International Research Network in Existential Therapy (IRNET)
We hope that you will be willing to complete this questionnaire, and so participate in our study of the personal changes that take place during the course of therapy.
Thank you for your assistance, and best wishes

The IRNET Team
Digby Tantam, Emmy van Deurzen, Dan Stiwne, Martin Milton, and Chris Blackmore
First name *
Your answer
Second name
(optional)
Your answer
Unique identifier *
Please choose from Place of birth, Name of first pet or Mother's maiden name
Your answer
Date of completion *
Please add the date as follows DD/MM/YYYY
Your answer
Have you filled in this questionnaire before? Roughly how many times?
We want to follow changes. So completing the questionnaire several times at intervals of a month or more is very helpful to us.
Do you confirm that you have read and understand the information for this project and have had the opportunity to ask questions? *
Do you understand that your participation is voluntary and that you are free to withdraw at any time without giving any reason? *
Do you understand that your responses will be anonymised before analysis, and do you give permission for members of the research team to have access to your anonymised responses? *
Do you agree to take part in this project? *
Overall, how satisfied or dissatisfied are you with your counselling/psychotherapy?
Very dissatisfied
Very satisfied
Overall, to what extent do you think counselling/psychotherapy is helping you?
Not at all
A lot
To what extent is therapy helping you to:
... feel more able to deal with your problems?
Not at all
A lot
... have a greater sense of purpose in your life?
Not at all
A lot
... feel less upset or distressed?
Not at all
A lot
... face up to the realities of life, however awful?
Not at all
A lot
... get on better with other people?
Not at all
A lot
... live life more fully?
Not at all
A lot
... feel more able to make choices?
Not at all
A lot
... be more aware of your feelings and thoughts?
Not at all
A lot
... feel happier in your life?
Not at all
A lot
... think more clearly?
Not at all
A lot
... feel more connected to others?
Not at all
A lot
... feel more able to be yourself?
Not at all
A lot
... understand more about how you came to be the way you are?
Not at all
A lot
... be more self accepting?
Not at all
A lot
Over the last 2 weeks, how often have you been bothered by any of the following problems? Little interest or pleasure in doing things?
1- not at all; 2- several days; 3- more than half the days; 4- nearly every day
Not at all
Nearly every day
Feeling down, depressed, or hopeless?
Not at all
Nearly every day
Trouble falling or staying asleep, or sleeping too much?
Not at all
Nearly every day
Feeling tired or having little energy?
Not at all
Nearly every day
Poor appetite or overeating?
Not at all
Nearly every day
Feeling bad about yourself, or that you are a failure or have let yourself or your family down?
Not at all
Nearly every day
Trouble concentrating on things, such as reading the newspaper or watching television?
Not at all
Nearly every day
Moving or speaking so slowly that other people could have noticed? Or the opposite, being so fidgety or restless that you have been moving around a lot more than usual?
Not at all
Nearly every day
Thoughts that you would be better off dead or of hurting yourself in some way?
Not at all
Nearly every day
If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?
1- not difficult at all; 2- somewhat difficult; 3- very difficult ;4- extremely difficult
Not difficult at all
Extremely difficult
Below are some statements about feelings and thoughts. Please select the box that best describes your experience of each over the last 2 weeks. I've been feeling optimistic about the future
1- None of the time; 2- Rarely; 3- Some of the time; 4- Often; 5- All of the time
None of the time
All of the time
I've been feeling useful?
None of the time
All of the time
I've been feeling relaxed?
None of the time
All of the time
I've been feeling interested in other people?
None of the time
All of the time
I've had energy to spare?
None of the time
All of the time
I've been dealing with problems well?
None of the time
All of the time
I've been thinking clearly?
None of the time
All of the time
I've been feeling good about myself?
None of the time
All of the time
I've been feeling close to other people?
None of the time
All of the time
I've been feeling confident?
None of the time
All of the time
I've been able to make up my own mind about things?
None of the time
All of the time
I've been feeling loved?
None of the time
All of the time
I've been interested in new things?
None of the time
All of the time
I've been feeling cheerful?
None of the time
All of the time
Over the last 2 weeks, how often have you been bothered by the following problems?
1- not at all; 2- several days; 3- more than half the days; 4- nearly every day
Not at all
Nearly every day
Feeling nervous, anxious or on the edge?
Not at all
Nearly every day
Not being able to stop or control worrying?
Not at all
Nearly every day
Worrying too much about different things?
Not at all
Nearly every day
Trouble relaxing?
Not at all
Nearly every day
Being so restless that it is hard to sit still?
Not at all
Nearly every day
Becoming easily annoyed or irritable?
Not at all
Nearly every day
Feeling afraid as if something awful might happen?
Not at all
Nearly every day
How old are you? *
Your answer
Are you female or male? *
For how many months have you seen your psychotherapist/counsellor? *
Your answer
Do you want to have the results of this study sent to you? *
The results can only be distributed by email.
Would you like to be interviewed by us regarding your existential counselling or psychotherapy? *
If you want the results and/or to be interviewed, how can we come in contact with you?
You can leave your email, telephone number, post address or Skype details.
Your answer
Have you answered all the questions? *
Which statement best describes your feelings and choices? There is not much I can do to help myself.
1- Strongly Agree; 2- Agree; 3- Neither Agree nor Disagree; 4- Disagree; 5- Strongly Disagree
strongly disagree
strongly agree
Often, there is no way I can complete what I have started.
strongly disagree
strongly agree
I can’t begin to understand my problems.
strongly disagree
strongly agree
I am overwhelmed when I have personal difficulties and problems.
strongly disagree
strongly agree
I don’t know how to begin to solve my problems.
strongly disagree
strongly agree
There is not much I can do to make a difference in my life.
strongly disagree
strongly agree
I haven’t yet found my life’s purpose.
strongly disagree
strongly agree
I don’t know who I am, where I came from or where I am going.
strongly disagree
strongly agree
I have a lack of purpose in my life.
strongly disagree
strongly agree
In this world, I don’t know where I fit in.
strongly disagree
strongly agree
I am far from understanding the meaning of life.
strongly disagree
strongly agree
There is a great void in my life at this time.
strongly disagree
strongly agree
Below are five statements that you may agree or disagree with. Using the 1 - 7 scale below, indicate your agreement with each item by placing the appropriate number on the line preceding that item. Please be open and honest in your responding. In most ways my life is close to my ideal.
7 - Strongly agree; 6 - Agree; 5 - Slightly agree; 4 - Neither agree nor disagree; 3 - Slightly disagree; 2 - Disagree; 1 - Strongly disagree
strongly disagree
strongly agree
The conditions of my life are excellent.
strongly disagree
strongly agree
I am satisfied with my life.
strongly disagree
strongly agree
So far I have got the important things I want in life.
strongly disagree
strongly agree
If I could live my life over, I would change almost nothing.
strongly disagree
strongly agree
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