Introduction and Overview
Name: ______________________________ Date: ________________ Communication True of me True of my spouse N/A Comments Hardly ever shows a sincere interest in what I am saying Regularly speaks to me in a way that is grumpy, unloving, and sometimes disrespectful Sometimes is evasive in communication and sends “backdoor” messages… i.e. “What’s wrong?” “Nothing!” Often belittles me Dominates the conversation with me Punishes me by tone or reaction Punishes me by blowing up Punishes me by clamming up Cares more about watching the TV than talking with me Cares more about surfing the Internet than talking with me Cares more about ___________ than talking with me Seems more interested in talking with others (friends, parents, church family, etc.) than talking with me Has a habit of saying offensive or shocking things in order to get my attention
Part 2 · Page 2
Can be nasty or sarcastic in their way of responding to me Lectures and moralizes in our conversations Has to mindread, and read into the other person's words and accuse me of meaning things I didn't really say Insists on having the last word Often brings up my past mistakes Often refuses my suggestions or advice without really thinking about what I am saying Is too serious and somber and need to be more cheerful and bright Rarely pays me a compliment or gives me positive feedback Keeps emotions bottled up too much Gets easily offended when I am sharing my day with him/her – thinks I’m just complaining Holds grudges for extended periods of time till he/she gets her way Does not seem to really forgive me Brings up the past / uses it against me Will not let go of the past
Children & Child Rearing
True of me True of my spouse N/A Comments Puts kid(s) first over me Ends up sleeping with child(ren) most nights or the child(ren) ends up sleeping with us Rarely helps me with caring for the child(ren) Lets child(ren) watch too much TV/movies/Internet/video games Thinks I’m not very involved with the kids Would like me to help more with the child(ren) – putting to bed Needs to get the child(ren) to learn to put themselves to sleep at night Coddles the child(ren) Disciplines the child(ren) way too much - too much of a disciplinarian Rarely helps with disciplining the child(ren) Does not have much of a relationship with the child(ren) We can’t agree on how many children we should have
Household Organization
True of me True of my spouse N/A Comments Allows clutter everywhere Stresses too much about the order of the house Can’t keep the car clean Can’t keep up with the laundry Leaves their clothes lying around Rarely helps clean the dishes / kitchen cleanup Rarely helps with household chores Rarely helps with the cooking Rarely helps with the laundry Never finishes with household projects Extended Family / In-Laws True of me True of my spouse N/A Comments Consults way to much with their parents Takes their parents advice over mine quite often Thinks I hate his/her parents
Part 5 · Page 5
Defends his/her family before defending me Lets his/her family determine our family outings / vacations / or special times together Gets way too much advice from his / her parents Intimacy / Romance True of me True of my spouse N/A Comments Almost never wants to have relations Seems to always want to have relations How often are you and your spouse together intimately Check one Once a week or more About every two weeks Maybe once a month Maybe every other month About 2 or 3 times a year Almost never Can’t just cuddle, always wants to have relations Withholds relations to punish me Rarely recognizes when I am trying to be romantic May have a problem with pornography
Part 6 · Page 6
Seems to have scars from the past that we can’t get over It seems all my spouse thinks about is intimacy Rarely seems to enjoy our times of intimacy Habits True of me True of my spouse N/A Comments Often stays up too late Goes to bed too early Snores too much - it keeps me up! Hardly trusts anyone Has low self-esteem Drives too slow/fast (circle one) Has difficulty finishing things Does not like to fix things around the house Watches too much TV/Internet Shops way too much Hates shopping
Part 7 · Page 7
Gets upset because I spend more time with friends/work than I do with her/him Walk with God True of me True of my spouse N/A Comments Struggles with his/her walk with God Rarely/never has family devotions Seems spiritually proud / “holier than thou” Seems spiritually defeated I wish my spouse would read the Bible with me Finances True of me True of my spouse N/A Comments Does not seem to care about finances Stresses out too much about finances Says I don’t have enough faith or trust in God with regard to money
Part 8 · Page 8
Buys a lot of stuff without regard to a budget or need to save money Never likes to do anything special because it will cost too much money Doesn’t understand the need to save money for the future Other Comments ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________