Sex & Love Therapy® Partner(s) Questionnaire
This form is an optional tool for providing your therapist with additional information. Each partner completes this form.
Email address *
Full Name *
Your answer
Partner(s) Name *
Your answer
Phone
Your answer
What is the problem that led you to decide to come to therapy? *
Your answer
How long have you and your partner been together? In what form? (i.e,.dating, living together, married)? *
Your answer
How was the decision to live together or marry made? *
Your answer
What was the very beginning of your relationship like? *
Your answer
How long did this phase last? *
Your answer
What was your first disillusionment? *
Your answer
What happened and how did you resolve it? *
Your answer
Did this lead to any changes in your relationship? *
Your answer
When did you first become aware of significant differences between the two of you? *
Your answer
How are the two of you similar? *
Your answer
How are you different? *
Your answer
What do you do when there is conflict between the two of you? *
Your answer
What does your partner do? *
Your answer
What do you do when you are angry? *
Your answer
What does your partner do when angry? *
Your answer
What strengths do you have that support resolving differences? *
Your answer
What strengths does your partner have? *
Your answer
Do you spend time alone? *
Your answer
Do you enjoy your free time? *
Your answer
Does planning how to spend it create anxiety for you? *
Your answer
Do you have separate friendships with people who are not mutual friends? *
Your answer
Does this create conflict in your relationship? *
Your answer
Are you comfortable doing activities away from your partner? *
Your answer
What do you like to do? *
Your answer
How comfortable are you with your partner spending time away from you? *
Your answer
On a scale of 1 to 10, how open are you in expressing your innermost wants, thoughts, desires, and feelings to your partner? *
Totally Closed
Totally Open
When you feel like you want support or encouragement from your partner, do you get it? *
Your answer
How? *
Your answer
When your partner wants support or encouragement from you, do you feel that you give it? *
Your answer
How?
Your answer
Do you support your partner's development as an individual? (Give an example) *
Your answer
Do you support your partner's development as an individual? *
Your answer
What do you find most satisfying about it? *
Your answer
What do you find least satisfying about it? *
Your answer
How has your sexual relationship changed since you were first together? *
Your answer
What is one thing that you wish was different about your sexual relationship? *
Your answer
When do you feel most gratified in your relationship? *
Your answer
Do the two of you have joint commitments to goals, projects, work, or social causes? *
Your answer
Does this add or detract from the bond between you? *
Your answer
If your relationship was a movie, drama, or book, what would it be titled? *
Your answer
How would it end? *
Your answer
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