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* 1. Have you ever experienced the loss of a loved one, who is still alive, and this created a major change in or ended the relationship?

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* 2. Did/do you experience difficulties accepting the fact that your loved one is no longer in your life as he/she once was?

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* 3. Does it feel as if this loss has made it difficult for you to move forward and live your
life?

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* 4. Do you still have memories, good or bad, of this person that can distract you, or even occupy your thoughts at times?

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* 5. Did/do you feel disconnected from yourself or others as a result of
the loss of this loved one in your life as your relationship once was?

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