Couples Dyadic Adjustment Scale

Couples Dyadic Adjustment Scale

CONFIDENTIAL

Client Full Name*

First NameLast Name

Client Email Address*

example@example.com

Which therapist are you scheduled with?*

Unknown

Most persons have disagreements in their relationships. Please indicate below the approximate extent of agreement or disagreement between you and your partner for each item on the following lists.

	Always Agree (5)	Almost Always Agree (4)	Occasionally Disagree (3)	Frequently Disagree (2)	Almost Always Disagree (1)	Always Disagree (0)
1. Handling Family Finances
2. Matters of Recreation
3. Religious Matters
4. Demonstrations of Affection
5. Friends
6. Sex Relations
7. Conventionality (Correct or Proper Behavior)

	Always Agree (5)	Almost Always Agree (4)	Occasionally Disagree (3)	Frequently Disagree (2)	Almost Always Disagree (1)	Always Disagree (0)
8. Philosophy of Life
9. Ways of Dealing with Parents or In-laws
10. Aims, Goals, and Things Believed Important
11. Amount of Time Spent Together
12. Making Major Decisions
13. Household Tasks
14. Leisure Time Interests & Activities
15. Career Decisions

	All The Time (0)	Most of The Time (1)	More Often Than Not (2)	Occa-sionally (3)	Rarely (4)	Never (5)
16. How often do you discuss or have you considered divorce, separation, or terminating your relationship?
17. How often do you or your partner leave the house after a fight?
18. In general, how often do you think that things between you and your partner are going well?
19. Do you confide in your partner?
20. Do you ever regret that you married? (or lived together?)
21. How often do you and your partner quarrel?
22. How often do you and your partner "get on each other's nerves?"

	Every Day (4)	Almost Every Day (3)	Occa-sionally (2)	Rarely (1)	Never (0)
23. Do you kiss your partner?

	All of Them (4)	Most of Them (3)	Some of Them (2)	Very Few of Them (1)	None of Them (0)
24. Do you and your partner engage in outside interests together?

How often would you say the following events occur between you and your partner?

	Never (0)	Less Than Once a Month (1)	Once or Twice a Month (2)	Once or Twice a Week (3)	Once a Day (4)	More Often (5)
25. Have a stimulating exchange of ideas
26. Laugh together
27. Calmly discuss something
28. Work together on a project

These are some things about which couples sometimes agree and sometimes disagree. Indicate if either item below caused differences of opinions or were problems in your relationship during the past few weeks. (Check Yes or No)

	Yes (0)	No (1)
29. Being too tired for sex.
30. Not showing love.

The circles below indicate different degrees of happiness in your relationship. The middle point, "Happy," represents the degree of happiness of most relationships. Indicate the circle which best describes the degree of happiness, all things considered, of your relationship.

	Extremely Unhappy (0)	Fairly Unhappy (1)	A little unhappy (2)	Happy (3)	Very happy (4)	Extremely happy (5)	Perfect (6)
31. Degree of happiness

32. Which of the following statements best describes how you feel about the future of your relationship?

I want desperately for my relationship to succeed, and would go to almost any length to see that it does.I want very much for my relationship to succeed, and will do all I can to see that it does.I want very much for my relationship to succeed, and will do my fair share to see that it does.It would be nice if my relationship succeeded, but I can't do much more than I am doing now to help it succeed.It would be nice if it succeeded, but I refuse to do any more than I am doing now to keep the relationship going.My relationship can never succeed, and there is no more that I can do to keep the relationship going.