This research is for a coaching solution/approach to help people.

Have you experienced, sexual or verbal abuse, relationship betrayal, divorce, a traumatising family situation or maybe a terrible shock? Or anything in your life that has caused you to no longer trust or has completely broken your trust?

If so, I am interested in both big and small things (nothing is insignificant). If you would like to submit more than one scenario, please just click on the link again for a new blank form (or reload this page).

Should you need to, you will find a “save and continue later” option next to the “Submit” button at the bottom of the page. This generates a unique funky link that only you have access to for a maximum of 30 days and then it is automatically deleted.

This is a private form. Once you “Submit” an email is sent to me with what you typed – and the form then returns to blank. Nothing is stored online. Nothing can be viewed by anyone. This is strictly Private and Confidential.

There are 9 questions I would like your help with; none of which are compulsory, however, they all help me understand. I realise this is difficult and need to emphasise, how much I appreciate your help.

  • If you could give your situation a title, topic or a name, what would it be? (Anything goes)
  • Which category does your topic fit into? (Please choose one)
  • What happened to cause this betrayal or disappointment? Feel free to write your whole story or just a few points. Help me understand how bad it was for you and why it is difficult for you to trust?
  • Can you list the emotions or feelings that come up, when you think about this?
  • What have you tried that has helped you on your journey?
  • What did you try, that did not help you?
  • Please help me understand where you are on your journey. Rate where you are today from 1-10. Some numbers have a description for the rating, to help you position where you are:
  • May I use this information anonymously to help others by building coping mechanisms or solutions for them to implement? This might include telling your story anonymously to help others
  • How can I contact you to let you know when I am running a free Zoom webinar/coaching session about establishing trust in your life again?
  • What is your best email address for me to use to get hold of you?
  • If you would you prefer me to send you a WhatsApp message, please provide your cell/mobile number:
  • This field is for validation purposes and should be left unchanged.

I appreciate your vulnerability, openness and willingness to help others – this will be kept strictly confidential (like a doctor).

Thank you!!     Much appreciated!!