Relationship Check-In

Please correct the errors described below.

Directions

Complete this separately from your partner. Do not compare answers until your session. For each statement, rate how true it feels in your relationship right now:

Complete this separately from your partner. Do not compare answers until your session.

For each statement, rate how true it feels in your relationship right now:

1. I trust my partner to follow through on what they say they will do.

Not at all A little Sometimes Often Very much

2. I feel like the responsibilities in our relationship are equitable, even if they aren't divided evenly.

Not at all A little Sometimes Often Very much

3. I feel responsible for remembering, reminding, planning, or keeping track of things for my partner.

Not at all A little Sometimes Often Very much

4. When I agree to do something, I have a realistic plan or system for following through.

Not at all A little Sometimes Often Very much

5. When I make a mistake or don't follow through, I can own my part without becoming defensive or blaming my partner.

Not at all A little Sometimes Often Very much

6. I can tell the difference between something I would prefer and something that is truly a limit or non-negotiable for me.

Not at all A little Sometimes Often Very much

7. I can make a specific request of my partner without criticism, bringing up the past, or adding a list of other complaints.

Not at all A little Sometimes Often Very much

8. I can allow my partner to handle something differently than I would without stepping in, correcting, or taking over.

Not at all A little Sometimes Often Very much

9. I take responsibility for managing my own stress, disappointment, and emotional reactions instead of expecting my partner to fix them.

Not at all A little Sometimes Often Very much

10. Our relationship still has enough fun, affection, connection, or enjoyment that it feels like we are partners—not just people managing life together.

Not at all A little Sometimes Often Very much

11. What is one thing you wish your partner understood about your experience in this relationship?

12. What is one thing you could personally do differently that would make your relationship work better?

13. If your relationship were working 20% better three months from now, what would you notice?

First and Last Name

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Directions

Complete this separately from your partner. Do not compare answers until your session. For each statement, rate how true it feels in your relationship right now:

Therapy, No Filter

Using a no nonsense approach to mental health, the Therapy, No Filter method redefines personal growth by connecting experts who have agency in the service they provide with consumers seeking agency in the services they receive.

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