Music of the Night Love Me Tender Superman Love Theme Making Love out of Nothing Sunrise Sunset Loving Feeling Some music for your pleasure Marriage Questionnaire Please take a few minutes and fill out our questionaire. We are trying to discover the foundation for good marriages. We are also tring to uncover the root causes of the major problems that arise in marriages. We want to be able to help couples before and during their marriage to build strong, healthy and growing relationships Tell Us A Little About Yourself Are you: Male Female Your marital status-If you have been divorced, please check that along with your current status. Married Engaged Contemplating Marriage Not Married, Living with Someone Not Married, Just Broke up with Someone Divorced How many long term relationships have you had? None This is the first One - Three Four - Seven Eight - Ten More than Ten On Average, how long do your relationships last? Under 6 Months Between 6 Months and 1 Year Between 1 and 2 Years Between 3 and 5 Years Between 6 and 10 Years More Than 10 Years Please check your Age group. Under 18 Between 19 and 24 Between 25 and 34 Between 35 and 44 Between 45 and 54 More than 55 Basic Marriage Facts 1) Rate your marriage: Yuck!1 2 3 4 5 6 7 8 9 10 Wow!! 2) Where did you meet your Spouse? 3) Under what circumstances did you meet your Spouse? 4) What did you do for dates? 5) How long did you know each other before you were married? Less than One Month One to Six Months Greater than Six Months but less than 1 Year Longer than a Year but Less than Two Years Two Years or more 6) Did you make a total commitment to your spouse before or at the time of your marriage? Yes No Rating Your Marriage 7)How well did you think you knew each other before marriage? Not well1 2 3 4 5 6 7 8 9 10 Very Well 8) How well did you actually know each other before marriage? Not well 1 2 3 4 5 6 7 8 9 10 Very well 9a)Did the reality of your marriage meet your expectations? Yes No 9b) If not, what is different? 9c)Is the reality better or worse than your expectations? Better Worse Communication 10) Before marriage, did you discuss what you both wanted out of life? Yes No 11)Did you communicate well before marriage? Yes No 12) Do you talk (not fight) now? Yes No 13) Can you talk comfortably to your spouse about intimate things? Yes No 14) Is your spouse your best friend? Yes No 15) Can you have a discussion without it turning into a fight? Yes No 16) Are you afraid of upsetting or angering your spouse if you wish them to do something a different way? Yes No Attraction - Then and Now 17a) What attracted you to this person in the first place? 17b) Do you still find this attractive? Yes No 17c)Why or why not? 18) What is/was the basis of your relationship with your spouse? Number in order of importance to you. Financial Friendship Physical Attraction Intellectual Emotional Support Family Expectations Spiritual Compatibility Love Sex Dependability 19a) Does your spouse have personal habits that are annoying to you? Yes No 19b) How annoying? Not Very1 2 3 4 5 6 7 8 9 10 I'm Ready to Leave 20a) Did you want to change something about your partner after you were married? Yes No 20b) If so, what? 20c)Did you accomplish it? Yes No 20d) If you didn't accomplish it, is it still a problem? Yes No 20e)How big of a problem? Not Much1 2 3 4 5 6 7 8 9 10 I'm Ready to Leave 21) What did you learn about your spouse after marriage that is causing a problem now (such as gambling, hobbies, personal habits, etc.)? 22) Do you resent your spouse's friends? Yes No 23) Do you feel he/she spends too much time with those friends? Yes No 24a) List in order of importance what you see as the 10 most important things to your spouse. (Ex: Job, kids, sports, hobbies, boat, car, friends, telephone, computer, you, etc) 1: 2: 3: 4: 5: 6: 7: 8: 9: 10: 24a) List in order of importance the 10 most important things to you. 1: 2: 3: 4: 5: 6: 7: 8: 9: 10: 25)Do you feel that you are being taken for granted by your Spouse? Yes No Family Pressures 26) Did your father approve your choice of spouse? Yes No 27) Did your mother approve your choice of spouse? Yes No 28)Describe your relationship with your father? Horrible 1 2 3 4 5 6 7 8 9 10 Fantastic 29)Describe your relationship with your mother? Horrible 1 2 3 4 5 6 7 8 9 10 Fantastic 30a) Did your family expect you to marry? Yes No 30b) How did you feel about that? 31a) Did your family expect you to have children? Yes No 31b)How did you feel about that? 32) Does your spouse's family expect the wife to work? Yes No 33) Does your spouse's family expect you to have children? Yes No 34)How much pressure has been excerted by the wife's family for her to work? None 1 2 3 4 5 6 7 8 9 10 Intense 35) How much pressure has been excerted by the wife's family for you to have children? None 1 2 3 4 5 6 7 8 9 10 Intense 36) How much pressure has been excerted by the husband's family for the wife to work? None 1 2 3 4 5 6 7 8 9 10 Intense 37) How much pressure has been excerted by the husband's family for you to have children? None 1 2 3 4 5 6 7 8 9 10 Intense 38)How much pressure is there to change your chosen career? None 1 2 3 4 5 6 7 8 9 10 Intense Ulterior Motives 39) Why did you get married, check all that apply? Unlimited Sex Independence Love Security Money Get away from a situation Rebellion Seemed like a good idea at the time Lesser of two evils Unplanned (by at least one party) Pregnancy Sex 40a) Rate your sexual