Each spouse/partner should
complete the survey separately, answering "Yes" or "No" to
the following questions.
- Can you communicate your needs clearly?
- Do you find it easy to talk to your spouse?
- Do you find it easy to listen to your spouse?
- Do you assertively express your feelings?
- Are you aware of and attentive to the emotional needs of your spouse?
- Are you aware of your needs and are they as important as those of your spouse?
- Do you and your spouse spend
time together in shared activities?
- Do you have other meaningful
relationships and interests?
- Do you work through
significant conflicts?
- When you attempt to resolve
a conflict or make a decision is your negotiation fair and democratic?
- Do you let go of the need
to "be right"?
- Are you open to constructive
feedback?
- Do you forgive yourself and
your spouse?
- Do you accept your mistakes
and learn from them?
- Do you fulfill each other's
sexual needs?
- Do you share the chores and
responsibilities of the marriage/family equally?
- Do you support each other's
relationships with family?
- Is your marriage free from
intimidation and abuse of all kinds?
- Is there "space"
in your marriage for you to grow and be yourself?
- Are you able to care for
each other in times of hardship or illness?
- Do you trust your partner to
tell you the truth at all times?
- Do you feel good about
yourself when you are with your partner?
- Do you have clear and
explicit agreements and boundaries (yet allow for flexibility)?
- Are play, humor, and having
fun together commonplace?
- Are you willing to take
risks and be vulnerable?
- Can you enjoy being alone
and is privacy respected?
- Do you take responsibility
for your own behaviors and happiness?
Compare your answers.
Then, make a list of all of the
items that either one of you answered "No".
Discuss the importance of these
qualities. If there are several, and you feel they are important, discuss how
you can work toward achieving these goals.
If you struggle to
communicate, or cannot agree on important characteristics of a healthy
relationship you may want to consider couples counseling.
This survey was adapted from http://www.no-problem-marriage-counseling.com/couple-counseling-questionnaire.html
