Women’s Empowerment Embodied

Mental & Emotional Empowerment

Please take some time to think about the areas you would like to feel more empowered

Life Areas

(If it doesn’t apply to you, just write N/A)

You can fill out this form and send it to me as we will be going over all of this in our next session. ( I will send you a copy of your answers so you have them for yourself). Or you can write about it in your own personal journal.

PLEASE CHOOSE 3 AREAS THAT YOU MOST WANT TO FOCUS ON IN OUR SESSION. Three areas you really want more empowerment in your life.

Consider the following life areas (and add any of your own) and rank from 0 - 10 how empowered you feel in each area. So, for each category, how much power do you assert in the area? Do you feel like you have the mental, emotional, spiritual, energetic and physical resources (or can acquire them) to express your preferences and desires in this area and to create in a way that shapes reality to your vision?

0 = I have no resource (power) in this area

2 = I have some resource (power) in this area

5 = I have a fair amount of resource (power) in this area

8 = I am powerful in this area and generally feel like I have resources to express my preferences and desires in this area and to create in a way that shapes reality to my vision

10 = I am fully powerful in this area and have all the resources I need to express my preferences and de

Name

First Name

Last Name

CAREER :: Being promoted :: Being seen :: Creating my own business :: Following my dreams :: Speaking up to my boss :: Contributing to projects :: Sharing my ideas :: Writing and expressing myself :: Being on stage :: Raising my hand to speak :: Presenting my true opinion even if others don’t agree :: Managing others :: Managing myself :: Other ----- WRITE DOWN ALL THE WAYS YOU FEEL DISEMPOWERED IN YOUR CAREER:

Career (1 -10?)

HEALTH :: Exercising :: Eating healthy :: Making empowering choices :: Feeling healthy :: Thinking healthy thoughts :: Taking care of my body :: Taking care of myself medically :: Asserting my rights/opinions with doctors :: Connecting with my body :: Listening to my own intuition/inner wisdom around my health (vs others) :: Other: ---WRITE DOWN ALL THE WAYS YOU FEEL DISEMPOWERED WITH YOUR HEALTH.

HEALTH (1-10?)

FAMILY :: Mother :: Father :: Brother :: Sister :: Grandparent(s) :: Children :: Spouse :: Other:---- WRITE DOWN ALL THE WAYS YOU FEEL DISEMPOWERED IN YOUR FAMILY LIFE.

FAMILY (1-10?)

RELATIONSHIPS :: Friends :: Social events Being at parties :: Networking :: Expressing myself in my relationships :: Setting good boundaries in relationships :: Asking for what I need :: Expressing my desires :: Other ----WRITE DOWN ALL THE WAYS YOU FEEL DISEMPOWERED IN RELATIONSHIPS.

RELATIONSHIPS (1-10?)

SEX :: Practicing safe sex :: Getting tested for STDs :: Asking for what I desire :: Expressing my boundaries :: Saying no :: Stopping if I need to :: Not having sex out of obligation :: Creating the sex life I desire :: Owning my sexuality :: Connecting to my sexuality :: Celebrating my sexuality :: Loving my body :: Other: :: WRITE DOWN ALL THE WAYS YOU FEEL DISEMPOWERED IN YOUR SEX LIFE.

SEXLIFE (1-10?)

SPIRITUALITY :: Owning my spiritual power :: Recognizing my own wisdom :: Trusting my own spiritual authority :: Having a healthy/empowering relationship to spiritual figures :: Trusting my own connection to the universe :: Feeling that women are equally spiritual to men :: Other: ---- WRITE DOWN ALL THE WAYS YOU FEEL DISEMPOWERED IN YOUR SPIRITUALITY.

SPIRITUALITY (1-10?)

COMMUNITY :: Speaking up in a community :: Sharing my truth :: Sharing my love :: Expressing myself :: Building community :: Connecting with others :: Feeling confident :: Other: :: WRITE DOWN ALL THE WAYS YOU FEEL DISEMPOWERED IN YOUR COMMUNITY.

COMMUNITY (1-10?)

FRIENDS :: Making new friends :: Maintaining important friendships :: Being true to myself in friendships :: Being honest :: Having good boundaries :: Other: -----WRITE DOWN ALL THE WAYS YOU FEEL DISEMPOWERED IN FRIENDSHIPS.

FRIENDSHIPS (1-10?)

MISSION/PURPOSE :: Owning my real purpose :: Contributing to my mission :: Being honest with myself about what my mission/purpose is :: Sharing my vision with others :: Taking action :: Building the structure/foundation of my mission/purpose :: Other: ----- WRITE DOWN ALL THE WAYS YOU FEEL DISEMPOWERED IN YOUR MISSION/PURPOSE.

MISSION/PURPOSE (1-10?)

CREATIVITY :: Expressing myself creatively :: Supporting my inner child’s creativity :: Playing :: Taking time for myself :: Relaxing in life :: Enjoying life :: Writing :: Making art :: Believing in my creative expressions :: Expressing my creativity to the world :: Other: -----WRITE DOWN ALL THE WAYS YOU FEEL DISEMPOWERED IN YOUR CREATIVE LIFE.

CREATIVITY (1-10?)

SELF EXPRESSION :: Dressing myself :: Dancing :: My home :: My style :: My sense of humor :: Being outgoing :: Being introverted when needed :: Following my own instincts :: Trusting myself :: Other: -----WRITE DOWN ALL THE WAYS YOU FEEL DISEMPOWERED IN YOUR SELF EXPRESSION.

SELF EXPRESSION (1-10?)

Mental & Emotional Empowerment

Life Areas

518-229-9149

Jeanette.Fultz@gmail.com