Partner Intimacy Questionnaire

Partner Intimacy Questionnaire

See where you rank in the various forms of Intimacy. This assessment is best done on a computer or tablet.
Your Name*

First NameLast Name
Your Partner's Name*

First NameLast Name
Your Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Would you like an Intimacy Therapist to contact you?*

YesNo
Would you like to sign up for the Newsletter?*

YesNo
Forgiveness Intimacy

Apologizing to each other. Ask for forgiveness. Ask your spouse, “What can I do to be a better husband/wife?”
I apologize to my partner when I know I have hurt his or her feelings and he or she accepts my apology without resentment.*

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1 is Never, 5 is Always
When my partner apologizes to me, I accept his or her apology without resentment.*

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1 is Never, 5 is Always
When I have accepted responsibility for the things that I have done incorrectly or mistakenly, I have asked my partner, “how can I do better” or “how can I help?”*

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1 is Never, 5 is Always
Spiritual Intimacy

Discovering and sharing values, religious views, spiritual feelings, meaning in life, etc. Pray and meditate together and share spiritual insight with your partner. Create a spiritual experience for your partner and write a prayer for your partner
My partner and I are comfortable sharing our personal values, beliefs, and religious views.*

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1 is Never, 5 is Always
My partner and I demonstrate a high level of support over each other’s values, beliefs, and religious views*

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1 is Never, 5 is Always
My partner and I both prioritize spiritual intimacy.*

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1 is Never, 5 is Always
My partner and I work together to let our spiritual insights lead our relationship and direction in life.*

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1 is Never, 5 is Always
Emotional Intimacy

Feeling connected at an emotional level. Being in tune with each other’s emotions; being able to share significant meanings and feelings with each other, including negative feelings. Create time for you and your partner to share significant meanings and feelings. Use loving words toward your partner often in public and in private & write your partner love letters.
I feel that my partner and I make a strong effort to spend quality time with each other.*

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1 is Never, 5 is Always
I feel that my partner and I are able to vulnerably share our feelings, likes, and dislikes.*

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1 is Never, 5 is Always
My partner and I both value maintaining a strong emotional connection with each other.*

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1 is Never, 5 is Always
My partner and I can recognize, accept, and communicate our feelings in a healthy manner.*

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1 is Never, 5 is Always
Sexual Intimacy

Enjoy pleasuring one another.
I understand my partner’s sexual needs and they understand mine because they are communicated clearly. *

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1 is Never, 5 is Always
My sexual drive is similar to that of my partner’s.*

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1 is Never, 5 is Always
I enjoy sexually pleasing my partner and my partner sexually satisfies me.*

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1 is Never, 5 is Always
My partner and I can sexually satisfy one another without using any alcohol or drugs.*

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1 is Never, 5 is Always
Financial Intimacy

Working together to balance differing attitudes about money. Have a conversation with your partner on your family history on money and what money means to you. Develop a unified plan for budgeting, spending, and saving. Share and create financial goals that will benefit you all as a couple.
My partner and I can have productive conversations about finances and what money means to each of us.*

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1 is Never, 5 is Always
My partner and I have a shared plan for budgeting, spending, and saving.*

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1 is Never, 5 is Always
My partner and I are in agreement over working toward similar financial goals.*

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1 is Never, 5 is Always
Friendship Intimacy

Feeling a close connection and regard for one another as friends. Plan a date for the other person.
My partner and I prioritize having regular dates with each other. *

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1 is Never, 5 is Always
I believe my partner and I are friends. *

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1 is Never, 5 is Always
My partner and I choose and remember dates that help us to remember why we fell in love with each other in the first place *

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1 is Never, 5 is Always
Community Intimacy

Sharing in acts of service together. Growing closer as a couple as you experience the joythat comes from giving to others. Volunteer together and be active in social justice together.
My partner and I spend adequate time participating in advocacy, charity, outreach, social justice, and/or community initiatives.*

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1 is Never, 5 is Always
I feel closer to my partner when we participate in advocacy, charity, outreach, social justice, and/or community initiatives.*

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1 is Never, 5 is Always
Work Intimacy

Experiencing closeness through sharing common tasks, such as: Maintain a house and yard, raise a family, earn a living, and participate in community affairs, etc.
My partner and I spend adequate time working on our homefront together.*

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1 is Never, 5 is Always
I experience more closeness with my partner when we regularly work together at home.*

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1 is Never, 5 is Always
I support my partner's career goals.*

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1 is Never, 5 is Always
Linguistic Intimacy

Connect through talking. Listen to and value your spouse’s ideas. Be loving, compassionate, respectful, giving, truthful, and open in your communication. Check in and flirt with each other throughout the day. Play a communication game with question for example – Card Decks. Dedicate time to talk and be an active listener.
My partner and I share and demonstrate mutual respect for each other’s intellectual capabilities and viewpoints.*

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1 is Never, 5 is Always
I feel that my partner and I spend adequate time having meaningful conversation about intellectual topics.*

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1 is Never, 5 is Always
We strive to create a safe and open environment for my partner and I to communicate.*

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1 is Never, 5 is Always
It is important to me that I take the time to thoroughly understand what my partner communicates to me.*

