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. -––
Finances
-–– 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. -––
SPECIFIC RELATIONSHIP PROBLEM PROFILE
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?
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