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Couple Therapy Test
HIPAA
Compliance
1
Do you ever desire to improve your relationship?
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No, I rarely want to improve our relationship.
I often think about wanting to improve our relationship.
I constantly want to work on our relationship.
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2
How often do you and your partner argue?
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We rarely or never argue.
We occasionally argue but I don't think we have disagreements more than other couples we know.
We frequently argue.
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3
Do you feel heard and understood by your partner when you express your thoughts and feelings?
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Yes, I always feel my partner hears and understands me.
My partner sometimes makes me feel heard and understood.
I rarely or never feel like my partner hears and understands me when I share my thoughts or feelings.
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4
Are you satisfied with the level of intimacy and emotional connection in your relationship?
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Yes, completely.
Our emotional intimacy and connection could be better.
I'm not satisfied with our emotional intimacy and connection.
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5
Do you and your partner have difficulty resolving conflicts peacefully?
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No, we handle conflicts well.
We sometimes resolve conflicts, but it can be a challenge.
Yes, our conflicts often escalate.
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6
Are there unresolved issues from the past that continue to affect your relationship?
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No, our past issues are resolved.
There are a few unresolved issues.
I feel that there are many unresolved issues in our relationship.
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7
How often do you feel distant or disconnected from your partner?
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I rarely or never feel disconnected from my partner.
I occasionally feel distant or disconnected from my partner
I frequently feel distant and disconnected from my partner.
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8
Are you both satisfied with your level of communication in the relationship?
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Yes, we both feel that we communicate well.
Our communication could improve.
Communication is a big issue for us.
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9
Do you or your partner often feel misunderstood or unappreciated?
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No, we feel understood and appreciated.
One of us will occasionally feel misunderstood or under-appreciated.
Yes, we commonly feel misunderstood or unappreciated by each other.
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10
Is trust an issue in your relationship?
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Trust is not a problem.
Trust has been compromised in some ways.
Trust is a major concern in our relationship.
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11
How satisfied are you overall with your relationship?
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I'm very satisfied.
I'm somewhat satisfied, but there's room for improvement.
I'm rarely satisfied in our relationship.
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12
Full Name
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First Name
Last Name
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13
Date of Birth
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-
Date
Year
Month
Day
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14
Phone Number
*
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Please enter a valid phone number.
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15
Email
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example@example.com
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16
In which state are you currently residing?
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Please Select
Georgia
Louisiana
Texas
New York
Other
Please Select
Please Select
Georgia
Louisiana
Texas
New York
Other
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17
Your score is
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