Kick Start Recovery Programme - Users Background

1.

100% of survey complete.

General Information

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* 1. Age?

Under 16

16-18

18-25

26-35

36-45

46-55

Over 55

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* 2. Gender

Male

Female

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* 3. Sexual Orientation?

Heterosexual

Gay

Lesbian

Unknown

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* 4. Where do you currently live?

North East

North West

Midlands

East

London & Home Counties

South East

South West

Wales

Scotland

Northern Ireland

Eire

Europe

USA

Other (please specify)

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* 5. At what age do you think your problem started?

0-10

11-16

17-25

26-35

36-45

46-55

Over 55

Don't know

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* 6. Which of the following statements are true for you?

I was physically or sexually abused as a child

I have experienced traumatic events

I felt neglected as a child

My family background was stable and supportive

I suffer with depression and/or anxiety

My work is very stressful

I didn't know sex/pornography could become addictive until it was too late

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* 7. Please rate your current self esteem based on a 1 to 5 scale where 1 is very low and 5 is very high

	Very Low	Low	Average	Good	Very Good
My current self esteem is:	My current self esteem is: Very Low	My current self esteem is: Low	My current self esteem is: Average	My current self esteem is: Good	My current self esteem is: Very Good

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* 8. Please indicate which of the following professionals you have approached for help with your problem

GUM Clinic

Psychiatrist

Independent Counsellor/Psychotherapist/Sex Therapist

Relate Counsellor or Sex Therapist

Specialist Sex Addiction Therapist

Online Treatment Provider

Residential Rehabilitation

12 Step Group

Pastor/Minister/Vicar

None

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* 9. Which of the following behaviours do you, or did you, engage in as part of your sexual addiction?

Pornography

Dating Sites/Facebook/hook ups

Telephone sex

Cyber chat

Webcam sex

Adult TV channels

Visiting sex workers

Visiting masseurs

Sex with strangers

Multiple affairs

Exhibitionist/Voyeuristic behaviours (including dogging)

Fetish behaviours

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* 1. Age?

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* 2. Gender

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* 3. Sexual Orientation?

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* 4. Where do you currently live?

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* 5. At what age do you think your problem started?

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* 6. Which of the following statements are true for you?

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* 7. Please rate your current self esteem based on a 1 to 5 scale where 1 is very low and 5 is very high

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* 8. Please indicate which of the following professionals you have approached for help with your problem

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* 9. Which of the following behaviours do you, or did you, engage in as part of your sexual addiction?

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* 10. What triggered you to seek help for problem today?