Couples Questionnaire

 

Couples Questionnaire (to be completed  separately)

 

 

 

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 (dating, living together, married)?

 

 

 

 


3. What initially attracted you to your partner and how did you decide to be partners?

 

 

 

 


4. What do you find most fulfilling about your relationship?

 

 

 

 

 


5. What was the very beginning of your relationship like? How long did this phase last?

 

 

 

 

 


6. What was your first disillusionment with your partner? What happened and how did you resolve it?

 

 

 

 

 


7. When do you feel least fulfilled in your relationship?

 

 

 

 

 


8. In what significant ways are the two of you similar? Different?

 

 

 

 

9. How do you resolve conflicts?

 

 

 

 

10. What do you do when you are angry? What does your partner do when angry? How do you respond to your partner when they are angry?

 

 

 

 

 

  

 


11. Do you spend time in activities away from your partner? If so, how often? Do you spend time alone with people who are not mutual friends? Does this create conflict in  your relationship?

 

 

 

 

 


12. How comfortable are you doing activities away from your partner? How comfortable are you with your partner doing things away from you?

 

 

 

 

 

 


13. How safe do you feel expressing your innermost thoughts and feelings to your partner? How do you ask for emotional support from your partner when you are feeling vulnerable? Do you expect to get it?

 

 

 

 

 

 


14. Would your partner say that you are emotionally responsive to his/her vulnerability? Explain.

 

 

 

 

 


15. Do you take an active, energetic role in nourishing the relationship? Does your partner do the same? 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. Do you believe that your partner is giving at least 50% to the relationship?

 

 

 

 

 


18. Do the two of you have joint commitments to projects, work activities or social  causes? If so, what?

 

 

 

 

 


19. Did you deliberately decide to create something together in one of these areas?

 

 

 

  


20. Does this project seem to add or detract from the bond between you?

 

 

 

  


21. How satisfying is your sexual relationship to you? How satisfying do you believe your sexual relationship is to your partner? What is the average frequency for you to be sexually intimate with your partner? What would you most like to be different in your sexual experience together?

 

 

 

 

 

 


22. If your relationship were a drama, movie or book, what would it be titled? How would it end?

 

 

 

 

 

 


©2003 The Couples Institute