THE RESTORE FRAMEWORK Δ
Current Relationship Status
Do you currently live together
Which of the following best describes your current concern? (You may tick more than one)
Betrayal/Infidelity Emotional Disconnection Trust Issues Communication Difficulties Emotional Exhaustion Identity/Self-worth Struggles Conflict & Tension Anxiety/Emotional Overwhelm Relational Uncertainty Separation/Divorce Discernment Grief or Emotional Pain Other
Instructions
There are no wrong or right answers to the statements in this assessment.
Ensure you are in a calm and unhurried state before taking this assessment.
The assessment requires you to HONESTLY give responses that reflect your authentic self.
Answer truthfully for the most accurate reflection of your personality and your desires.
Section 1 - Betrayal Impact Exploration Please read each statement carefully and rate how true it currently feels for you using the scale below:
5 - Strongly Agree
4 - Agree
3 - Neutral
2 - Disagree
1 - Strongly Disagree
1. I find it difficult to emotionally relax around my partner now.
2. My mind frequently replays the betrayal or related thoughts.
3. I feel emotionally on guard even during normal interactions.
4. Small situations now trigger stronger emotional reactions in me.
5. I feel emotionally exhausted carrying the weight of this experience.
6. I struggle to believe what my partner says without questioning it internally.
7. I feel emotionally disconnected from my partner.
8. It is difficult for me to feel safe being emotionally vulnerable now.
9. I sometimes question whether the relationship was ever truly secure.
10. Physical or emotional closeness feels different or more complicated now.
11. This experience has negatively affected how I see myself.
12. I sometimes question my worth, attractiveness or value because of what happened.
13. I feel less emotionally confident than I used to.
14. I compare myself to the other person involved or imagined possibilities.
15. Part of me feels emotionally rejected or replaced.
16. I feel torn between wanting repair and wanting emotional distance.
17. I struggle to make sense of why this happened.
18. I feel grief over what I believed this relationship was.
19. I sometimes feel emotionally numb or detached.
20. I fear being hurt again in the future.
21. I feel uncertain about the future of this relationship.
22. I feel emotionally alone even when my partner is present.
23. I sometimes suppress my emotions to avoid becoming overwhelmed
24. I do not feel fully understood in my pain.
25. I want healing, but I am unsure what healing should look like now.
Section 2 - Emotional Safety & Nervous System Check-In Please read each statement carefully and rate how true it currently feels for you using the scale below:
5 - Strongly Agree
4 - Agree
3 - Neutral
2 - Disagree
1 - Strongly Disagree
1. I find it difficult to feel emotionally calm lately.
2. My emotions often feel close to the surface.
3. Small situations affect me more intensely than they used to.
4. I struggle to emotionally settle after upsetting interactions.
5. I feel emotionally overstretched internally
6. I feel mentally “on guard” much of the time.
7. I frequently anticipate emotional disappointment or conflict.
8. I overanalyze conversations or interactions afterward
9. I find it difficult to fully relax emotionally around certain people or situations.
10. My body often feels tense even when I try to rest.
11. I feel emotionally drained more often than refreshed.
12. Sometimes I emotionally shut down because everything feels overwhelming.
13. I feel mentally tired from carrying emotional weight internally.
14. I avoid certain conversations because I fear becoming emotionally overwhelmed.
15. I sometimes feel disconnected from my emotions altogether.
16. I currently feel emotionally safe in very few spaces or relationships.
17. I struggle to feel emotionally grounded within myself.
18. I long for emotional rest but find it difficult to access internally.
19. I feel emotionally lonely even when around other people.
20. I sometimes feel emotionally disconnected from my own body or needs
21. I find it difficult to return to emotional balance after distress.
22. My thoughts often continue racing long after stressful moments end.
23. I feel emotionally fragile or easily affected lately.
24. I wish I could emotionally exhale, but something inside still feels unsettled.
25. I desire emotional peace, but I am unsure how to fully regain it.
Section 3 - Attachment Style Please read each statement carefully and rate how true it currently feels for you using the scale below:
