Relationship Questionnaires

Relationship Questionnaires
Yes‚ No
1. Can you say there’s no jealousy in your relationship?
2. Is your relationship free of drug and alcohol abuse?
3. Can you say you’re never asked to compromise your moral values?
4. Do you appreciate and enjoy each other’s family and friends
5. Have you discussed your long-term goals for faith and career in detail?
6. Do you have complete confidence in each other?
7. Has experience shown him/her to always be truthful and open with you?
8. Does he/she always follow through on promises and commitments?
9. Do you talk openly and easily with each other about everything?
10. Do you both listen carefully to one another and try to understand each other’s point of view?
11. Do you practice the same faith by praying and going to church together regularly?
12. Do you both agree that marriage is forever?
13. Do you refrain from using manipulation or blackmail to get your own way?
14. Do you like spending time together doing different activities? (not TV)
15. When you have a disagreement or the going gets tough‚ do both of you respond respectfully with patience and understanding?
16. Have your family and friends told you they approve of your relationship – That they feel it’s making you a better person?
17. Do you feel satisfied with your physical‚ intimate relationship?
18. Have you seen each other through bad times as well as good?
19. Do you both stay away from pornographic magazines‚ videos‚ internet‚ etc.?
20. If your spouse had a serious accident that maimed or disfigured him/her for life‚ would your love remain strong? Could your love survive without physical expression?
21. Do each of you dress‚ speak‚ and act modestly?
22. Can you admit your own shortcomings and discuss them openly?
23. Are you both generous in making sacrifices for each other?
24. Does your partner have the qualities needed to be a super spouse and a wonderful parent for your children?
25. Are you willing to give up power and let your loved one control some important decisions and circumstances?
True‚ False
1. I am satisfied with my sex life.
2. My partner doesn’t really listen to me.
3. I trust my partner.
4. I feel picked on and put down.
5. I am hopeful about our future.
6. It is not easy to share my feelings.
7. My partner often says‚ “I love you.”
8. Sometimes I feel rage.
9. I feel appreciated.
10. I am out of control.
11. My partner is there for me in hard times.
12. My partner is harsh in his or her criticism.
13. My partner understands me.
14. I fear my partner is bored.
15. My partner doesn’t like to share what’s on his or her mind.
16. I imagine myself divorced.
17. My relationship is what I always dreamed of.
18. I know I am right.
19. My partner treats me with dignity and respect.
20. My partner is a taker.
21. We often do fun things together.
22. Sometimes I just want to hurt my partner.
23. I feel loved.
24. I would rather lie than deal with a problem.
25. We still have a lot of passion in our relationship.
26. I am trapped with no escape.
27. My partner thinks I am fun to be with.
28. Our relationship has gotten boring.
29. We enjoying going out on dates alone.
30. My partner is ashamed of me.
31. We trust each other a great deal.
32. We have become nothing more than roommates.
33. I know my partner will never leave me.
34. I am no longer proud of my body.
35. My partner respects me.
36. My partner constantly compares me to others.
37. M partner still finds me desirable.
38. We just seem to want different things.
39. I am allowed to think for myself.
40. I feel crowded by my partner.
41. I am honest with my partner.
42. People have no idea what our relationship is really like.
43. My partner is open to suggestions.
44. My partner has shut me out.
45. My partner is my primary source of emotional support.
46. I feel judged and rejected by my partner.
47. My partner cares if I am upset or sad.
48. My partner treats me like a child.
49. My partner puts our relationship ahead of others.
50. I’ll never satisfy my partner.
51. My partner wants to hear my stories.
52. I chose my partner for the wrong reasons.
53. I look forward to our time together.
54. My partner thinks I am boring in bed.
55. My partner is lucky to have me.
56. My partner treats me like an employee.
57. I win my share of disputes.
58. I envy my friends’ relationships.
59. My partner would protect me if necessary.
60. I am suspicious of my partner.
61. I feel needed by my partner.
62. My partner is jealous of me.
In the left-hand column‚ rate the following items according to the frequency of occurrence:
(0) does not apply (1) rarely (2) sometimes (3) frequently (4) all of the time
In the right-hand column‚ check whether you consider the item a problem.
