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Analyze Your
Relationship



Write To Me, I Want
To Hear From You


Relationship Analysis Questionnaire

PAY  CLOSE ATTENTION TO WHO IS DOING THE "WANTING."

EVERY ANSWER MUST BE DIFFERENT. 

PICK A SPECIFIC TIME PERIOD. 

USE THE EXAMPLES ONLY AS A GUIDE. 


LET THE NUMBER YOU CHOOSE REFLECT THESE MEANINGS:  
From 00 to 05 = "It doesn't happen" or "Not at all." 
From 06 to 15 = "It goes terribly." 
From 16 to 25 = "It goes very badly." 
From 26 to 35 = "It goes badly." 
From 36 to 45 = "It goes a little badly." 
From 46 to 55 = "It doesn't go well or badly. It's in the middle." 
From 56 to 65 = "It goes a little well." 
From 66 to 75 = "It goes well." 
From 76 to 85 = "It goes very well." 
From 86 to 95 = "It goes extremely well." 
From 96 to 100 = "It goes fantastically!"

 
The Questions 

In this situation... How does it go?
1. When you want to take care of the other person 
       Examples
  • "Can I get you a soda?"
  • "Would you like a back rub?"
  • "You look tired, let me put the kids to bed."
 
Enter a number between 0-100.
See chart
2. When the other person wants to take care of you 
       Examples: 
  • "Can I get you a soda?"
  • "Would you like a back rub?"
  • "You look tired, let me put the kids to bed."
 
Enter a number between 0-100.
See chart
3. When you want to be taken care of by the other person 
       Examples: 
  • "Can I get you a soda?"
  • "Would you like a back rub?"
  • "You look tired, let me put the kids to bed."
 
Enter a number between 0-100.
See chart
4. When the other person wants to be taken care of by you 
       Examples: 
  • "Can I get you a soda?"
  • "Would you like a back rub?"
  • "You look tired, let me put the kids to bed."
 
Enter a number between 0-100.
See chart
5. When you want to share opinions with the other person 
       Examples: 
  • "We deserve a vacation."
  • "Children should be seen and not heard."
  • "Our religion is best."
 
Enter a number between 0-100.
See chart
6. When the other person wants to share opinions with you 
       Examples: 
  • "We deserve a vacation."
  • "Children should be seen and not heard."
  • "Our religion is best."
 
Enter a number between 0-100.
See chart
7. When you want to think clearly with the other person 
       Examples: 
  • "How can we get there from here?"
  • "Let's figure it out together."
  • "Will you explain to me how you did that?"
 
Enter a number between 0-100.
See chart
8. When the other person wants to think clearly with you 
       Examples: 
  • "How can we get there from here?"
  • "Let's figure it out together."
  • "Will you explain to me how you did that?"
 
Enter a number between 0-100.
See chart
9. When you want to have sex with the other person 
       Examples: 
  • Playfully teasing and inviting.
  • Sharing fantasies.
  • Having sex, making love, etc.
 
Enter a number between 0-100.
See chart
10. When the other person wants to have sex with you 
       Examples: 
  • Playfully teasing and inviting.
  • Sharing fantasies.
  • Having sex, making love, etc. 
 
Enter a number between 0-100.
See chart

 
   

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Relationship
Analysis



Write To Me, I Want To Hear From You!
Tony Schirtzinger, Therapist (Milwaukee) 

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