1.
Do you routinely share your most important thoughts, feelings
and life experiences with your partner?
Please choose one
Usually
Often
Rarely
Never
2.
Do your two bodies seem to love each other almost independently of your minds?
Please choose one
Usually
Often
Rarely
Never
3.
Are you able to manage any addictions or compulsions -- such
as alcohol, tobacco, food, work or sex -- so they don't become
a source of tension in your relationship?
Please choose one
Usually
Often
Rarely
Never
4.
Are your relationships with others -- including family, friends,
ex's and work colleagues -- sufficiently straight-forward so they present
no problems in your relationship?
Please choose one
Usually
Often
Rarely
Never
5.
Do you regularly
level with each other about how you feel toward each other,
even when the feelings are difficult or painful to express?
Please choose one
Usually
Often
Rarely
Never
6.
Are you able to label your feelings -- both "good" (e.g.,
gratitude, admiration, love) and "bad" (e.g., guilt, disappointment, anger)
-- at the moment you experience them?
Please choose one
Usually
Often
Rarely
Never
7.
Are you able to tell your partner these same feelings in a positive
and constructive way so that he or she can understand and
accept them?
Please choose one
Usually
Often
Rarely
Never
8.
Do you and your partner carve out special time at least once
a week to share what's really going on for you, and are you
able to truly able to listen to the other from the heart?
Please choose one
Usually
Often
Rarely
Never
9.
Do you both feel that the way money is earned and managed in
your relationship is fair?
Please choose one
Usually
Often
Rarely
Never
10.
When you think of all the day-to-day duties and responsibilities
of your life together, do you feel they're divided fairly
between the two of you?
Please choose one
Usually
Often
Rarely
Never
11.
Have you openly discussed with your partner how any differences
in gender, age, ethnicity, religion, career, education and
financial status make you feel?
Please choose one
Usually
Often
Rarely
Never
12.
Do you two consistently -- either on your own or with facilitation --
resolve conflicts until all resentment is dissolved?
Please choose one
Usually
Often
Rarely
Never
13.
Are you able to tell your partner when you're feeling upset without
being aggressive or disrespectful or shutting him or her out?
Please choose one
Usually
Often
Rarely
Never
14.
Have you clearly expressed to your partner that abusive or self-destructive
behaviors and sexual betrayals are unacceptable to you?
Please choose one
Usually
Often
Rarely
Never
15.
Are you aware that the most confounding issues with your partner
relate to your most confounding issues with your parents,
siblings and others you grew up with?
Please choose one
Usually
Often
Rarely
Never
16.
Are you able to stick up for yourself with your partner?
Please choose one
Usually
Often
Rarely
Never
17.
Are you aware of, and working on, your areas of low self-esteem?
Please choose one
Usually
Often
Rarely
Never
18.
Are you doing work that's deeply fulfilling and contributes to
the greater good?
Please choose one
Usually
Often
Rarely
Never
19.
Could you leave your partner if your baseline conditions for relationship
are violated or ignored and outside help has been refused
or failed?
Please choose one
Usually
Often
Rarely
Never
20.
Are you willing to pursue whatever education and
healing is necessary to keep you relationship healthy?
Please choose one
Usually
Often
Rarely
Never
