FRS FDAS - Rebuilders International, LLC

I am comfortable telling people I am separated from my love partner

Almost Always Usually Sometimes Seldom Almost Never

I am physically and emotionally exhausted from morning until night

Almost Always Usually Sometimes Seldom Almost Never

I am constantly thinking of my former love partner

Almost Always Usually Sometimes Seldom Almost Never

I feel rejected by many of the friends I had when I was in the love relationship

Almost Always Usually Sometimes Seldom Almost Never

I become upset when I think about my former love partner

Almost Always Usually Sometimes Seldom Almost Never

I like being the person I am

Almost Always Usually Sometimes Seldom Almost Never

I feel like crying because I feel so sad

Almost Always Usually Sometimes Seldom Almost Never

I can communicate with my former love partner in a calm and rational manner

Almost Always Usually Sometimes Seldom Almost Never

There are many things about my personality I would like to change

Almost Always Usually Sometimes Seldom Almost Never

It is easy for me to accept my becoming a single person

Almost Always Usually Sometimes Seldom Almost Never

I feel depressed

Almost Always Usually Sometimes Seldom Almost Never

I feel emotionally separated from my former love partner

Almost Always Usually Sometimes Seldom Almost Never

People would not like me if they got to know me

Almost Always Usually Sometimes Seldom Almost Never

I feel comfortable seeing and talking to my former love partner

Almost Always Usually Sometimes Seldom Almost Never

I feel like I am an attractive person

Almost Always Usually Sometimes Seldom Almost Never

I feel as though I am in a daze and the world doesn't seem real

Almost Always Usually Sometimes Seldom Almost Never

I find myself doing things just to please my former love partner

Almost Always Usually Sometimes Seldom Almost Never

I feel lonely

Almost Always Usually Sometimes Seldom Almost Never

There are many things about my body I would like to change

Almost Always Usually Sometimes Seldom Almost Never

I have many plans and goals for the future

Almost Always Usually Sometimes Seldom Almost Never

I feel I don't have much sex appeal

Almost Always Usually Sometimes Seldom Almost Never

I am relating and interacting in many new ways with people since my separation

Almost Always Usually Sometimes Seldom Almost Never

Joining a singles group would make me feel I was a loser like them

Almost Always Usually Sometimes Seldom Almost Never

It is easy for me to organize my daily routine of living

Almost Always Usually Sometimes Seldom Almost Never

I find myself making excuses to see and talk to my former love partner

Almost Always Usually Sometimes Seldom Almost Never

Because my love relationship failed, I must be a failure

Almost Always Usually Sometimes Seldom Almost Never

I feel like unloading my feelings of anger and hurt upon my former love partner

Almost Always Usually Sometimes Seldom Almost Never

I feel comfortable being with people

Almost Always Usually Sometimes Seldom Almost Never

I have trouble concentrating

Almost Always Usually Sometimes Seldom Almost Never

I think of my former love partner as related to me rather than as a separate person

Almost Always Usually Sometimes Seldom Almost Never

I feel like an okay person

Almost Always Usually Sometimes Seldom Almost Never

I hope my former love partner is feeling as much or more emotional pain than I am

Almost Always Usually Sometimes Seldom Almost Never

I have close friends who know and understand me

Almost Always Usually Sometimes Seldom Almost Never

I am unable to control my emotions

Almost Always Usually Sometimes Seldom Almost Never

I feel capable of building a deep and meaningful love relationship

Almost Always Usually Sometimes Seldom Almost Never

I have trouble sleeping

Almost Always Usually Sometimes Seldom Almost Never

I easily become angry at my former love partner

Almost Always Usually Sometimes Seldom Almost Never

I am afraid to trust people who might become love partners

Almost Always Usually Sometimes Seldom Almost Never

Because my love relationship ended, I feel there must be something wrong with me

Almost Always Usually Sometimes Seldom Almost Never

I either have no appetite or eat continuously which is unusual for me

Almost Always Usually Sometimes Seldom Almost Never

I don't want to accept the fact that our love relationship is ending

Almost Always Usually Sometimes Seldom Almost Never

I force myself to eat even though I'm not hungry

Almost Always Usually Sometimes Seldom Almost Never

I have given up on my former love partner and getting back together

Almost Always Usually Sometimes Seldom Almost Never

I feel very frightened inside

Almost Always Usually Sometimes Seldom Almost Never

It is important that my family, friends, and associates be on my side rather than on my former love partner's side

Almost Always Usually Sometimes Seldom Almost Never

I feel uncomfortable even thinking about dating

Almost Always Usually Sometimes Seldom Almost Never

I feel capable of living the kind of life I would like to live

Almost Always Usually Sometimes Seldom Almost Never

I have noticed my body weight is changing a great deal

Almost Always Usually Sometimes Seldom Almost Never

I believe if we try, my love partner and I can save our love relationship

Almost Always Usually Sometimes Seldom Almost Never

My abdomen feels empty and hollow

Almost Always Usually Sometimes Seldom Almost Never

I have feelings of romantic love for my former love partner

Almost Always Usually Sometimes Seldom Almost Never

I can make the decisions I need to because I know and trust my feelings

Almost Always Usually Sometimes Seldom Almost Never

I would like to get even with my former love partner for hurting me

Almost Always Usually Sometimes Seldom Almost Never

I avoid people even though I want and need friends

Almost Always Usually Sometimes Seldom Almost Never

I have really made a mess of my life

Almost Always Usually Sometimes Seldom Almost Never

I sigh a lot

Almost Always Usually Sometimes Seldom Almost Never

I believe it is best for all concerned to have our love relationship end

Almost Always Usually Sometimes Seldom Almost Never

I perform my daily activities in a mechanical and unfeeling manner

Almost Always Usually Sometimes Seldom Almost Never

I become upset when I think about my love partner having a love relationship with someone else

