1. Are you still having sex regularly?
A. Not at all
C. Most of the time
2. Do you feel like you and your boyfriend are on the same page regarding what you both want, or are you feeling like you are on different pages?
A. I really don’t feel like we are on the same page at all
B. I used to feel like we were, but lately, it doesn’t seem that way
C. I do feel like we are on the same page, but we just need to get over this hump. I have hope for our future, but only if things get better.
3. Do you feel like you still enjoy each other’s company and doing things together, or do you feel more like you are going through the motions?
A. Definitely going through the motions
B. A little bit of both at times
C. We do enjoy each other’s company, but I don’t think we spend nearly enough quality time together or doing things we both enjoy anymore
4. Do you feel like you are always on edge or walking on eggshells when you are around your boyfriend?
A. Yes, all of the time (nearly every day)
B. Frequently (several times a week)
C. Sometimes (1-2 times per week)
5. Do you often feel hurt, neglected, not cared for, or like your feelings don’t matter?
A. Yes, all of the time
B. Only when we are fighting, and it has become frequent lately
C. Sometimes, but I think he is working on that
6. Have you had an honest discussion with your boyfriend about how you are feeling and communicating your needs?
A. Yes, but nothing changed
B. It is awkward for me to explain how I am feeling, and I am not the best at expressing myself, but I am trying
C. Yes, and I think he understands my concerns and is willing to make some changes
7. Do you feel valued in your relationship? Are your emotional needs being met?
A. No, and when I try to express those things, it just turns into a huge argument, and nothing ever changes, and he doesn’t see it.
B. Most of the time, I don’t, but sometimes I do
C. I am confused, but it isn’t that he disrespects me
8. Would you rather spend time with your friends/family than with your boyfriend if you had the option?
A. Yes, definitely
B. Sometimes, but I do still enjoy spending time with him when we aren’t fighting
C. Not really. I enjoy time with them, but I wouldn’t say I prefer it over spending time with him.
9. Have you always felt less important or unappreciated in your relationship?
A. To some degree, there has always been an imbalance, but it wasn’t like it is now
B. There were always times where I felt that way
C. No, it wasn’t always this way
10. When you picture your future, do you picture it with him?
A. No, it is hard for me to envision marriage and a family with him
B. Sometimes, but I just try not to worry too much about the future
C. I do, but things will need to get better if we are going to have a future