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We have learned that the following questions help quickly identify how your relationship is doing. The questions might seem random, but most couples find that these questions make them think about their relationship in a new way. Please trust the process and try to answer to the best of your ability. You will find this really helps to speed up your progress with us.

1. LOVE MAPS
Read each statement and select TRUE or FALSE.

I can tell you some of my partner’s life dreams.

I can list the relatives my partner likes the least.

My partner is familiar with what are my current stresses.

I can list my partner’s major aspirations and hopes in life.

I know my partner’s major current worries.

2. FONDNESS AND ADMIRATION SYSTEM
Read each statement and select TRUE or FALSE

My partner really respects me.

I feel loved and cared for in this relationship.

Our relationship still has romance in it.

When I come into a room my partner is glad to see me.

My partner appreciates the things I do in this relationship.

3. TURNING TOWARD OR AWAY
Read each statement and select TRUE or FALSE.

I really enjoy discussing things with my partner.

We always have a lot to say to each other.

We have a lot of fun together in our everyday lives.

We really have a lot of interests in common.

We like to do a lot of the same things.

4. EMOTIONAL DISENGAGEMENT AND LONELINESS
Read each statement and select TRUE or FALSE.

I often find myself disappointed in this relationship.

I will at times find myself quite lonely in this relationship.

It is hard for my deepest feelings to get much attention in this relationship.

There is not enough closeness between us.

I have adapted to a lot in this relationship and I am not so sure it’s a good idea.

5. HARSH STARTUP
Read each statement and select TRUE or FALSE.
When we discuss our issues:

Arguments often seem to come out of nowhere.

I seem to always get blamed for issues.

My partner criticizes my personality.

Our calm is suddenly shattered.

I find my partner’s negativity unnerving and unsettling.

6. THE FOUR HORSEMEN
Read each statement and select TRUE or FALSE.
When we discuss our issues:

I have to defend myself because the charges against me are so unfair.

I often feel unappreciated by my partner.

My partner doesn’t face issues responsibly and maturely.

I am just not guilty of many of the things I get accused of.

My partner has a lot of trouble being rational and logical.

7. GRIDLOCK ON PERPETUAL ISSUES
Read each statement and select TRUE or FALSE.
When we discuss our issues:

We keep hurting each other whenever we discuss our core issues.

My partner has a long list of basically unreasonable demands.

I don’t feel respected when we disagree.

My partner often acts in a selfish manner.

When we discuss our issues, my partner acts as if I am totally wrong and he or she is totally right.

8. ACCEPTING INFLUENCE
Read each statement and select TRUE or FALSE.
When we discuss our issues:

I generally want my partner to feel influential in this relationship.

I usually do not tire while listening to my partner's opinions.

My partner has a lot of basic common sense.

I don’t reject my partner’s opinions out of hand.

My partner is basically a great help as a problem solver.

9. COMPROMISE
Read each statement and select TRUE or FALSE.
During our attempts to resolve conflict between us:

We are usually good at resolving our differences.

We both believe in meeting each other half way when we disagree.

In discussing issues we can usually find our common ground of agreement.

Yielding power is not very difficult for me.

Give and take in making decisions is not a problem in this relationship.

10. Shared Meanings Questionnaire Honoring Each Others Dreams: rituals

We want you to think about how well you and your partner have been able to create a sense of shared meaning in your lives together. We think that when people become committed to one another they create a new culture, and some relationships also involve the union of two very different cultures. But even if two people are coming from the same regional, cultural, ethnic, and religious background, they will have been raised in two very different families, and their merging involves the creation of a new culture.

Your Rituals

Reunions at the end of each day in our home are generally special times in my day.

During weekends we do a lot of things together that we enjoy and value.

I really look forward to and enjoy our vacations and the travel we do together.

When we do errands together we generally have a good time.

We have ways of becoming renewed and refreshed when we are burned out or fatigued.

11. Shared Meanings Questionnaire Honoring Each Others Dreams: Roles
Your Roles

We share many similar values in our roles as lovers and partners.

My partner and I have compatible views about the role of work in one’s life.

My partner and I have similar philosophies about balancing work and family life.

My partner supports what I would see as my basic mission in life.

My partner shares my views on the importance of family and kin (sisters, brothers, moms, dads) in our life together.

12. Shared Meanings Questionnaire Honoring Each Others Dreams: Goals

Your Goals

If I were to look back on my life in very old age, I think I would see that our paths in life had meshed very well.

My partner values my own accomplishments.

My partner honors my own very personal goals, unrelated to my relationship.

We have very similar financial goals.

Our hopes and aspirations, as individuals and together, for our children, for our life in general, and for our old age are quite compatible.

13. Shared Meanings Questionnaire Honoring Each Others Dreams: Symbols

Your Symbols

We see eye-to-eye about what “home” means.

We have similar views about the role of sex in our lives.

We have similar views about the role of love and affection in our lives.

