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Relationship Inventory
Couples Relationship Inventory
Rate Your Satisfaction in the following areas from 10% to 100%
Print this document & use the key at the bottom of the page to self-score
| 1. |
Commitment |
__________ % |
| 2. |
Respect for each other |
__________ % |
| 3. |
Intimacy - (sharing, spending time together) |
__________ % |
| 4. |
Fidelity |
__________ % |
| 5. |
Romance |
__________ % |
| 6. |
Fun |
__________ % |
| 7. |
Honesty |
__________ % |
| 8. |
Affection |
__________ % |
| 9. |
Sex |
__________ % |
| 10. |
Money |
__________ % |
| 11. |
Responsibility - (score self and partner and divide by 2) |
__________ % |
| 12. |
Lifestyle Plan |
__________ % |
| 13. |
Fighting Fair - (score self and partner and divide by 2) |
__________ % |
| 14. |
Communication |
__________ % |
| 15. |
Shared Values |
__________ % |
| 16. |
Spiritual Growth |
__________ % |
| 17. |
Parenting |
__________ % |
| 18. |
Anger Management |
__________ % |
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Total Scores and Divide by 18 |
|
RAW Score of |
1440 and over |
80-100% |
GOOD |
|
RAW Score of |
1260 to 1439 |
70-79.9% |
MODERATE |
|
RAW Score of |
1080 to 1259 |
60-69.9% |
FAIR
(could use therapy) |
|
RAW Score of |
900 to 1079 |
50-59.9% |
POOR
(E-mail) |
|
RAW Score of |
0 to 889 |
0-49.9% |
FAILING
( E-mail) |
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Please feel free contact me for an appointment or with any questions
Carole Bergen, Ph.D.
Call (253) 853-5800 for an appointment
Fax: (253) 858-5430
E-mail: carole@therapy4life.com |
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