1. Do you ever feel disrespect from your spouse?
2. Do you ever feel physically threatened by your spouse?
3. What is your relationship with alcohol and drugs?
A. We use them rarely, usually at social occasions
B. We drink or use substances occasionally
C. We use them quite often
D. We are a case of substance abuse
4. Are you certain your spouse is faithful?
B. Mostly certain
D. Not really
5. How often do you argue about money?
6. How concerned are you about each other’s emotional needs?
A. Very much
C. Not too much
D. Not at all
7. How do you cope with negative situations?
A. We talk through them without losing control
B. We fight but eventually get over
C. We ignore them
D. We fight a lot and our relationship degrades
8. What do you think about conflicts?
A. They are opportunities to evolve
B. They are annoying but they are a part of life
C. They should be ignored
D. They are an impediment to happiness
9. How happy are you with physical intimacy in your relationship?
A. Very happy
B. Mostly happy
C. Moderately happy
D. Not really happy
10. Do you have the opportunity to spend quality time separately?
A. Yes, we manage to recharge batteries separately
B. Yes, but not as often as we'd like
D. Almost never