We have similar values about the importance and meaning of money in our lives.

We have similar values about “autonomy” and “independence.”

14. NEGATIVE SENTIMENT OVERRIDE

Fill this form out thinking about your immediate past (last 2 to 4 weeks), or a recent discussion of an existing issue. Read each statement and select TRUE or FALSE.

In the recent past discussing our issues generally:

I felt innocent of blame for this problem.

I felt unjustly accused.

I felt personally attacked.

I felt unjustly criticized.

I wanted the negativity to just stop.

15. EFFECTIVE REPAIR ATTEMPTS

Read each statement and select TRUE or FALSE.

During our attempts to resolve conflict between us:

We are good at taking breaks when we need them.

Even when arguing we can maintain a sense of humor.

We are pretty good listeners even when we have different positions on things.

If things get heated we can usually pull out of it and change things.

My partner is good at soothing me when I get upset.

Overall, would you say...

1. We are staying emotionally connected , or we are becoming emotionally distant

Answer all the specific items below:

Just simply talking to each other.

Staying emotionally in touch with each other.

Feeling taken for granted?

Don’t feel my partner knows me very well right now.

Partner is (or I am) emotionally disengaged.

Spending time together.

Comments, and if things are fine, tell us how you are managing this area of your lives. If things are not fine, tell us the obstacles you see to improving this area of your relationship.

2. We are handling job and other stresses effectively , or we are experiencing the “spill over” of non-relationship stresses

Answer all the specific items below:

Helping each other reduce daily stresses.

Talking about these stresses together.

Talking together about stress in a helpful manner.

Partner listening with understanding about my stresses and worries.

Partner takes job or other stresses out on me.

Partner takes job or other stresses out on the children or others in our life.

Comments, and if things are fine, tell us how you are managing this area of your lives. If things are not fine, tell us the obstacles you see to improving this area of your relationship.

3. We are handling issues or disagreements well , or we are gridlocking on one or more issues

Answer all the specific items below:

Differences have arisen between us that feel very basic.

These differences seem irresolvable.

We are living day-to-day with hurts.

Our positions are getting entrenched.

It looks like I will never get what I hope for.

I am very worried that these issues may damage our relationship.

Comments, and if things are fine, tell us how you are managing this area of your lives. If things are not fine, tell us the obstacles you see to improving this area of your relationship.

4. This relationship is romantic and passionate , or it is becoming passionless; the fire is going out

Answer all the specific items below:

My partner has stopped being verbally affectionate.

I have stopped being verbally affectionate.

We rarely touch each other.

My partner has stopped feeling very romantic

I have stopped feeling very romantic.

My partner doesn’t seem to find me very attractive.

I don’t find my partner very attractive.

We rarely cuddle.

We have few tender or passionate moments.

I don’t initiate tender or passionate moments.

Comments, and if things are fine, tell us how you are managing this area of your lives. If things are not fine, tell us the obstacles you see to improving this area of your relationship.

5. Our sex life is fine , or there are problems in this area ?

Answer all the specific items below:

The frequency of sex.

The satisfaction my partner seems to get from sex.

The satisfaction I get from sex.

Being able to talk about sexual problems.

The two of us want different things sexually.

Problems of desire on my part.

Problems of desire on my partner’s part.

The amount of love in our lovemaking.

Comments, and if things are fine, tell us how you are managing this area of your lives. If things are not fine, tell us the obstacles you see to improving this area of your relationship.

6. An important event external to the relationship has not recently occurred in our lives . An important event external to the relationship HAS occurred, and we are dealing with this well , or we are not dealing with it well ?

Answer all the specific items below:

We have very different points of view on how to handle things.

This event has led my partner to be very distant.

This event has made us both irritable.

This event has led to a lot of fighting.

I’m worried about how this will all turn out.

We are now taking up very different positions.

Comments, and if things are fine, tell us how you are managing this area of your lives. If things are not fine, tell us the obstacles you see to improving this area of your relationship.

7. Major issues around children have arisen (including whether or not to have children) ,
or we do not have issues around children .

Answer all the specific items below:

We have very different points of view on goals for the children.

We have different positions on what to discipline the children for.

We have different positions on how to discipline the children.

We have issues about how to be close to our children.

We are not talking about these issues very well.

There is a lot of tension or anger about these differences, regarding children.

Comments, and if things are fine, tell us how you are managing this area of your lives. If things are not fine, tell us the obstacles you see to improving this area of your relationship.

8. The relationship is not handling issues with in-laws well , or this is not an issue .

Answer all the specific items below:

I feel unaccepted by my partner’s family.

I sometimes wonder which family my partner is in.

I feel unaccepted by my own family.

There is tension between us about what might happen.

This issue has generated a lot of irritability.

I am worried about how this is going to turn out.

Comments, and if things are fine, tell us how you are managing this area of your lives. If things are not fine, tell us the obstacles you see to improving this area of your relationship.

