1. List the things you like most about your relationship? 2. What attracted you to your partner or spouse? 3. What are the current problems within your marriage/relationship? 4. What are the things you most want to change? 5. How often do you argue? 6. What do you most often argue about? 7. Describe your most recent argument. How did it start? How did it end. 8. When you do argue, does someone end up leaving? Who? How long before they come back? 9. How long do you stay mad at each other? 10. Who is the first to attempt to make things better? 11. Do your arguments get physical? 12. On a scale 1-10, how would you rate your overall relationship? 13. Have you ever questioned your relationship? 14. List the qualities you dislike about your spouse/partner. 15. Of those qualities, which would you like your pouse/partner to show most improvement?
CHECK ALL THAT APPLY: WHEN WE'RE NOT GETTING ALONG...
WHAT I DO... What I Do...... ()I criticize ()I attack ()I blame ()I defend ()I analyze ()I rationalize ()I get quiet ()I become cold or aloof ()I clam up ()I withdraw ()I avoid conflict ()I leave
WHAT I FEEL... ()I feel scared. ()I feel afraid. ()I feel hurt ()I feel vulnerable ()I feel worried or nervous. ()I feel disappointed. ()I feel let down. ()I feel sad. ()I feel alone or lonely. ()I feel hopeless. ()I feel down or depressed. ()I feel empty. ()I feel disconnected. ()I feel isolated. ()I feel ignored. ()I feel shut out or pushed away. ()I feel rejected. ()I feel abandoned. ()I feel misunderstood. ()I feel my partner is never there for me. ()I feel frustrated. ()I feel angry. ()I feel like getting back. ()I feel like protecting myself. ()I feel guarded. ()I feel like clinging to my partner. ()I feel flooded with emotion. ()I feel unable to calm myself down ()I feel overwhelmed. ()I feel confused. ()I feel unable to focus my thoughts. ()I feel blank. ()I feel numb ()I have trouble putting thoughts into words. ()I feel smothered. ()I feel it's always my fault. ()I feel judged. ()I feel blamed or criticized. ()I feel put down. ()I feel I don't know what I have done. ()I feel analyzed. ()I feel invalidated. ()I feel discounted. ()I feel attacked. ()I feel controlled. ()I feel intimidated. ()I feel dismissed or "blown off". ()I feel uncared for or unwanted. ()I feel unlovable. ()I feel unattractive. ()I feel unimportant. ()I feel inadequate. ()I feel small or insignificant. ()I feel I don’t matter. ()I feel I’ve failed. ()I feel guilty.
In my body I feel... ()I feel my heart speeding up. ()I feel tense somewhere in my body. ()I feel uneasy in my stomach. ()I feel tightness in my throat. ()I feel pressure in my chest.
How we interact during conflict... ()I often want to avoid talking about our relationship.
()During an argument, I become become silent, withdraw and don’t want to discuss things.
()My partner often pushes an issue and won't let it drop.
()I often want to push my partner to talk about our relationship.
()I often get angry and critical to get my partner to talk.
()My partner withdraws a lot and won't face an issue when I want to talk.