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Welcome to the Dyadic Adjustment Scale for Couples!
Please follow the instructions on each page and fill out this form honestly, selecting the answer that best describes your current relationship. There will be a total of 32 questions.
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Please Enter Your Full Name
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*Please note: You and your partner should take this assessment separately.
First Name
Last Name
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2
Enter the name of your ServingLeaders counselor
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*Note: This counselor will receive a copy of your survey results.
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3
Questions 1-15
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Respond to each of the following statements.
Always agree
Almost always agree
Occasionally agree
Frequently disagree
Almost always disagree
Always disagree
1. Handling family finances
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Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 0, Column 5
2. Matters of recreation
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Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 1, Column 5
3. Religious matters
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 2, Column 5
4. Showing affection
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 3, Column 5
5. Friends
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Row 4, Column 5
6. Sex relations
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Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Row 5, Column 5
7. Correct or proper behavior
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Row 6, Column 2
Row 6, Column 3
Row 6, Column 4
Row 6, Column 5
8. Philosophy of life
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Row 7, Column 3
Row 7, Column 4
Row 7, Column 5
9. Ways of dealing with parents or in-laws
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Row 8, Column 2
Row 8, Column 3
Row 8, Column 4
Row 8, Column 5
10. Aims, goals, and things believed important
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Row 9, Column 1
Row 9, Column 2
Row 9, Column 3
Row 9, Column 4
Row 9, Column 5
11. Amount of time spent together
Row 10, Column 0
Row 10, Column 1
Row 10, Column 2
Row 10, Column 3
Row 10, Column 4
Row 10, Column 5
12. Making major decisions
Row 11, Column 0
Row 11, Column 1
Row 11, Column 2
Row 11, Column 3
Row 11, Column 4
Row 11, Column 5
13. Household tasks
Row 12, Column 0
Row 12, Column 1
Row 12, Column 2
Row 12, Column 3
Row 12, Column 4
Row 12, Column 5
14. Leisure time, interests, and activities
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Row 13, Column 1
Row 13, Column 2
Row 13, Column 3
Row 13, Column 4
Row 13, Column 5
15. Career decisions
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Row 14, Column 1
Row 14, Column 2
Row 14, Column 3
Row 14, Column 4
Row 14, Column 5
1. Handling family finances
2. Matters of recreation
3. Religious matters
4. Showing affection
5. Friends
6. Sex relations
7. Correct or proper behavior
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, and activities
15. Career decisions
Always agree
Row 0, Column 0
Almost always agree
Row 0, Column 1
Occasionally agree
Row 0, Column 2
Frequently disagree
Row 0, Column 3
Almost always disagree
Row 0, Column 4
Always disagree
Row 0, Column 5
Always agree
Row 1, Column 0
Almost always agree
Row 1, Column 1
Occasionally agree
Row 1, Column 2
Frequently disagree
Row 1, Column 3
Almost always disagree
Row 1, Column 4
Always disagree
Row 1, Column 5
Always agree
Row 2, Column 0
Almost always agree
Row 2, Column 1
Occasionally agree
Row 2, Column 2
Frequently disagree
Row 2, Column 3
Almost always disagree
Row 2, Column 4
Always disagree
Row 2, Column 5
Always agree
Row 3, Column 0
Almost always agree
Row 3, Column 1
Occasionally agree
Row 3, Column 2
Frequently disagree
Row 3, Column 3
Almost always disagree
Row 3, Column 4
Always disagree
Row 3, Column 5
Always agree
Row 4, Column 0
Almost always agree
Row 4, Column 1
Occasionally agree
Row 4, Column 2
Frequently disagree
Row 4, Column 3
Almost always disagree
Row 4, Column 4
Always disagree
Row 4, Column 5
Always agree
Row 5, Column 0
Almost always agree
Row 5, Column 1
Occasionally agree
Row 5, Column 2
Frequently disagree
Row 5, Column 3
Almost always disagree
Row 5, Column 4
Always disagree
Row 5, Column 5
Always agree
Row 6, Column 0
Almost always agree
Row 6, Column 1
Occasionally agree
Row 6, Column 2
Frequently disagree
Row 6, Column 3
Almost always disagree
Row 6, Column 4
Always disagree
Row 6, Column 5
Always agree
Row 7, Column 0
Almost always agree
Row 7, Column 1
Occasionally agree
Row 7, Column 2
Frequently disagree
Row 7, Column 3
Almost always disagree
Row 7, Column 4
Always disagree
Row 7, Column 5
Always agree
Row 8, Column 0
Almost always agree
Row 8, Column 1
Occasionally agree
Row 8, Column 2
Frequently disagree
Row 8, Column 3
Almost always disagree
Row 8, Column 4
Always disagree
Row 8, Column 5
Always agree
Row 9, Column 0
Almost always agree
Row 9, Column 1
Occasionally agree
Row 9, Column 2
Frequently disagree
Row 9, Column 3
Almost always disagree
Row 9, Column 4
Always disagree
Row 9, Column 5
Always agree
Row 10, Column 0
Almost always agree
Row 10, Column 1
Occasionally agree
Row 10, Column 2
Frequently disagree
Row 10, Column 3
Almost always disagree
Row 10, Column 4
Always disagree
Row 10, Column 5
Always agree
Row 11, Column 0
Almost always agree
Row 11, Column 1
Occasionally agree
Row 11, Column 2
Frequently disagree
Row 11, Column 3
Almost always disagree
Row 11, Column 4
Always disagree
Row 11, Column 5
Always agree
Row 12, Column 0
Almost always agree
Row 12, Column 1
Occasionally agree
Row 12, Column 2
Frequently disagree
Row 12, Column 3
Almost always disagree
Row 12, Column 4
Always disagree
Row 12, Column 5
Always agree
Row 13, Column 0
Almost always agree
Row 13, Column 1
Occasionally agree
Row 13, Column 2
Frequently disagree
Row 13, Column 3
Almost always disagree
Row 13, Column 4
Always disagree
Row 13, Column 5
Always agree
Row 14, Column 0
Almost always agree
Row 14, Column 1
Occasionally agree
Row 14, Column 2
Frequently disagree
Row 14, Column 3
Almost always disagree
Row 14, Column 4
Always disagree
Row 14, Column 5
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4
Questions 16-22
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Respond to each of the following statements.