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1 is Never, 5 is Always
My partner and I check-in with each other regularly to make sure that we are understanding and communicating each other and validating each other needs sufficiently and efficiently.*

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1 is Never, 5 is Always
I feel confident that I can express my needs and wants to my partner without leading to conflict.*

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1 is Never, 5 is Always
My partner and I do not criticize or become defensive with each other in our communication*

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1 is Never, 5 is Always
Crisis Intimacy

Developing closeness in dealing with problems and pain. Standing together in tragedies. Responding together in a united way to pressures of life such as working through problems, raising a family,illness, aging, etc. Discuss and develop a plan together on how to take care of certain predictable stressful events. Have conversations about how each of you deal with stress and what you want from your partner and identify a secret code between the two of you to notify that one of you is stress. Be fully present with your partner during stressful times and give them empathy.
I feel that when my partner and I are faced with a crisis, we are able to converse together, support one another and develop a plan together on how we will move through the crisis.*

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1 is Never, 5 is Always
Up to this point, crisis has brought us together more often than it has torn us apart.*

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1 is Never, 5 is Always
I am confident in our ability to handle crises.*

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1 is Never, 5 is Always
Conflict Intimacy

Facing and struggling with differences together. Using resolution of conflict to grow closer together. Validate the first-person concern and resolve that issue before moving to something else. Use “I” statements, sandwich techniques, and comforting touches (if appropriate). Write out your concerns out (maybe a few times) before you vomit them out.
My partner and I utilize appropriate techniques such as, “I” statements, validations, compromise methods, and reassuring touch (if needed and appropriate) when communicating to resolve conflict. *

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1 is Never, 5 is Always
My partner and I are able to agree to disagree without hurting each other's feelings. *

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1 is Never, 5 is Always
During conflicts, my partner and I validate and respect each other's feelings and opinions.*

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1 is Never, 5 is Always
My partner and I have expressed to each other what we do well when resolving conflict and we have communicated what we agree to do better.*

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1 is Never, 5 is Always
When my partner and I have a conflict on a subject matter, we are good at staying on topic and not discussing other different conflicts.*

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1 is Never, 5 is Always
My partner and I can effectively repair conflicts.*

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1 is Never, 5 is Always
Physical Intimacy

Touch and closeness between bodies. In a romantic relationship, it might include holding hands, cuddling, kissing, and sex. Your relationship doesn't have to be sexual or romantic to have physical intimacy.
I hug, kiss and touch my partner when I feel my partner needs it. *

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1 is Never, 5 is Always
I hug, kiss and touch my partner when I need to feel close to my partner.*

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1 is Never, 5 is Always
I enjoy when my partner hugs, kisses, and touches me everyday even when he or she is not initiating sex.*

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1 is Never, 5 is Always
I respect my partner's boundaries and needs on touch.*

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1 is Never, 5 is Always
Humor Intimacy

Sharing through laughing together. Having jokes between the two of you that only you share. Making each other laugh. Enjoying the funny side of life. Attend a comedy show together and watch sitcoms together. Send your partner funny things.
My partner and I laugh together often. *

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1 is Never, 5 is Always
My partner and I prioritize laughing and experiencing joy together.*

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1 is Never, 5 is Always
My partner and I go out of our way to make sure that we prioritize and experience joy and laughter together.*

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1 is Never, 5 is Always
Recreational Intimacy

Experiencing closeness and connection through fun and play. Help each other rejuvenate through stress-relieving and enjoyable recreation together. Work out together.
My partner and I spend adequate time participating in recreational activities to either destress or feel closer to each other and we enjoy it.*

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1 is Never, 5 is Always
As a couple we enjoy and value our alone together making meaningful memories. *

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1 is Never, 5 is Always
My partner and I often share experiences of beauty together, like nature, music, art, history, and worldly things.*

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1 is Never, 5 is Always
My partner and I spend time creating things together such as cooking meals because this makes us feel closer and we enjoy it.*

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1 is Never, 5 is Always
As a couple we enjoy spending time together with friends and family.*

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1 is Never, 5 is Always
As a couple, we can have fun with each other without any alcohol or drugs.*

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1 is Never, 5 is Always
My partner and I have regular dates and on our dates we do not discuss problems, finances, or children. *

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1 is Never, 5 is Always
Parenting Intimacy

Sharing the responsibilities of raising children. Provide for their physical, emotional, and spiritual needs. Work together in teaching and disciplining them as well as loving them. Play and travel with your kids together.
My partner and I are on the same page in raising our children.*

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1 is Never, 5 is Always
I demonstrate my appreciation for what I feel makes my partner an amazing parent.*

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1 is Never, 5 is Always
I feel good about my relationship and my partner's relationship with our children. *

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1 is Never, 5 is Always
My partner and I converse frequently and consistently on what is best for our children.*

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1 is Never, 5 is Always

Partner Intimacy Questionnaire

Forgiveness Intimacy

Spiritual Intimacy

Emotional Intimacy

Sexual Intimacy

Financial Intimacy

Friendship Intimacy

Community Intimacy

Work Intimacy

Linguistic Intimacy

Crisis Intimacy

Conflict Intimacy

Physical Intimacy

Humor Intimacy

Recreational Intimacy

Parenting Intimacy