relationship with your spouse. Yuck 1 2 3 4 5 6 7 8 9 10 Spectacular 40b) Do you desire: More sex Less sex Amount is about right 41) How important is sex to you? Unimportant 1 2 3 4 5 6 7 8 9 10 Absolutly Essential 42a) Do you enjoy sex? Yes No 42b)If no, why not? 43a) Have you discussed your sexual expectation with your spouse? Yes No 43b)If not, why? 44a) Can you communicate to your Spouse what is pleasurable and what is not pleasurable for you? Yes No 44b) If not, why? 45a) Do you know anything about the sexual responses of your spouse? Yes No 45b) Do you know what those responses mean? Yes No 46)Was sex ever discussed in your home when you were growing up? Yes No 47)Did your parents show non-sexual affection for one another openly? Yes No 48) Do you feel comfortable showing non-sexual affection for your spouse openly? Yes No 49) Do you have a special time set aside just for the two of you? Yes No 50) How often? Infrequently Every Other Month Once a Month Twice a Month Once a Week Twice a Week 51) What do you and your spouse enjoy doing together? 52)What do you enjoy doing alone? Jobs and Money 53a) Is your or your spouse's career a problem? Yes No 53b)If yes, why? 54) Did you discuss careers before marriage? Yes No 55a)Can you calmly discuss careers now? Yes No 55b)If not, why? 56) Was wife's working or staying home agreed upon before marriage? Yes No 57a)Who controls the money? Husband Wife Mutual Control Each controls their own 57b)Does this work for you? Yes No 57c) Why or Why not? 58a)Do you have his money and her money? Yes No 58b)If so, whose money gets spent on essentials? His Hers Both 58c)List in order of importance what you consider the 5 most essential things to spend money on? 1: 2: 3: 4: 5: 58d)List in order of importance what you consider the 5 most essential things to your Spouse to spend money on? 1: 2: 3: 4: 5: 59) Who makes the decision on how money is spent? Husband Wife Each Makes decisions We Decide Together 60) Do you calmly discuss major purchases? Yes No 61a)Have you ever fought about money? Yes No 61b)How often? 61c) Does fighting solve anything? Yes No Children 62a) Did you plan your family together? Yes No 62b)Did you discuss this before marriage? Yes No 62c)Did you agree on this issue? Yes No 62d)If no, who surrendered? Husband Wife 62e) Why? 62f)Is this a point of conflict? Yes No 62g) If no, why not? 63a)Who is the primary care giver for the children? Wife Husband 63b)Is this a problem? Yes No 63c)Why or why not? 64a)Can the primary care giver have a few hours away from the children without having to hire an outside babysitter? Yes No 64b)If not, why? 64c)Is this a problem? Yes No 64d) Why or why not? Household Chores 65)Do you divide the household chores? Yes No 66a)Who's job is it? (his or hers) Job Description His Hers Both Cooking Childcare Taking out Garbage House Cleaning Laundry Auto Repair Cleaning the Car Mowing the Lawn Household Repairs Bill Paying Cleaning the Garage Washing Dishes Grocery Shopping Planning Meals Chauffeuring Children 66b) Are these inflexible? Yes No 66c) Do you fight over it? Yes No 66d) Do you or your spouse have an ATTITUDE about it? Self Spouse Neither Both 67) If your spouse has to work extra hours, are you cheerfully willing to do his/her chores? Yes No 68a)Do you resent your spouse's business trips and extra hours at work? Yes Always Yes Often Yes Sometimes Seldom Never 68b) If you answered Yes, do you let him/her know? Yes No 68c) Do you have an ATTITUDE about it? Yes No 68d) If you resent your spouse's business trips or overtime, can you explain why? 69a) Have you tried working together on the chores? Yes No 69b)Why or why not? 70a) Do you feel you do more than your share of the total work load? Yes No 70b)If yes, why do you feel that way? 70c)Does this bother you? Yes No 71a) Do you perceive that you spouse creates unneccessary extra work for you? Yes No 71b) If yes, why? 71c) Does this bother you? Yes No 71d) Have you tried to talk about it? Yes No 71e)If yes, what was the result? Religion 72a)Are you religious? Yes No 72b)How religious? Not Very 1  2 3  4 5  6 7  8 9  10 Extremely 72c)Were you religious before your marriage? Yes No 73a)Is your spouse religious? Yes No 73b)How religious? Not Very 1 2 3 4 5 6 7 8 9 10 Extremely 73c)Was your spouse religious before your marriage? Yes No 74)Did you discuss your religious beliefs before marriage? Yes No 75) Do your beliefs cause conflict with your spouse? Yes No 76)Can you resolve these conflicts without fighting or one person surrendering everything? Yes No Stress 77a)If you and your spouse have both had an extremely stressful day, how do YOU deal with it? Check all that apply: Fight Make Passionate Love To Your Spouse Ignore Your Spouse Bury Yourself in a Hobby Go For A Walk Take a Nap Work Out at the Gym Talk it out with your Spouse Take a Bath or Shower Throw Things Break Things Other(explain) 77b)Does this work? Yes No 77c)If not, why? 78)Have you and your spouse ever discussed dealing with stress? Yes No 79)What causes your stress? 80)Can you eliminate or reduce it? Yes No 81)Is stress affecting your relationship to your spouse? Yes No 82)Do you percieve that stress is affecting your spouse's relationship to you? Yes No Summary 83)Is your spouse considerate of your needs and feelings? Always Sometimes Never 84)Are you considerate of your spouse's needs and feelings? Always Sometimes Never 85a)If you could do one thing different, what would it be? 85B)Why?