Printable worksheet
The complete Three Scenes intake
Answer these 19 prompts by hand and you have everything a Three Scenes script needs. Nothing on this page is interactive and nothing you write here is stored — it's a worksheet to save, print, or copy into your own notes. New to the method? Read how it works first.
1 of 19 · required
Goal
In one line: what do you want to be true that isn't true yet?
2 of 19 · required — Failure
Repeating behaviors
What specific self-sabotaging behaviors do you keep repeating?
3 of 19 · required — Failure
Words that sting
What exact words has someone said to you that still sting? Quote them directly.
4 of 19 · required — Failure
Formative moment
What early moment helped seed this pattern? Describe one moment you can still picture.
5 of 19 · required — Failure
Avoidance
What are you avoiding, tolerating, or lying about—to yourself or someone else?
6 of 19 · required — Failure
Who is affected
Who is affected by this pattern, and how?
7 of 19 · required — Failure
Default emotion
What emotion do you default to when this pattern is active?
8 of 19 · required — Failure
Rescue hope
What are you secretly hoping will save you instead of taking action?
9 of 19 · required — Breakthrough
Refusal
What will you never let yourself become again? Begin with “I refuse” or “I will never.”
10 of 19 · required — Breakthrough
Identity claim
Who are you choosing to be instead, in a few core words?
11 of 19 · required — Breakthrough
Internal shift
What is the one internal shift underneath this change?
12 of 19 · required — Breakthrough
Changed action
What action will you take differently going forward?
13 of 19 · required — Success
Business fully working
What does your business look like when it is fully working?
14 of 19 · required — Success
Financial outcome
What financial outcome is present? State a real number or range.
15 of 19 · required — Success
Support system
Who is supporting you, and how do those relationships feel?
16 of 19 · required — Success
Body and mind
What do your body and mind feel like, physically and emotionally, day to day?
17 of 19 · required — Success
Closest relationships
What do your family and closest relationships look like now?
18 of 19 · required — Success
Newfound ease
What has become easy or automatic that used to be hard?
19 of 19 · required — Success
External validation
What recognition, referrals, opportunities, or other external validation is present?
Plain-text version
Select all of the block below and paste it into any notes app or document.
THREE SCENES — WORKSHEET 1. GOAL (required) In one line: what do you want to be true that isn't true yet? ______________________________________________ ______________________________________________ ______________________________________________ 2. REPEATING BEHAVIORS (required — Failure) What specific self-sabotaging behaviors do you keep repeating? ______________________________________________ ______________________________________________ ______________________________________________ 3. WORDS THAT STING (required — Failure) What exact words has someone said to you that still sting? Quote them directly. ______________________________________________ ______________________________________________ ______________________________________________ 4. FORMATIVE MOMENT (required — Failure) What early moment helped seed this pattern? Describe one moment you can still picture. ______________________________________________ ______________________________________________ ______________________________________________ 5. AVOIDANCE (required — Failure) What are you avoiding, tolerating, or lying about—to yourself or someone else? ______________________________________________ ______________________________________________ ______________________________________________ 6. WHO IS AFFECTED (required — Failure) Who is affected by this pattern, and how? ______________________________________________ ______________________________________________ ______________________________________________ 7. DEFAULT EMOTION (required — Failure) What emotion do you default to when this pattern is active? ______________________________________________ ______________________________________________ ______________________________________________ 8. RESCUE HOPE (required — Failure) What are you secretly hoping will save you instead of taking action? ______________________________________________ ______________________________________________ ______________________________________________ 9. REFUSAL (required — Breakthrough) What will you never let yourself become again? Begin with “I refuse” or “I will never.” ______________________________________________ ______________________________________________ ______________________________________________ 10. IDENTITY CLAIM (required — Breakthrough) Who are you choosing to be instead, in a few core words? ______________________________________________ ______________________________________________ ______________________________________________ 11. INTERNAL SHIFT (required — Breakthrough) What is the one internal shift underneath this change? ______________________________________________ ______________________________________________ ______________________________________________ 12. CHANGED ACTION (required — Breakthrough) What action will you take differently going forward? ______________________________________________ ______________________________________________ ______________________________________________ 13. BUSINESS FULLY WORKING (required — Success) What does your business look like when it is fully working? ______________________________________________ ______________________________________________ ______________________________________________ 14. FINANCIAL OUTCOME (required — Success) What financial outcome is present? State a real number or range. ______________________________________________ ______________________________________________ ______________________________________________ 15. SUPPORT SYSTEM (required — Success) Who is supporting you, and how do those relationships feel? ______________________________________________ ______________________________________________ ______________________________________________ 16. BODY AND MIND (required — Success) What do your body and mind feel like, physically and emotionally, day to day? ______________________________________________ ______________________________________________ ______________________________________________ 17. CLOSEST RELATIONSHIPS (required — Success) What do your family and closest relationships look like now? ______________________________________________ ______________________________________________ ______________________________________________ 18. NEWFOUND EASE (required — Success) What has become easy or automatic that used to be hard? ______________________________________________ ______________________________________________ ______________________________________________ 19. EXTERNAL VALIDATION (required — Success) What recognition, referrals, opportunities, or other external validation is present? ______________________________________________ ______________________________________________ ______________________________________________ SCENE ONE — FAILURE (the spiral if nothing changes) Written in first person and present tense from inside the pattern. Use the person's exact words and end at the low point without softening it. SCENE TWO — BREAKTHROUGH (the turning point) Open with refusal, then claim the chosen identity and changed action. SCENE THREE — SUCCESS (the five-sense payoff) Open with a physical or sensory detail, then show the circumstances and payoff. HOW TO USE IT: read all three aloud, in order, slowly — about four minutes. Record it once in one take. Repeat daily for two weeks before judging it.
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