Items:

Most persons have disagreements in their relationships. Please indicate below the approximate extent of agreement or disagreement between you and your partner for each item on the following list.

1. Handling family finances

2. Matters of recreation

3. Religious matters

4. Demonstrations of affection

5. Friends

6. Sex Relations

7. Conventionality (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 interest and activities

15. Career decisions

    Response Options:
    Always Agree - 5
    Almost always agree - 4
    Occasionally disagree - 3
    Frequently disagree - 2
    Almost always disagree - 1
    Always disagree - 0

16. How often do you discuss or have you considered divorce, separation, or terminating your relationship?

17. How often do you or your mate leave the house after 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 mate?

20. Do you ever regret that you married? (or live together)

21. How often do you and your partner quarrel?

22. How often do you and your mate “get on each other’s nerves?”

    Response Options:
    All the time - 0
    Most of the time - 1
    More often than not - 2
    Occasionally - 3
    Rarely - 4
    Never - 5

23. Do you kiss your mate?

    Response Options:
    Every day - 4
    Almost every day - 3
    Occasionally - 2
    Rarely - 1
    Never - 0

24. Do you and your mate engage in outside interests together?

    Response Options:
    All of them - 4
    Most of them - 3
    Some of them - 2
    Very few of them - 1
    None of them - 0

    How often would you say the following events occur between you and your mate?

25. Have a stimulating exchange of ideas

26. Laugh together

27. Calmly discuss something

28. Work together on a project

    Response Options:
    Never - 0
    Less than once a month - 1
    Once or twice a month - 2
    Once or twice a week - 3
    Once a day - 4
    More often - 5

    These are some things about which couples sometimes agree and sometime disagree. Indicate if either item below caused differences of opinions or were problems in your relationship during the past few weeks.

29. Being too tired for sex

30. Not showing love

    Response Options:
    Yes - 0
    No - 1

31. The dots on the following line represent different degrees of happiness in your relationship. The middle point, “happy”, represents the degree of happiness of most relationship. Please circle the dot which best describes the degree of happiness, all things considered, of your relationship.

    Response Options:
    Extremely Unhappy - 0
    Fairly Unhappy - 1
    A Little Unhappy - 2
    Happy - 3
    Very Happy - 4
    Extremely Happy - 5
    Perfect - 6

32. Which of the following statements best describes how you feel about the future of your relationship?

    Response Options:
    I want desperately for my relationship to succeed, and would go to almost any length to see that it does - 5
    I want very much for my relationship to succeed, and will do all I can to see that it does - 4
    I want very much for my relationship to succeed, and will do my fair share to see that it does - 3
    It would be nice if my relationship succeeded, but I can’t do much more than I am doing now to help it succeed - 2
    It would be nice if it succeeded, but I refuse to do any more than I am doing now to keep the relationship going - 1
    My relationship can never succeed, and there is no more that I can do to keep the relationship going - 0