Counselling Request Form
Thank you for requesting a shamanic counselling session with Craig Berry, of Shaman's Hearth. We can make contact via Facebook Messenger, WhatsApp, or Skype. To facilitate our discussion, please have a careful think through the following questions and give as much pertinent detail as you feel is needed to fully answer the question. Please contain any rambling, and focus on the terms of the question, as they are specific to exploring your process.
Requested Service *
<35 Mins: A shorter consultation time for light work, and simple stagnation clearing. <50 mins: A medium consultation for deeper questions, work and treatment; suitable for shadow work. <4 hours. A half day session suitable for deeper works, and involved explorations.
Preferred payment method: *
The issue, in brief:
Using as few words as possible, and no more than a short paragraph, summarise the most pressing issue or event that you want to discuss.
Your answer
Please list any relevant parties
... along with their relationship to you and length of association if not lifetime. E.g. John, mid 30s, friend since high school 18 years ago. One person or identity per line, please.
Your answer
Objective Data:
Using a perspective that is as objective as possible, please list ALL of the relevant objective data, using one line per item. Guide: “She left me.” is a subjective statement. “She left.” is the objective data. The “me” is the subjective attachment of a personalised story written by fear.We are seeking a sequence of data only at this point. For example:It was two Saturday evenings ago. I got drunk. Hit power pole in car going home. Charged and convicted of drunk driving for fifth time. Fined 2000 and lost license for a year. Wife upset with me. ** One item per line, please.
Your answer
Subjective Impressions:
Please now describe your subjective impressions, responses or reasons relevant to each of the objective items listed above. Be as brutally honest about what subjective factors are really present.Extending the above example:It was two Saturday evenings ago. - I was working overtime to get a report done for my immediate boss who acted out like a spoiled brat all day.I got drunk. - It was after work, and I needed to let off some frustration and forget about work for a while.Hit power pole in car going home. - I was thinking about quitting work and looked up in time to jerk on the wheel. Now my car is halfway up a power pole I just almost knocked over. Feels like the world is telling me to get f***ed.
Your answer
Subjective Impacts
Since this triggering incident, describe what patterns have been expressing, or what thoughts have been coming back that you’d like assistance with.Example: It’s felt like no matter what I do, it seems like the world works to find some way to blow things up on me, right when they are going well.
Your answer
The Issues
Looking into the words you’ve written above, what issues can you identify as active in your commentary or discussion?Example: I can’t stand my job. I hate what I’ve become with this company. I feel like a sell-out.
Your answer
The Underlying Patterns and Fears
Looking into those issues, what underlying fear patterns can you identify as active? Example: I have a fear of success.
Your answer
Desired Outcome
Now you have examined the issues in more detail, what outcome would you seek in an ideal world? (Hint, “Getting better” is just a soundbite.) Example: I want to know if I should leave this job. I want to stop destroying my life with these repetitive patterns of self-sabotage.
Your answer
How would you like to approach this issue?
If you came to a solution while filling out this form, would you please share your insight here?
Your answer
Your Time Zone
What is your closest capital city (and country) that is in the same time zone as you?
Your answer
What is your preferred contact time?
Your answer
Your cellular number (including country code)
Your answer
Your WhatsApp number, if different
Your answer
Your answer
Your Skype number or ID
Your answer
Your email address
Your answer
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