Masturbation/Porn/Sexual Addiction Coaching Pre-Work/Application: Family of Origin
For the entire application, please be honest. With all answers, we do not accept "I don't know, maybe, not sure" as an answer and we encourage you to reflect and dig deeper. If a question does not apply to your life in any way (like having a child) then you can say N/A.

There are 5 parts to this application:
1. Family of Origin
2. Relationship History
3. Personality & Personal Values
4. Current Relationship
5. Masturbation/Porn/Sexual Addiction Information
Email address *
What is your full name? *
Age *
Ethnicity *
What is your hometown? *
Growing up, were you parents married? *
Did they divorce? If so, when? And was it a clean and easy divorce, or was it hard on you and the entire family? Please explain. *
What were/are your parents jobs as you grew up? *
Was your family financially stable growing up? *
What was the living environment? A house, apartment, condo? etc. *
Do you have any siblings? If so, were you close with them? And where do you fall in the birth order (oldest, middle, youngest, only)?
Can you please describe the household dynamic growing up (family members in your house, whether parents worked, divorce, addiction, etc.) *
Were your parents emotionally attentive or emotionally distant? *
Did your parents ask about your day and how your life is going as you were growing up? *
Did you feel safe in your home growing up? *
Did you ever experience any abuse in your life? *
How did your parents interact with each other? Was it loving/romantic? Was it distant? Was it short? etc. *
How did your parents communicate with each other? Was it direct? Passive-aggressive? Thoughtful? Mean? etc. *
Did your parents ever abuse each other or cheat/betray each other? *
As a child, were you bullied? If so, how did that impact you? *
Did your parents talk to you about sex, intimacy, morality, honor, and dignity? *
Did your parents talk to you about porn? If so, how did the conversation go? *
Did your dad use porn to your knowledge? *
Can you describe your overall childhood in a couple sentences? *
Do you believe anything from your childhood has had a lasting impact on your adult life? If so, please explain *
If there is anything else you want to add or say, please share here *
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