Relationship Analysis Questionnaire

Written by Tony Schirtzinger, MSSW, CICSW

PAY CLOSE ATTENTION TO WHO IS DOING THE "WANTING."
EVERY ANSWER MUST BE A DIFFERENT NUMBER.
PICK A SPECIFIC TIME PERIOD.
USE THE EXAMPLES ONLY AS A GUIDE.
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LET THE NUMBER YOU CHOOSE REFLECT THESE MEANINGS:
From 00 to 05 = "It doesn't happen" or "Not at all."
From 06 to 15 = "It goes terribly."
From 16 to 25 = "It goes very badly."
From 26 to 35 = "It goes badly."
From 36 to 45 = "It goes a little badly."
From 46 to 55 = "It doesn't go well or badly. It's in the middle."
From 56 to 65 = "It goes a little well."
From 66 to 75 = "It goes well."
From 76 to 85 = "It goes very well."
From 86 to 95 = "It goes extremely well."
From 96 to 100 = "It goes fantastically!"

The Questions

	In this situation...	How does it go?
	1. When you want to take care of the other person Examples "Can I get you a soda?" "Would you like a back rub?" "You look tired, let me put the kids to bed."	Enter a number between 0-100. See chart above
	2. When the other person wants to take care of you Examples: "Can I get you a soda?" "Would you like a back rub?" "You look tired, let me put the kids to bed."	Enter a number between 0-100. See chart above
	3. When you want to be taken care of by the other person Examples: "Can I get you a soda?" "Would you like a back rub?" "You look tired, let me put the kids to bed."	Enter a number between 0-100. See chart above
	4. When the other person wants to be taken care of by you Examples: "Can I get you a soda?" "Would you like a back rub?" "You look tired, let me put the kids to bed."	Enter a number between 0-100. See chart above
	5. When you want to share opinions with the other person Examples: "We deserve a vacation." "Children should be seen and not heard." "Our religion is best."	Enter a number between 0-100. See chart above
	6. When the other person wants to share opinions with you Examples: "We deserve a vacation." "Children should be seen and not heard." "Our religion is best."	Enter a number between 0-100. See chart above
	7. When you want to think clearly with the other person Examples: "How can we get there from here?" "Let's figure it out together." "Will you explain to me how you did that?"	Enter a number between 0-100. See chart above
	8. When the other person wants to think clearly with you Examples: "How can we get there from here?" "Let's figure it out together." "Will you explain to me how you did that?"	Enter a number between 0-100. See chart above
	9. When you want to have sex with the other person Examples: Playfully teasing and inviting. Sharing fantasies. Having sex, making love, etc.	Enter a number between 0-100. See chart above
	10. When the other person wants to have sex with you Examples: Playfully teasing and inviting. Sharing fantasies. Having sex, making love, etc.	Enter a number between 0-100. See chart above

To find the Moment of Greatest STRESS in your relationship, add 5 points to your answers for #5 and #6... and subtract 5 points from your answers for # 9 and #10. Then find the LOWEST score out of all 10 questions and go to Moment of Great Stress

back to: Relationship Quiz Table of Contents

reviewed by:
Harry Croft, MD (Psychiatrist)
Medical Director, HealthyPlace.com

Created on December 28, 2008 Last Updated on July 17, 2009