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COUPLES QUESTIONNAIRE
Click Here to answer this questionnaire online
| 1. | What is the problem that led you to decide to come to therapy? |
| 2. | How long have you and your partner been together? In what form? (i.e., dating, living together, married) |
| 3. | What initially attracted you to your partner? |
| 4. | How was the decision to live together or marry made? |
| 5. | What was the very beginning of your relationship like? How log did this phase last? |
| 6. | What was your first disillusionment? What happened and how did you resolve it? Did this lead to any changes in your relationship? |
| 7. | When did you first become aware of significant differences between the two of you? In what important ways are the two of you similar? Different? How do you resolve these differences ? |
| 8. | What do you do when you are angry? What does your partner do when angry? |
| 9. | Do you spend time in activities away from your partner? If so, how often? Doing what? |
| 10. | Do you spend time alone or with people who are not mutual friends? Does this create conflict in your relationship? |
| 11. | Do you enjoy your free time? Does planning how to spend it create anxiety for you? |
| 12. | How comfortable are you doing activities away from your partner? How comfortable are you with your partner spending time away from you? |
| 13. | On a scale of 1 to 10, how open are you in expressing your innermost thoughts and feelings to your partner? (1 is totally closed and 10 is totally open) |
| 14. | When you feel like you need support or encouragement from your partner, do you get it? How? |
| 15. | When your partner needs support or encouragement, do you feel that you give it? How? |
| 16. | Do you support your partner's development as an individual? How (give example)? Do you support his/her growth as an individual even when you don't agree? How (give example)? |
| 17. | Describe your sexual relationship. What do you find most satisfying about it? What do you find least satisfying about it? |
| 18. | When do you feel most gratified in your relationship? |
| 19. | When do you feel most frustrated in your relationship? |
| 20. | Do the two of you have joint commitments to goals, projects, work, or social causes? Does this add or detract from the bond between you? |
| 21. | If your relationship was a movie, drama or book, what would it be titled? How would it end? |
