Bethesda Workshops Alumni Survey


Gender:   Male      Female   Month     Year     You Attended Workshop

 

Workshop:            
  Healing for Men Healing for Women Healing for Spouses

 

I. SOBRIETY (Sobriety is defined as free from sexual acting out or co-addictive behaviors)

 

Sobriety [0 = fully participating in behavior;  10 = never struggle with behavior]
    0 1    2 3 4  5 6 7 8  9  10
 Rate your level of sobriety at the time of your workshop.  
 Rate the strength of your sobriety over the last four weeks  
 Rate your overall level of sobriety since your workshop.   

 

Rate your level of struggle with the following behaviors: 

 

Addict:

Pre-Workshop/Height of Addiction      Behavior Post-Workshop
0 1  2 3 4  5 6 7 8  9  10   [0 = fully participating in behavior;  10 = never struggle with behavior]   0 1    2 3 4  5 6 7 8  9  10
   Fantasy/preoccupation   
   Masturbation   
   Internet pornography  
   Cybersex/chat rooms/email   
   Affair (emotional or sexual)  
   Prostitutes/anonymous sex  
   Strip clubs  
   Other   

 

Co-Addict:                             

Pre-Workshop/Height of Addiction      Behavior Post-Workshop
0 1  2 3 4  5 6 7 8  9  10   [0 = fully participating in behavior;  10 = never struggle with behavior]   0 1    2 3 4  5 6 7 8  9  10
  Obsession about addict    
  Attempt to control/influence addict’s recovery     
  Detective work  
  Withdrawal   
  Using sex to control or withholding sex  
  Maintaining boundaries  
  Anger and blame  
 

Engaging in own unhealthy  behavior

(Eating, shopping, focusing on kids, abusing alcohol or drugs, own sexual acting out, etc.)

  

 

II.  RECOVERY TOOLS

 

Rate your use of the following recovery tools:                     

Tool [0 = never using tool;  10 = consistently using tool]
    0 1    2 3 4  5 6 7 8  9  10
 Attend meetings     
Talk with sponsor    
 Work the 12 Steps  
 Connect with safe people  
  Journal  
 Participate in counseling  
Take prescribed medication    
Engage in spiritual practices   

 

III.  MARRIAGE RELATIONSHIP

 

 

        Yes         No      
 Were you married at the time you attended your workshop?                       
   (include separated or in process of divorce)                        
  Did your spouse pursue recovery?                      
  Are you still married to the same person?                    
   
  [0 = on verge of divorce;  10 = relationship you’ve always wanted]  
    0 1    2 3 4  5 6 7 8  9  10
 If so, rate the strength of your relationship:  
  I chose to divorce My spouse chose to divorce We mutually agreed to divorce
  If not, what happened?

 

 

IV.  WORKSHOP EXPERIENCE                                 

 

Tool [0 = not helpful at all; 10 = extremely helpful]
    0 1    2 3 4  5 6 7 8  9  10
How significant was the workshop in your recovery process?   
Rate the following workshop components:                         
   
Being with other participants   
Workshop leaders  
Information learned  
Small group experiences  
 Trauma egg  
Saturday night ceremony     
 Spiritual focus   
Other                

 

 

V.  ADDITIONAL COMMENTS    


  

 

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Help and hope for those who seek healing from sexual brokenness, sin, and addiction.