1.       When you think or talk about the problems that caused you to come into treatment, do you ever feel Pain or Hurt?   If you do, how intense is the feeling (1 = not intense; 10 = Very intense)?  Why did you rate it the way that you did?

2.      When you think or talk about the problems that caused you to come into treatment, do you ever feel Mad or Angry? If you do, how intense is the feeling (1 = not intense; 10 = Very intense)?  Why did you rate it the way that you did?

3.       When you think or talk about the problems that caused you to come into treatment, do you ever feel Afraid or Anxious? If you do, how intense is the feeling (1 = not intense; 10 = Very intense)?  Why did you rate it the way that you did?

4.  When you think or talk about the problems that caused you to come into treatment, do you ever feel Guilt or Shame? If you do, how intense is the feeling (1 = not intense; 10 = Very intense)?  Why did you rate it the way that you did?

5.      Did you ever try to get rid of these feelings by using denial to try and convince yourself you didn’t have these problems? If you do, how intense is the feeling (1 = not intense; 10 = Very intense)?  Why did you rate it the way that you did?