9. Being attracted to other people or jealousy is not an issue , or partner is flirtatious ?

Answer all the specific items below:

This area is a source of a lot of hurt.

This is an area that creates insecurity.

I can’t deal with the lies.

It is hard to re-establish trust.

There is a feeling of betrayal.

It’s hard to know how to heal this.

Problems of desire on my partner’s part.

Comments, and if things are fine, tell us how you are managing this area of your lives. If things are not fine, tell us the obstacles you see to improving this area of your relationship.

10. There has been a recent extra-relationship affair (or I suspect there is one) or this is not an issue

Answer all the specific items below:

This area is a source of a lot of pain.

This has created insecurity.

I can’t deal with the deception and lying.

I can’t stop being angry.

I can’t deal with my partner’s anger.

I want this to be over but it seems to never end

I am tired of apologizing.

It is hard to trust again.

I feel that our relationship has been violated.

It’s hard to know how to heal this.

Comments, and if things are fine, tell us how you are managing this area of your lives. If things are not fine, tell us the obstacles you see to improving this area of your relationship.

11. When disagreements arise, we resolve issues well , or unpleasant fights have occurred

Answer all the specific items below:

There are more fights now.

The fights seem to come out of nowhere.

Anger and irritability has crept in to our relationship.

We get into arguments where we are hurting each other.

I don’t feel very respected lately.

I feel criticized.

Comments, and if things are fine, tell us how you are managing this area of your lives. If things are not fine, tell us the obstacles you see to improving this area of your relationship.

12. We are in synchrony on basic values and goals ,
or differences between us in these areas or in desired “life style” are emerging

Answer all the specific items below:

Differences have arisen in life goals.

Differences have arisen about important beliefs.

Differences have arisen on leisure time interests.

We seem to be wanting different things out of life.

We are growing in different directions.

I don’t much like who I am with my partner.

Comments, and if things are fine, tell us how you are managing this area of your lives. If things are not fine, tell us the obstacles you see to improving this area of your relationship.

13. Very hard events (for example, violence, drugs, other addictions) have NOT occurred within the relationship ,
or: The relationship has had to endure very hard events ?

Answer all the specific items below:

There has been physical violence between us.

There is a problem with alcohol or drugs.

This is turning into a relationship I hadn’t bargained for.

Our relationship “contract” is changing.

I find some of what my partner wants upsetting or repulsive.

I am now feeling somewhat disappointed by this relationship.

Comments, and if things are fine, tell us how you are managing this area of your lives. If things are not fine, tell us the obstacles you see to improving this area of your relationship.

14. We work well as a team , or we are not working very well as a team right now

Answer all the specific items below:

We used to share more in the family’s workload.

We seem to be pulling in opposite directions.

Partner does not share in housework or child care.

Partner is not carrying weight financially.

I feel alone managing this family.

Partner is not being very considerate.

Comments, and if things are fine, tell us how you are managing this area of your lives. If things are not fine, tell us the obstacles you see to improving this area of your relationship.

15. We are coping well with issues of power, control, or influence , or we are having trouble in this area

Answer all the specific items below:

I don’t feel influential in decisions we make.

Partner has become more domineering.

I have become more demanding.

Partner has become passive.

Partner is “spacey”, not a strong force in the relationship.

I am starting to care a lot more about who is running things.

Comments, and if things are fine, tell us how you are managing this area of your lives. If things are not fine, tell us the obstacles you see to improving this area of your relationship.

16. We are handling issues of finances well , or we are having trouble in this area

Answer all the specific items below:

I, or partner, just doesn’t bring in enough money.

We have differences about how to spend our money.

We are stressed about finances.

Partner is financially more interested in self than us.

We are not united in managing our finances.

There is not enough financial planning.

Comments, and if things are fine, tell us how you are managing this area of your lives. If things are not fine, tell us the obstacles you see to improving this area of your relationship.

17. We are doing well having fun together , or we are not having very much fun together these days

Answer all the specific items below:

We don’t seem to have very much time for fun.

We try but don’t seem to enjoy our times together very much.

We are too stressed for fun.

Work takes up all our time these days.

Our interests are so different now that there are no fun things we like to do together.

We plan fun things to do but they never happen.

Comments, and if things are fine, tell us how you are managing this area of your lives. If things are not fine, tell us the obstacles you see to improving this area of your relationship.

18. We are feeling close in the area of spirituality together , or we are not doing very well in that area these days

Answer all the specific items below:

Sharing the same beliefs.

Agreeing about religious ideas and values.

Issues about the specific church, mosque, synagogue, etc.

Communicating well about spiritual things.

Issues that about spiritual growth and change.

Spiritual issues involving family or children.

Comments, and if things are fine, tell us how you are managing this area of your lives. If things are not fine, tell us the obstacles you see to improving this area of your relationship.

What are your personal goals in approaching us for help right now? Where would you like to see relationship improvement first?

In case something was omitted, or an important area was left out, please add any additional comments here:

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