NSEV History Form

Name_____________________________________Date___________

These are common issues for the Non-Somatic Extraordinary Vessels. I provide NO counseling for these issues. I let the needles, tuning forks, magnets do the healing. If you need further help please seek professional psychological care.

Circle all that applies to you:
Have you ever felt/had any of the following?

A.Who am I?    Why am I here?      What is my purpose?      What is the meaning of life?                   Is this all there is?              What does it mean to be whole?
Is there trauma in your ancestral lineage?              Do you feel guilt/anxiety
when you don’t want to fulfill family expectations?              Cultural
expectations?                 Birth Trauma?                              Failure to thrive as an infant?
Chronic diarrhea/constipation?                          Food Allergies?
Food intolerance like Lactose?           Leaky Gut?              Celiac Disease?
Emotional eating?              Chronic Fatigue?              Chronic Depression?
Inability to pursue new ideas?                     Feel like a hamster running on a
wheel – exhausted but keep running?                       Anxiety/Panic attacks?
Pursue things that don’t support your growth?               Reckless passions
and desires- unsatisfied when you fulfill them?           Accomplish
something and then feel empty?                Apathy?                   No passion?
Weak Legs?                Unstable emotions?                    Unhealthy lifestyle choices?
Digestive problems made worse by emotional stress?
Loose your footing when life becomes too much?                   Do you ever want to be told where to go and what to do- someone else making your decisions for you?

B. Birth trauma – difficult birth,   premature birth,   long birth,   forceps, C-section,                  no bonding with mother,
Can’t nurture yourself?
Feel guilty nurturing yourself?                    Difficulty loving yourself?
Eating disorders?             Food=comfort?                       Feel empty?
Can’t soothe yourself?                        Inability to let go of the past?
Inability to accept the present?                   Difficulty dealing with stress, failure or frustration?
Feel fearful/anxious frequently?
Did you have an over controlling mother?             Any chemical addictions? Tobacco addiction?
Alcohol addiction?              Do you feel like you don’t
belong anywhere?                       Gynecological problems?

C. Difficulty with confidence in ability to accomplish tasks?
Believe the world is a difficult place?                    Fearless but wounded?                             Codependency?
Difficulty dealing with authority?
Hard to stand up for yourself ?                   Need others to create structure for your life?
Anger at people who tell you what to do?
Feel like you can’t accomplish anything ?                 Low self respect?
Apathy/cowardice?                        Seizures/rigidity of spine?
Emotionally rigid See things in black + White ?              Extroverted?
More comfortable with thinking than feeling?
Anger management issues ?                      Impulsive/risky behavior without regard for consequences?
Low/No courage to face fears?         Inability to maintain upright posture?             Gynecological problems?               infertility?
Stiff back – hard to bend forward/backward ?           Hemorrhoids?
Ache in head, neck or back?

 

D. Obsess about events?           Discontented?               Unhappy about your state of beingness?
Pain in heart center?                  Emotional pain creating
suffering in all aspects of life?            Not content with who you are?
Anxiety    Shame    Guilt        Unfulfilled yearning?          Broken heart?
Life out of control ?          Unable to achieve the future you want ?           Stuck in memories of traumatic/unhappy past?
Want to rewrite you history?
What if….??                  Anxiety based on past and inability to overcome it?
Can’t remember parts or all of past due to it being so overwhelming?
Remember things differently than siblings ?               Difficulty expressing yourself?
Difficulty telling your story – if you did it would be too
emotionally overwhelming ?                 Very uncomfortable with visible signs of aging – anxiety?
Changes/Challenges are difficult for you?
Feel very stuck ?         Depressed?           Frustrated?              Chronic joint pain?
Fibromyalgia ?          Numb/tingling in joints?                     Emotional back ache?
Sadness ?      vomiting?           indigestion ?           Food sensitivities?          Gas?          Bloating?

 

 

 

E. Fear of moving forward in any/all areas of your life based on your history and experience?                    Avoid conflict – anger displaced Headache?
Joint pain?                        Dampen emotions by drinking alcohol, eating too much, too much TV?
Passive/Agressive behavior ?                Resistance to change?
Midlife crisis – act like a millennial ?          Judgement – others +/or self?
Blame others +/or Self ?              Disappointed with your life and blame others?
Depression?                 Lack momentum or sense of direction in life?
Never found passion or mastered anything?                   Can’t focus on one thing long enough to master it?
Trouble prioritizing?                 Easily distracted?
Fingers in too many pies ?                  Chaotic and lack purpose?             Movement going nowhere?
Self defeating/sabotaging behavior – often repeating it when you
know it doesn’t work ?                Lash out physically when angry or afraid?
Immobilized with fear?               When afraid you do nothing?
Fear of the future ?       Fear of death?         Nothing ever goes right?
Real success is impossible to achieve?              Doing nothing is better than being disappointed again?
Ear problems?        Back pain?       Shoulder pain?  Hip pain?

 

F. Uncomfortable with who you are?      Hate self?           Loath self?
Need to demonstrate you are worthy?        Distrust you are worthy?
Look outside of your self for validation?              Feel like something is wrong with you?        Feel wrong for simply existing?         Abdominal pain ?       Low back pain?    Genital pain?       Parasitic infections?           Feel like you aren’t in alignment with who you really are?    Weighed down by hurts of the past?     Feel unworthy?
Want to withdraw from world?     Sleep a lot?         Not refreshed when wake up?
Overly focused on yourself ?         Obsessed with your needs + desires?
Feel shock/hurt when others think you are selfish?                Deep sense of emptyness/loneliness ?         Difficult to look at yourself?              Pain in throat?
Hold back from speaking up for fear of ridicule ?        Difficult to speak your truth ?      Suicidal tendencies?             Look inside and see nothing but darkness ?         Weight gain?          Eye problems?

 

 

 

G.   Stuck, unable to move forward due to fear?      Abused?           Bullied?
Continuously bracing for next attack ?           When try to engage the world or participate – told to go away or threatened?            Feel like you’re holding back all the time?               High blood pressure?              Migraines?             Stroke?       Seizures?        Joint pain?
Belching?            Allergies ?               Rebellion?
Radical activism?              Can’t accept world as is and will do anything to change it- then you will be ok?      Focus is external?                Constantly pushing against the world?      Pain?        Exhaustion?                 Feel defeated?     Withdraw?           Depression?
Chronic fatigue ?          Feel like a runaway freight train?               Unable to slow down and recharge?        Unable to be in present moment?                                                                                               Chronic pain – head,   neck,   shoulders,   hips,   low back?
Do you think you are relaxed and are told you aren’t and it feels like judgement?     Do you believe you have to keep going to be free and relaxed?                  Feel agitated?                      Eye problems?           Epilepsy?                  Urinary problems?

 

H. Unresolved emotions, memories, beliefs detrimental to living your purpose ?                  Trauma not dealt with?                       Difficulty moving forward in life?
Feel heavy?         Feel lethargic?         Feel tired?            Feel stuck?
Exhaustion?        Stop trying?       Feel defeated?        Extra weight around the middle of your body ?                    Low back pain?              Painful periods?               Infertility?           Diarrhea?
Frequent urination?              Vaginal discharge?
Premature ejaculation?              Suffering and don’t know why?            Stubborn?           Do you accept yourself as unique?
Do you dislike different aspects of yourself?    Do you think you have a flat personality?              Do you have deeply held beliefs?                    Feel like you are never yourself around people?
Feel full around your middle?           Urinary problems?                 Pain in waist?
Pain in low back?          Headache?           Cold legs and feet?
Muscle pains in legs ?                        Hip and groin pain?

 

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