Physical Block
1. When did your weight issue start? ____________________________________
2. a) Describe your discomfort: ______________________________________________________
b) How does this make you feel? ___________________________________________________
3. Your weight issue bothers or affects which area of your life? __________________________
4. In this area, is there a person or situation that makes you feel what is described in #2, at the time
of, or just before your weight issue started? ____________________________________
Emotional
5 a) Desire: Your weight issue prevents you from having or doing what?
_______________________________________________________________________________
b) Need: The fact that you do not…..(repeat answer #5a) prevents you from being what?
________________________________________________________________________________
NB: Realise that what you want is…. (repeat answer #5) but you block yourself because a part of you fears something.
Mental (belief)
6 a) In the situation mentioned in answer #4, if you would give yourself the right to (repeat answer
#5), what unpleasant thing could happen, what do you FEAR? ____________________________
b) If that happened, you would judge yourself or people would judge you of being what? ________
______________________________________________________________________________
Conclusion
Can I accept that, for the moment, I feel ______________________________ because I BELIEVE that if I am ______________________________, I will be _______________________
(no.5) (no.8)
To start healing, I need to agree to be____________________________________________ for the moment (no.8)
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