After you’ve answered the questions, please email your responses to caronsmithcounselling@gmail.com. Short answers are just fine – this is just a snapshot of what’s going on for the two of you.

Thank you!

Couples Questionnaire

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? 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? How do you resolve conflicts? What do you do when you are angry? What does your partner do when angry?

9. 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?

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

11. 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?

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

13. Do you take an active, energetic role in nourishing the relationship? Does your partner do the same? How?

14. 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)?

15. Do you believe that your partner is giving at least 50% to the relationship?

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

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

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

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

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