Making Decisions
When we have a problem or make a decision:
-‎–‎– 1. We disagree. -‎–‎–
-‎–‎– 2. My partner gets angry. -‎–‎–
-‎–‎– 3. I get angry. -‎–‎–
-‎–‎– 4. I give in. -‎–‎–
-‎–‎– 5. My partner gives in. -‎–‎–
-‎–‎– 6. We don’t compromise. -‎–‎–
-‎–‎– 7. I make the decisions. -‎–‎–
-‎–‎– 8. My partner makes the decisions. -‎–‎–
-‎–‎– 9. We avoid making decisions. -‎–‎–
-‎–‎– 10. My feelings get hurt. -‎–‎–
-‎–‎– 11. My partner’s feelings get hurt. -‎–‎–
-‎–‎– 12. We argue about trivial issues. -‎–‎–
-‎–‎– 1. My partner overspends. -‎–‎–
-‎–‎– 2. My partner won’t spend. -‎–‎–
-‎–‎– 3. My partner begrudges my spending. -‎–‎–
-‎–‎– 4. We have no plans regarding monthly spending. -‎–‎–  
-‎–‎– 5. We have no agreement about savings. -‎–‎–
-‎–‎– 6. We have no understanding of where the money goes. -‎–‎–
-‎–‎– 7. My partner conceals debts or where the money goes. -‎–‎–
-‎–‎– 8. We have no agreement on setting priorities. -‎–‎–
-‎–‎– 9. We have no responsibility for spending. -‎–‎–
Sex Relations
-‎–‎– 1. My partner is more interested in sex than I am. -‎–‎–
-‎–‎– 2. My partner is less interested in sex than I am. -‎–‎–
-‎–‎– 3. I find it hard to talk to my partner about sex. -‎–‎–
-‎–‎– 4. Our sexual relationship is not fulfilling. -‎–‎–
-‎–‎– 5. I am reluctant to behave affectionately because my partner becomes too amorous. -‎–‎–
-‎–‎– 6. We differ in the kind of sex we each prefer. -‎–‎–
-‎–‎– 7. My partner uses sex to control or punish me. -‎–‎–
-‎–‎– 8. My partner is much too interested in sex. -‎–‎–
-‎–‎– 9. My partner is not sensitive to my sexual wishes. -‎–‎–
-‎–‎– 10. We don’t agree on birth control. -‎–‎–
Recreation and Leisure Activities
-‎–‎– 1. We don’t spend as much leisure time together as I’d like. -‎–‎–
-‎–‎– 2. My partner spends too much time on his/her own leisure-time activity. -‎–‎–
-‎–‎– 3. My partner has no time or energy for leisure activities. -‎–‎–
-‎–‎– 4. My partner does not seem to enjoy recreation with me. -‎–‎–
-‎–‎– 5. I feel compelled to do things I’d rather not. -‎–‎–
-‎–‎– 6. We don’t enjoy the same activities. -‎–‎–
-‎–‎– 7. My partner doesn’t have enough hobbies or recreational interests. -‎–‎–  
-‎–‎– 8. There is no balance between our recreational time spent together or separately. -‎–‎–
-‎–‎– 9. My partner has no balance between work and recreation. -‎–‎–
-‎–‎– 10. We have different ideas as to what constitutes a good time. -‎–‎–
The list that follows represents problem areas common to relationships in trouble. Some may apply to you. Some may not. Begin by circling every item on the list that plays a negative role in your relationship. Using the spaces to the left of the items‚ rank the problem areas‚ making 1 your worst problem area and going up from there. Use the spaces to the right of the items to write a sentence that describes the essence or core element of each problem.
-‎–‎– Trust -‎–‎–
-‎–‎– Sex -‎–‎–
-‎–‎– Money -‎–‎–
-‎–‎– Family -‎–‎–
-‎–‎– Time -‎–‎–
-‎–‎– Children -‎–‎–
-‎–‎– Lack of Intimacy -‎–‎–
-‎–‎– Communications -‎–‎–
-‎–‎– Rage -‎–‎–
-‎–‎– Drugs/Alcohol -‎–‎–
-‎–‎– Harshness -‎–‎–
-‎–‎– Criticisms -‎–‎–
-‎–‎– Fear -‎–‎–
-‎–‎– Infidelity -‎–‎–
-‎–‎– Boredom -‎–‎–
-‎–‎– Lack of Passion -‎–‎–
-‎–‎– Jealousy -‎–‎–
-‎–‎– Division of Labor -‎–‎–
-‎–‎– Lack of Respect -‎–‎–
-‎–‎– Religious Differences -‎–‎–
-‎–‎– Different Values -‎–‎–
-‎–‎– Lack of Support -‎–‎–
-‎–‎– Selfishness -‎–‎–
-‎–‎– Laziness -‎–‎–
-‎–‎– Humiliation -‎–‎–
-‎–‎– Lying -‎–‎–
-‎–‎– Unreliability -‎–‎–
-‎–‎– Career Conflict -‎–‎–
-‎–‎– Gambling -‎–‎–
-‎–‎– Physical Abuse -‎–‎–
-‎–‎– Emotional Abuse -‎–‎–
-‎–‎– Sexual Abuse-‎–‎–
Circle either Yes or No to the following questions.
1. In all honesty‚ do you feel that you give‚ while your partner takes?
2. Is your relationship a parent/child relationship‚ rather than the interaction of two adults?
3. Do you and your partner fight with increasing frequency and/or intensity
4. Do you find yourself frequently apologizing?
5. Do you feel that you just need some space and time alone?
6. Looking back over the last year of your relationship‚ do you feel that you have made most of the sacrifices and changes?
7. Do you find that you frequently make excuses for your mate‚ either to yourself or other people?
8. Do you feel that your emotional needs are not being met?
9. If you answered “yes” to #8: Do you feel that this has substantially cheated you out of a big part of your life?
10. Are you physically frustrated in your relationship?
11. Do you feel that your relationship plays second fiddle to your mate’s job‚ or the children‚ or other priorities?
12. Do you keep significant secrets from your mate?
13. Do you feel that you are being used?
14. Do you feel that there has to be more to your life than that which you are living in this relationship?
15. Do you see patterns developing or being played out in your relationship that mirror those in either of your parents’ marriages?
16. Do you find yourself too threatened to take the risk of true intimacy in your relationship?
17. Do you feel that you are the only one who legitimately works on your relationship?
18. Is guilt a major factor in your relationship?
19. Do you feel that you are just going through the motions in your relationship?
20. Is your partner more like a roommate than a partner?
21. Do you entertain fantasies about not being in this relationship?
22. Do you find that in order to have peace and harmony with your mate‚ you have had to stop being who you really are?
23. Have you and your partner stopped working at your relationship‚ and just accepted it as is?
24. Are you in a relationship today simply because you were in it yesterday‚ rather than because you really want to be?
This instrument can be found at:
For more information: USA: 704-655-2827; Ireland: 064 6634513
Balanced Choices has locations in Davidson‚ NC USA and Southwest Ireland