'd like help understanding
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10. When it comes to deepening your mindfulness practice, what kind of support feels most helpful right now?
A. A steady community rhythm with guidance and shared practice
B. Gentle, individualized guidance that meets emotional or nervous system needs
C. Opportunities to explore insight, inquiry, and understanding more deeply
D. A combination of community practice and personalized support
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