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Relationship Problems Questionnaire

The document is a problem areas questionnaire that asks individuals to rate their level of satisfaction with how different relationship areas are handled in their relationship. It lists 15 common relationship problem areas and has the individual indicate how satisfied or dissatisfied they are with each on a scale. It then asks them to circle the top 3 most important areas they would like to work on in therapy.

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Jomyra Palomino
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94 views1 page

Relationship Problems Questionnaire

The document is a problem areas questionnaire that asks individuals to rate their level of satisfaction with how different relationship areas are handled in their relationship. It lists 15 common relationship problem areas and has the individual indicate how satisfied or dissatisfied they are with each on a scale. It then asks them to circle the top 3 most important areas they would like to work on in therapy.

Uploaded by

Jomyra Palomino
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Problem Areas Questionnaire Heavey, Christensen, & Malamuth, 1995

Name ____________________ Date: ___________

The following is a list of areas in which couples are often dissatisfied or have disagreements about each other’s behavior. Please fill in
the bubble which represents how dissatisfied you are with how each of the following areas is handled in your relationship.

Completely Completely
Satisfied/happy Dissatisfied/unhappy

1. Handling family finances............................................ O O O O O O O

2. Children or parenting……....….................................. O O O O O O O

3. Demonstrations of affection......................................... O O O O O O O

4. Sex relations................................................................. O O O O O O O

5. Career/job decisions...................................................... O O O O O O O

6. Household tasks............................................................ O O O O O O O
.
7. Trust or jealousy............................................................. O O O O O O O

8. Dealing with in-laws/parents/relatives.......................... O O O O O O O

9. Recreation-leisure time together……..………............. O O O O O O O

10. Drugs or alcohol............................................................ O O O O O O O

11. Religion....................................................................... O O O O O O O

12. Moodiness/temper/emotionality……........................... O O O O O O O

13. Aims, goals, priorities, major decisions in life............ O O O O O O O

14. Appropriate behavior or appearance............................ O O O O O O O

15. Other ______________________________________ O O O O O O O

Now circle the numbers of the three most important areas that you would like to work on in therapy.

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