Couple Intervention Readiness Questionnaire

Readiness Questionnaire

COUPLE INTERVENTION READINESS QUESTIONNAIRE

For each statement check the appropriate response. Please note that not every statement applies to every relationship, please check (N/A) if that statement is not applicable to your relationship.

I want to be in a committed relationship
I believe that my partner wants to be in a committed relationship
I feel motivated to work on the issues in our relationship
I want to be in a committed relationship
I believe my partner is motivated to work on the issues in our relationshipI want to be in a committed relationship
I would like to build on the strengths of our relationship
I want to achieve a deeper level of emotional intimacy with my partner
I want to achieve greater sexual satisfaction with my partner
I want to achieve a higher level of relationship satisfaction with my partner
I believe that there are enough positive aspects to our relationship that make it worth working through challenges with my partner
I believe that my partner and I have the potential to resolve issues effectively with one another with some guidance
I rely too much on my partner for my happiness and want to learn to be more independent
I feel that my partner is too dependent on me
I have difficulty getting close to my partner and want to have a deeper connection with him/her
I feel that my partner is too distant and want to have a closer relationship with him/her
I believe we can't move forward in our relationship without profession intervention
I believe we need to learn how to build a healthy marital relationship
I feel that addiction issues (e.g. alcohol, sex, gambling, eating, etc.) are having a significant negative impact on our relationship
I am teachable and open to learning how to improve myself
I want to address a breach of trust that has occurred in our relationship
I want to address abuse that has occurred in our relationship
I want assistance determining if my partner and I are compatible with one another
I am seeking clarity to determine how to proceed with our relationship
I would like for my partner and me to amicably separate from one another
I believe we need a positive support network for our marriage
I believe we would fit in with a group of positive couples seeking to improve their marriage

Provide your information to access your offer

SHMS Speaker Offer Collector
First
Last