5 - Strongly Agree
4 - Agree
3 - Neutral
2 - Disagree
1 - Strongly Disagree
1. I deeply value emotional closeness in relationships.
2. I feel safest when emotional communication is open and consistent.
3. I become emotionally affected when I sense distance from someone I care about.
4. I desire reassurance when relationships feel uncertain.
5. I long for emotional connection, even when I struggle to express it.
6. I worry about being emotionally rejected or abandoned.
7. I overthink changes in people’s tone, energy or communication.
8. I sometimes fear people may stop loving or choosing me.
9. I become emotionally unsettled when communication suddenly changes
10. I seek signs that reassure me the relationship is still secure.
11. I sometimes pull away emotionally when I feel overwhelmed.
12. Depending too much on others emotionally feels uncomfortable to me.
13. I prefer handling emotional struggles privately rather than relying on others.
14. I sometimes suppress emotions to avoid feeling vulnerable.
15. Too much emotional closeness can sometimes feel overwhelming to me.
16. Conflict affects my sense of emotional safety strongly.
17. I struggle to relax emotionally after relational tension or disagreement.
18. I sometimes become defensive or guarded during emotional conversations.
19. I find it difficult to fully trust emotional safety in relationships.
20. I desire emotional safety, but part of me fears vulnerability.
21. I generally believe healthy emotional connection is possible.
22. I can usually express my needs without excessive fear or shame.
23. I often feel torn between wanting closeness and wanting distance.
24. I feel emotionally secure when relationships are calm and consistent.
25. My past relational experiences still affect how I approach relationships today
Section 4 - Relational Beliefs & Narrative Audit Please read each statement carefully and rate how true it currently feels for you using the scale below:
5 - Strongly Agree
4 - Agree
3 - Neutral
2 - Disagree
1 - Strongly Disagree
1. I find it difficult to fully trust people emotionally.
2. I believe emotional closeness often leads to disappointment.
3. I feel emotionally safer when I remain guarded.
4. I sometimes expect relationships to eventually become painful.
5. I believe consistency is necessary before emotional safety can grow.
6. I sometimes question whether I am truly enough in relationships.
7. Part of me fears being emotionally replaced or abandoned.
8. I sometimes feel I must earn love through effort, performance or sacrifice.
9. I struggle to believe I can be fully loved while being my authentic self.
10. I sometimes compare myself to others relationally.
11. Conflict often makes me fear emotional disconnection.
12. I associate vulnerability with the possibility of emotional hurt.
13. I sometimes suppress my true feelings to protect myself emotionally.
14. I believe emotional misunderstandings can deeply damage relationships.
15. I often become emotionally cautious after relational disappointment.
16. I believe healthy relationships require intentional emotional work.
17. I sometimes expect disappointment even when things seem calm.
18. I believe unresolved emotional wounds can affect relationships deeply.
19. I sometimes prepare emotionally for hurt before it even happens.
20. I believe emotional safety is one of the most important parts of a relationship
21. I believe healing and healthier relationships are possible.
22. I desire deep emotional connection despite past disappointments.
23. I believe people can grow emotionally and relationally.
24. I sometimes feel torn between hope and emotional self-protection.
25. My past experiences strongly influence how I interpret present relationships
Section 5 Identity & Self-Worth Exploration Please read each statement carefully and rate how true it currently feels for you using the scale below:
5 - Strongly Agree
4 - Agree
3 - Neutral
2 - Disagree
1 - Strongly Disagree
1. I feel connected to who I truly am.
2. I sometimes feel emotionally lost or disconnected from myself.
3. I feel confident in my personal value beyond relationships or external validation.
4. I sometimes struggle to recognize myself emotionally after painful experiences.
5. I feel I have a strong sense of personal identity.
6. My sense of worth is easily affected by how others treat me.
7. I sometimes question whether I am enough.
8. I feel emotionally valuable even when others disappoint me.
9. I sometimes tie my worth to acceptance, approval or validation from others.
10. I believe I deserve emotional safety, respect and healthy love.
11. I find it difficult to express my true emotional needs confidently.
12. I sometimes silence parts of myself to maintain peace or connection.
13. I feel increasingly aware of my emotional needs and boundaries.
14. I trust myself to make healthy emotional decisions.
15. I sometimes ignore my own emotional wellbeing while focusing on others.
16. I feel emotionally secure within myself most of the time.
17. Difficult experiences have negatively affected my confidence.
18. I feel emotionally stronger than I used to be.
19. I sometimes fear being unwanted, rejected or emotionally insignificant.
20. I believe my value remains intact even during painful seasons.
21. I desire a healthier relationship with myself emotionally.
22. I feel I am still rediscovering parts of myself.
23. I believe healing can strengthen my sense of self.
24. I want to feel more emotionally grounded and internally secure.
25. I believe I am worthy of healthy connection, care and emotional peace.
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