Almost Always Usually Sometimes Seldom Almost Never

I feel capable of facing and dealing with my problems

Almost Always Usually Sometimes Seldom Almost Never

I blame my former love partner for the failure of our love relationship

Almost Always Usually Sometimes Seldom Almost Never

I am afraid of becoming sexually involved with another person

Almost Always Usually Sometimes Seldom Almost Never

I feel adequate as a fe/male love partner

Almost Always Usually Sometimes Seldom Almost Never

It will only be a matter of time until my love partner and I get back together

Almost Always Usually Sometimes Seldom Almost Never

I feel detached and removed from activities around me as though I were watching them on a movie screen

Almost Always Usually Sometimes Seldom Almost Never

I would like to continue having a sexual relationship with my former love partner

Almost Always Usually Sometimes Seldom Almost Never

Life is somehow passing me by

Almost Always Usually Sometimes Seldom Almost Never

I feel comfortable going by myself to a public place such as a movie

Almost Always Usually Sometimes Seldom Almost Never

It is good to feel alive again after having felt numb and emotionally dead

Almost Always Usually Sometimes Seldom Almost Never

I feel I know and understand myself

Almost Always Usually Sometimes Seldom Almost Never

I feel emotionally committed to my former love partner

Almost Always Usually Sometimes Seldom Almost Never

I want to be with people but I feel emotionally distant from them

Almost Always Usually Sometimes Seldom Almost Never

I am the type of person I would like to have for a friend

Almost Always Usually Sometimes Seldom Almost Never

I am afraid of becoming emotionally close to another love partner

Almost Always Usually Sometimes Seldom Almost Never

Even on the days when I am feeling good, I may suddenly become sad and start crying

Almost Always Usually Sometimes Seldom Almost Never

I can't believe our love relationship is ending

Almost Always Usually Sometimes Seldom Almost Never

I become upset when I think about my love partner dating someone

Almost Always Usually Sometimes Seldom Almost Never

I have a normal amount of self-confidence

Almost Always Usually Sometimes Seldom Almost Never

People seem to enjoy being with me

Almost Always Usually Sometimes Seldom Almost Never

Morally and spiritually, I believe it is wrong for our love relationship to end

Almost Always Usually Sometimes Seldom Almost Never

I wake up in the morning feeling there is no good reason to get out of bed

Almost Always Usually Sometimes Seldom Almost Never

I find myself daydreaming about all the good times I had with my love partner

Almost Always Usually Sometimes Seldom Almost Never

People want to have a love relationship with me because I feel like a lovable person

Almost Always Usually Sometimes Seldom Almost Never

I want to hurt my former love partner by letting him/her know how much I hurt emotionally

Almost Always Usually Sometimes Seldom Almost Never

I feel comfortable going to social events even though I am single

Almost Always Usually Sometimes Seldom Almost Never

I feel guilty about my love relationship ending

Almost Always Usually Sometimes Seldom Almost Never

I feel emotionally insecure

Almost Always Usually Sometimes Seldom Almost Never

I feel uncomfortable even thinking about having a sexual relationship

Almost Always Usually Sometimes Seldom Almost Never

I feel emotionally weak and helpless

Almost Always Usually Sometimes Seldom Almost Never

I think about ending my life with suicide

Almost Always Usually Sometimes Seldom Almost Never

I understand the reasons why our love relationship did not work out

Almost Always Usually Sometimes Seldom Almost Never

I feel comfortable having my friends know our love relationship is ending

Almost Always Usually Sometimes Seldom Almost Never

I am angry about the things my former love partner has been doing

Almost Always Usually Sometimes Seldom Almost Never

I feel like I am going crazy

Almost Always Usually Sometimes Seldom Almost Never

I am unable to perform sexually

Almost Always Usually Sometimes Seldom Almost Never

I feel as though I am the only single person in a couples-only society

Almost Always Usually Sometimes Seldom Almost Never

I feel like a single person rather than a married person

Almost Always Usually Sometimes Seldom Almost Never

I feel my friends look at me as unstable now that I'm separated

Almost Always Usually Sometimes Seldom Almost Never

I daydream about being with and talking to my former love partner

Almost Always Usually Sometimes Seldom Almost Never

I need to improve my feelings of self-worth about being a wo/man

Almost Always Usually Sometimes Seldom Almost Never

What is your gender?

Female

Male

Prefer not to say

>Do you have kids?

None

0-5 years old

6-12 years old

13-18 years old

19 or older

>What do you do during normal work hours?

Stay at home parent

Physical/Active type of job

Managerial job

Desk Job

Not currently working/Other

> Where are you in the divorce process?

Did you initiate the divorce?

How long were you or have you been married?

How long ago did you get divorce or when do you expect to be divorced?

Please tell us a little bit about your story (optional)

Did you/do you have many friends or family to talk to and support you during your divorce and soon after? (optional but very helpful)

Is there anything else you would like to share with us that might be helpful?

Email address

Name

Phone Number

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