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Childhood Trauma Questionnaire
Tailored Online Therapy

Assess your past experiences with our Childhood Trauma Questionnaire.

 

This confidential tool helps identify potential trauma impacts, guiding your therapist in providing personalized support.

Childhood Trauma Screening
Online Therapy Enhancement

Completing a Childhood Trauma Questionnaire is crucial for effective online child trauma therapy with Canada Online Therapy. This in-depth assessment helps uncover and understand the effects of early trauma, providing your therapist with essential insights.

 

By sharing this information, you ensure that your online therapy for childhood trauma is customized to address your unique needs, using proven, evidence-based methods to support recovery and personal development. Enhance your therapeutic journey with a thorough analysis of your trauma history, leading to more focused and effective therapy sessions.

 

Canada Online Therapy also accepts insurance, making high-quality, trauma-informed care more accessible.

Childhood Trauma Questionnaire

Adapted from: Pennebaker, J.W. & Susman, J.R. (1988). Disclosure of traumas and psychosomatic processes. Social Science and Medicine, 26, 327-332.

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This form is only for admitted and assessed current clients of Canada Online Therapy, Lee Park Psychotherapist.

Childhood Trauma Questionnaire

1. Prior to the age of 18, did you experience a death of a very close friend or family member?
1 b. On a 7-point scale where 1=NOT AT ALL TRAUMATIC, 4=SOMEWHAT TRAUMATIC, and 7=EXTREMELY TRAUMATIC, how traumatic was this?
1 c. On a 7-point scale where 1=NOT AT ALL and 7=A GREAT DEAL, how much did you confide in others at the time?traumatic was this?
2. Prior to the age of 18, was there a major upheaval between your parents (such as divorce, separation)?
2 b. On a 7-point scale where 1=NOT AT ALL TRAUMATIC, 4=SOMEWHAT TRAUMATIC, and 7=EXTREMELY TRAUMATIC, how traumatic was this?
2 c. On a 7-point scale where 1=NOT AT ALL and 7=A GREAT DEAL, how much did you confide in others at the time?
3. Prior to the age of 18, did you have a traumatic sexual experience (raped, molested, etc.)?
3 b. On a 7-point scale where 1=NOT AT ALL TRAUMATIC, 4=SOMEWHAT TRAUMATIC, and 7=EXTREMELY TRAUMATIC, how traumatic was this?
3 c. On a 7-point scale where 1=NOT AT ALL and 7=A GREAT DEAL, how much did you confide in others at the time?
4. Prior to the age of 18, were you the victim of violence (child abuse, mugged or assaulted -- other than sexual)?
4 b. On a 7-point scale where 1=NOT AT ALL TRAUMATIC, 4=SOMEWHAT TRAUMATIC, and 7=EXTREMELY TRAUMATIC, how traumatic was this?
4 c. On a 7-point scale where 1=NOT AT ALL and 7=A GREAT DEAL, how much did you confide in others at the time?
5. Prior to the age of 18, were you extremely ill or injured?
5 b. On a 7-point scale where 1=NOT AT ALL TRAUMATIC, 4=SOMEWHAT TRAUMATIC, and 7=EXTREMELY TRAUMATIC, how traumatic was this?
5 c. On a 7-point scale where 1=NOT AT ALL and 7=A GREAT DEAL, how much did you confide in others at the time?
6. Prior to the age of 18, did you experience any other major upheaval that you think may have shaped your life or personality significantly?
6 c. On a 7-point scale where 1=NOT AT ALL TRAUMATIC, 4=SOMEWHAT TRAUMATIC, and 7=EXTREMELY TRAUMATIC, how traumatic was this?
6 d. On a 7-point scale where 1=NOT AT ALL and 7=A GREAT DEAL, how much did you confide in others at the time?
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