Questionnaire for Each Partner

Amy Newshore, CMHC

amy@coachingbyamy.com
4138249269

Please fill this out so that we can discuss your answers at our individual session. Please set aside about 45 minutes. Thank you!

Name

Date

1. What problem(s) led you to come to Relationship Coaching?

2. How long have you been together? Are you married, dating, living together?

3. What initially attracted you to each other? How did you decide to get married or live together?

4. What do you find most fulfilling about your relationship?

5. What was the very beginning of your relationship like? How long did this phase last?

6. What was your first disillusionment? What happened and how did you resolve it?

7. When do you feel least fulfilled in your relationship?

8. In what significant ways are the two of you similar? Different? What methods have you worked out to accommodate or compromise on your differences?

9. Do you spend time in activities away from your partner? If so, how often?

Do you spend time alone with people who are not mutual friends? Does this create conflict in your relationship?

10. How comfortable are you doing activities away from your partner? How comfortable are you with your partner doing things away from you?

11. How safe do you feel expressing your innermost thoughts and feelings to your partner?

How do you ask for emotional support from your partner when you are feeling vulnerable?

Do you expect to get it?

12. Would your partner say that you are emotionally responsive to his/her vulnerability? Explain.

13. Do you take an active, energetic role in nourishing the relationship? How?

14. Do you support your partner’s development as an individual? How (give example)?

Do you support his/her growth as an individual even when you don’t agree? How (give example)?

15. Do you do projects together? If so, do they seem to add or detract from the bond between you?

16. If your relationship were a drama, movie or book, what would it be titled? How would it end?

17. When was the last time you had sex and how was it?

18. Is your sexual relationship something you want to address?

If you chose Other, please explain.

20. What are some strengths you bring to your relationship?

21. What would you like to improve regarding your own behavior/actions in your relationship?

22. In our work together, it is essential that each partner keep the focus on themselves and what their part is in the difficult relationship dynamics. Are you willing to keep the focus on yourself and put time and effort into practicing new and better ways to relate to your partner/spouse?

23. Please add anything else you think would be important for me to know.

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