Grief Assessment

Using the scale below, assign a number from 1 to 7 to each of the words which represents how you are feeling.

1) I never feel this way
2) I do not feel this way 90% of the time
3) I do not feel this way 75% of the time
4) I feel neutral
5) I do feel this way 75% of the time
6) I do feel this way 90% of the time
7) I always feel this way.

Column

1.   Scared
2.   Lonely
3.   Reactive
4.   Hopeless
5.   Vulnerable
6.   Anger
7.   Unnatural
8.   Irritated
9.   Stuck
10. Purposeless
11. Stressed
12. Dazed
13. Suspicious
14. Mournful
15. Unhappy

Total for column one __________

One

1   2   3   4   5   6   7
1   2   3   4   5   6   7
1   2   3   4   5   6   7
1   2   3   4   5   6   7
1   2   3   4   5   6   7
1   2   3   4   5   6   7
1   2   3   4   5   6   7
1   2   3   4   5   6   7
1   2   3   4   5   6   7
1   2   3   4   5   6   7
1   2   3   4   5   6   7
1   2   3   4   5   6   7
1   2   3   4   5   6   7
1   2   3   4   5   6   7
1   2   3   4   5   6   7

Column

16. Peaceful
17. Sociable
18. Proactive
19. Hopeful
20. Self-reliant
21. Calm
22. Natural
23. Motivated
24. Moving
25. Purposeful
26. Stress-free
27. Clear-headed
28. Trusting
29. Cheerful
30. Happy

Total for column two _________

Two

High Grief           75 - 105                 High Grief         1 - 45
Moderate Grief    45 - 75                  Moderate Grief 45 - 75
Low Grief             1 - 45                   Low Grief         75 – 105

This assessment shows where your consciousness is with your grief.
If your column one is moderate to high or column two is moderate to low you may want to look for help to work through the pain of your grief.

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