Valley of Renewell, LLC

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CONFIDENTIAL TCE QUESTIONNAIRE

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TCE's

Traumatic Childhood Experiences

 

Traumatic Childhood Experiences (TCE’s) - from conception to age 18 - play a significant role in our mental, physical, emotional and spiritual health during adulthood. If you can honestly answer ‘no’ to each one of the following questions, there is a good chance that you are (or will become) a well-adjusted, healthy adult.

 

The object for this section is to identify and resolve childhood experiences which may have a detrimental health impact on your adult life. This is for your own use and the questions should be answered in private.

 

Print this form, answer the questions and refer to it often. Use additional sheets of paper, notebook, or journal to expound upon each “yes” answer.           

                                                                                                                                CIRCLE

Traumatic Childhood Experiences (TCE’s) Confidential Questionnaire.  N = no   Y = yes

 

Were you ever enrolled in day care, nursery school, or kindergarten, or under the frequent care of a ‘baby sitter’?                                                                                    N     Y                                                                                 

Was your home ever severely damaged or destroyed due to fire, vandalism, hate crime, act of war . . . or natural disaster such as hurricane, mud slide, tornado, flood, etc.?                                                                                                                                                     N      Y

 

Were you ever personally subjected to or injured by any of the above?                                                                                                                                                                N       Y

 

Did you or your family ever move to a different location?                              N      Y

 

Did either or both of your parents die before you were eighteen?                   N      Y

 

Were your parents divorced or separated?                                                        N      Y

 

Were one or both of your parents imprisoned?                                                 N      Y

 

Did a parent, sibling or close friend or family pet die before you were eighteen?

                                                                                                                           N      Y

 

Did you live in a single parent home?                                                               N      Y

 

Did you live in an orphanage or under foster care or on the streets?                N       Y

 

Have you ever lived with or had close association with anyone who was: 

            An alcoholic or problem drinker?                                                          N      Y

            Used or abused illegal drugs or medicines?                                           N      Y

            Abused legally prescribed or over the counter (OTC) drugs

                        or medicines?                                                                              N      Y

            Exhibited signs of excessive worry, anxiety, fear, or depression?       

            Exhibited signs of any obsessive-compulsive personality disorder                      

                        such as excessive working, shopping, cleanliness, or dietary

                        habits (overeating, anorexia, bulimia), etc.                                N       Y

Did you, personally experience any of those traits mentioned above?              N       Y

 

 

Were you ever subjected to an actual or attempted robbery, mugging, sexual

fondling or rape (vaginal, oral or anal intercourse)?                                           N      Y

 

Been coerced into touching someone else’s body in a sexual way?                     N       Y

 

If you lived in a two parent home:

          Did both parents work?                                                                                N      Y

          Did neither parent work?                                                                              N      Y

          Were you ever a ‘latch key’ kid?                                                                  N      Y

 

Were you or someone in your household ever chronically ill or mentally ill?      N     Y

 

Did you or someone in your household ever contemplate suicide or make a         

suicide attempt?                                                                                                       N     Y

 

Were you ever exposed to a widespread industrial or household chemical

spill, or other toxic chemicals, even harsh household cleaning agents such

as chlorine bleach, ammonia, or lye?                                                                      N      Y

 

Did you frequently drink, bathe in or swim in chlorinated water?

(NOTE: consider all water from municipal sources as being chlorinated).           N     Y

 

Were you frequently exposed to second-hand tobacco smoke?                             N     Y

 

Have you ever received vaccination(s), antibiotics or other prescribed or

            non-prescribed (Over The Counter) medication in any form?                   N     Y

 

Were you ever a participant in (or a victim of):

          Gang violence?                                                                                              N     Y

          Any form of frequent bullying, insult, humiliation, intimidation,

                       threats, name- calling or ridicule?                                                     N     Y

          Were you ever attacked by a person or an animal?                                        N     Y

          Were you a war refugee or forced into political exile?                                  N     Y     

          Were you or anyone else in the home subject to frequent slapping,

                       pushing, or shoving?                                                                          N     Y

          Tied, chained, or locked up?                                                                           N     Y

          Fearful of being hurt?                                                                                      N     Y

          Intentionally burned, bitten or tortured?                                                         N     Y

          Threatened with a weapon (knife, axe, gun, baseball bat, etc.)?                     N     Y

          Beaten to the point of bruising or personal injury?                                         N     Y

 

Have you often felt:

          Unneeded, unloved, unimportant or unwanted?                                              N     Y

          ‘Dirty’ or loathsome or stupid?                                                                       N     Y

           Neglected or abused?                                                                                      N     Y

          That your spiritual needs were not being met.                                                 N     Y

 

Consider your physical needs.

