Couple Questionnaire

Early and past patterns of relating carry over to current circumstances and relationships.

 In this relationship I feel -    

-secure

-resistant

-avoidant

add...............

How much of my behaviour in this relationship may be influenced by my past relationships?

What can I do differently in this present relationship that might make a difference?

How can I think differently in my relationship now that might just make a difference?

How can I feel differently in my relationship that might make a difference?

What are my biggest fears about my relationship?

What do I hope this partner will give to me in this relationship?

What are my ideals regarding this relationship?

I wish…

What were my mother’s unlived dreams… 

For herself

For me

What were my father’s unlived dreams...

For himself

For me

What feels true for me about my mother?  

Great… Terrible… or ...

What feels true for me about my father? 

Great… Terrible… or ...

What do I hope for from my spouse?                     

What do I hope to become with my spouse? 

Hero

Admirer

Guide 

Worshipper

Lover

Parent

Seducer 

Genius

Nurturer

Equal partner

Comforter

Companion

add..................

What has aroused aggression in me the past?

What might arouse aggression in me in this relationship?

What do I do/think/feel when my aggression is aroused?

What has caused me to feel afraid in the past?

What might cause me to feel afraid in this relationship?

What do I do/say/think/feel when I am afraid?

What has aroused my jealously in the past?

What might arouse my jealousy in this relationship?

What do I do/say/think/feel when I am jealous?

When have I felt envious in the past?

What might arouse my envy in this relationship?

What do I do/say/think/feel when I am envious?

When have I felt hurt in the past?

What might hurt me in this relationship?

What do I do/say/think/feel when I am hurt?

What hurt have I caused in the past?

What hurt might I cause in this relationship?

What do I do/say/think/feel when I cause hurt?

When have I felt sad in the past?

What might I be sad about in this relationship?

What do I do/say/think/feel when I am sad?

When have I had joy in the past?

What will give me great joy in this relationship?

What do I do/say/think/feel when I am joyful?

When have I felt peace in the past?

How might I feel peace in this relationship?

What do I do/say/think/feel when I am peaceful?

When have I felt competent in the past?

How can I feel competent in this relationship?

What do I do/say/think/feel when I am competent?

When have I felt powerful in the past?

How will I feel powerful in this relationship?

What do I do/say/think/feel when I am powerful?

What am I learning about myself?

What am I learning about the person I intend entering a relationship with?

If I need help – who might be able to help me?

If my intended partner needs help, what can I do about it?

In what ways has this questionnaire been useful to me?

What am I learning?