All the time
Most of the time
More often than not
Occasionally
Rarely
Never
16. How often do you discuss or have considered divorce, separation, or terminating your relationship?
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Row 0, Column 1
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Row 0, Column 4
Row 0, Column 5
17. How often do you or your partner leave the house in a fight?
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 1, Column 5
18. In general, how often do you think that things between you and your partner are going well?
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Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 2, Column 5
19. Do you confide in your partner?
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Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 3, Column 5
20. Do you ever regret that you married (or lived together)?
Row 4, Column 0
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Row 4, Column 5
21. How often do you and your partner quarrel?
Row 5, Column 0
Row 5, Column 1
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Row 5, Column 3
Row 5, Column 4
Row 5, Column 5
22. How often do you and your partner "get on each other's nerves"?
Row 6, Column 0
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Row 6, Column 2
Row 6, Column 3
Row 6, Column 4
Row 6, Column 5
16. How often do you discuss or have considered divorce, separation, or terminating your relationship?
17. How often do you or your partner leave the house in 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"?
All the time
Row 0, Column 0
Most of the time
Row 0, Column 1
More often than not
Row 0, Column 2
Occasionally
Row 0, Column 3
Rarely
Row 0, Column 4
Never
Row 0, Column 5
All the time
Row 1, Column 0
Most of the time
Row 1, Column 1
More often than not
Row 1, Column 2
Occasionally
Row 1, Column 3
Rarely
Row 1, Column 4
Never
Row 1, Column 5
All the time
Row 2, Column 0
Most of the time
Row 2, Column 1
More often than not
Row 2, Column 2
Occasionally
Row 2, Column 3
Rarely
Row 2, Column 4
Never
Row 2, Column 5
All the time
Row 3, Column 0
Most of the time
Row 3, Column 1
More often than not
Row 3, Column 2
Occasionally
Row 3, Column 3
Rarely
Row 3, Column 4
Never
Row 3, Column 5
All the time
Row 4, Column 0
Most of the time
Row 4, Column 1
More often than not
Row 4, Column 2
Occasionally
Row 4, Column 3
Rarely
Row 4, Column 4
Never
Row 4, Column 5
All the time
Row 5, Column 0
Most of the time
Row 5, Column 1
More often than not
Row 5, Column 2
Occasionally
Row 5, Column 3
Rarely
Row 5, Column 4
Never
Row 5, Column 5
All the time
Row 6, Column 0
Most of the time
Row 6, Column 1
More often than not
Row 6, Column 2
Occasionally
Row 6, Column 3
Rarely
Row 6, Column 4
Never
Row 6, Column 5
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5
Questions 23-26
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Respond to how frequently the following events occur between you and your partner.
More than once a day
Once a day
Once or twice a week
Once or twice a month
Less than once a month
Never
23. Have stimulating exchange of ideas
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Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 0, Column 5
24. Laugh together
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 1, Column 5
25. Calmly discuss something
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 2, Column 5
26. Work together on a project
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 3, Column 5
23. Have stimulating exchange of ideas
24. Laugh together
25. Calmly discuss something
26. Work together on a project
More than once a day
Row 0, Column 0
Once a day
Row 0, Column 1
Once or twice a week
Row 0, Column 2
Once or twice a month
Row 0, Column 3
Less than once a month
Row 0, Column 4
Never
Row 0, Column 5
More than once a day
Row 1, Column 0
Once a day
Row 1, Column 1
Once or twice a week
Row 1, Column 2
Once or twice a month
Row 1, Column 3
Less than once a month
Row 1, Column 4
Never
Row 1, Column 5
More than once a day
Row 2, Column 0
Once a day
Row 2, Column 1
Once or twice a week
Row 2, Column 2
Once or twice a month
Row 2, Column 3
Less than once a month
Row 2, Column 4
Never
Row 2, Column 5
More than once a day
Row 3, Column 0
Once a day
Row 3, Column 1
Once or twice a week
Row 3, Column 2
Once or twice a month
Row 3, Column 3
Less than once a month
Row 3, Column 4
Never
Row 3, Column 5
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Question 27: Which of the following statements best describes how you feel about the future of your relationship?
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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 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 than I can do to keep the relationship going.
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Questions 28 & 29: Indicate if either of the items below caused differences of opinion or were problems in your relationship during the past few weeks.
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Yes
No
Yes
No
Being too tired for sex
Not showing love
Being too tired for sex
Not showing love
Yes
No
Yes
No
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Question 30: How many outside interests do you and your partner engage in together?
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All of them
Most of them
Some of them
Very few of them
None of them
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9
Question 31: What is the overall degree of happiness - all things considered - that best describes your relationship?
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Extremely Happy
Very happy
Happy
Fairly unhappy
Extremely unhappy
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10
Question 32: How often do you kiss your partner?
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Every day
Almost every day
Occasionally
Rarely
Never
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