          Did you often go unwashed?                                                                           N     Y

          Was your hair often unkempt?                                                                         N     Y

          Was your clothing often neglected, dirty, shabby, ripped, worn, or torn?       N     Y

          Did you suffer from a lack of food or inadequate nutrition?                           N     Y

          Were you forbidden to run, jump, play, climb trees, get dirty or play

                        in the water or the mud?                                                                    N     Y

 

Were you often discouraged from using your imagination or daydreaming?            N      Y

 

Were your mannerisms often annoying or disruptive to others or to your                                      classroom?                                                                                                              N     Y

 

Did you participate in:

           Structured early-learning programs?                                                              N     Y

           Heavily or tightly scheduled activities?                                                          N     Y

           Organized, highly competitive individual or team:                      

                     sports, music, drama, dance, debate, etc.?                                            N     Y

 

Did you ever experience:

          Severe hunger or near-starvation?                                                                    N     Y

          Severe accident or trauma?                                                                               N     Y

          Severe illness, hospitalization, or surgery (including dental)?                         N     Y

 

Did either of your parents use nicotine, alcohol, or other drugs within one year

prior to your conception?                                                                                            N     Y

 

Did your mother use alcohol, nicotine, caffeine or other drugs while she

            was pregnant with you?                                                                                  N     Y

 

Was your mother exposed to second-hand tobacco smoke or harsh

            chemicals before you were born?                                                                   N     Y

 

Did you ever receive a diagnosis of dyslexia, attention deficit disorder (ADD),

           attention deficit hyperactivity disorder (ADHD), or other learning                                              disorders’?                                                                                                      N    Y

 

Did you ever take medication such as Ritalin for ‘learning disorders’?                    N    Y

 

MALES:

             Did you enter into an early marriage which failed?                                      N    Y

             Did you ever father a baby out of wedlock (aborted or born)?                     N    Y

             Did you  become a single dad?                                                                      N    Y

 

 

FEMALES:

          Were you ever pregnant out of wedlock?                                                          N     Y

               (IF YES) More than once?                                                                            N     Y

               Did you have an abortion?                                                                            N     Y

                          (If Yes) More than one?                                                                     N     Y

                          Was/were the baby/babies adopted?                                                  N     Y           Did you enter into an early marriage which failed?                                               N     Y

     Did you elect to become a single mom?                                                                N     Y

 

 

NOTE: This questionnaire does NOT include all of the possible sources of Childhood Traumatic Experiences.  TCE’s are only one category of several sources of toxic thoughts which are known precursors to mental, spiritual, emotional, and physical degeneration, debility, and disease.

 

The coping mechanisms and techniques which helped us survive traumatic childhood situations ARE NOT VALID FOR USE IN ADULT LIFE. They are toxic to our physical, mental, emotional and spiritual health and are detrimental to our overall well-being.

 

ONE OR MORE ‘yes’ answers to the above questions could be indicative of potential serious problems which might surface during adulthood. . . even twenty, forty. . . sixty or more years after the fact. Fortunately, we don’t need to continue to be victims of our heredity or environment. The vast majority of childhood trauma can be resolved, and natural healing (without medication) can start to take place within a few days.

 

Thinking about some childhood experiences and/or answering the TCE questionnaire may open a ‘can of worms’. If troubling thoughts arise, please consult with a competent Cosmic Expansion Transformational Holistic Health Care Provider and/or Spiritual Adviser.

 

 

© US and International copyright 2010 by Richard L. Newell

 

 

 

 

 

 

 

 

 

Valley of Renewell, LLC

"Healthier Mind, Body, 
Spirit, Emotions - 
and A Healthier Pocketbook!