Church Rehab — Survey

Please avoid names or identifying details in free‑text answers.

Gender

Male Female Other / I'd prefer not to say

Ethnicity/Race

African-American Asian-American Hispanic or Latinx Indigenous American European-American

Denominational Affiliation (select all that apply)

Describe Your Involvement With The Church

Attender Volunteer Church Staff

Who was primarily responsible for your hurt?

Pastor Elder / Deacon / Board Member / Leadership Staff Fellow Staff Member Volunteer Manager or Supervisor Fellow Attender

Which of the following categories best describes the nature of your hurt? (check all that apply) Other (optional)

Please describe the situation and context surrounding your hurt

How long ago did this incident or experience occur?

Less than a year ago 1–3 years ago 3–5 years ago 5–7 years ago 7–10 years ago More than 10 years ago

Which of the following best describes the emotional impact on you? (select all that apply) Other (optional)

Did the experience affect your faith or spirituality?

Yes No

Did this experience affect your relationships within or outside the church?

Yes No

How did you respond to the hurt?

I only shared it with friends I brought the issue to church leadership I confronted the individual responsible I kept it a secret

How did church leadership respond to your situation?

They were supportive They were indifferent They were dismissive

Which formal steps were taken by the church to address your situation?

Counseling Investigation Mediation No steps were taken by church leadership

What was the impact of the church's response on your healing process?

The Church's response helped my healing process The Church's response caused further harm

Did this experience lead you to voluntarily leave your job/place of service?

Yes No

Did this experience of church hurt lead to the loss of your job?

Yes No

Were you asked to sign a Non-Disclosure Agreement (NDA) upon your departure?

Yes No

Have you sought counseling or support outside the church to help process your experience?

Yes No

What, if anything, has been most helpful in your recovery from church hurt?

Are you currently involved in any form of church community or spiritual gathering?

Yes No

What recommendations would you make to churches aiming to prevent and effectively address church hurt?

May we contact you if we would like to hear more about your story?

Yes No

First Name Last Name Email Phone Number

We will only use this to follow up about this survey, if you gave permission.

Thank you for your trust.

Your voice helps others feel less alone and helps leaders do better. We’ll publish results at church.rehab.