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Is Your Relationship Stuck in a Negative Cycle?

What best describes your relationship right now?

*

A

We argue often and can’t seem to resolve things

B

We avoid conflict and are left feeling distant

C

feel unheard or misunderstood

D

There’s tension, even when we’re not arguing

E

Things are mostly okay, but something feels off

How often do you and your partner experience conflict or tension?

*

A

Almost every day

B

A few times a week

C

Once a week

D

Occasionally

E

every now and again

When conflict happens, what does it usually look like?

*

A

Escalates quickly into arguments

B

One of us shuts down or withdraws

C

We go in circles and never resolve it

D

One person dominates or controls the conversation

E

We avoid talking about it altogether

F

A combination of the above

During or after these moments, how do you usually feel?

*

A

Frustrated

B

Hurt or rejected

C

Unheard or dismissed

D

Lonely or disconnected

E

Emotionally exhausted

How much is this affecting your overall happiness right now?

*

A

A lot—it’s weighing on me daily

B

Quite a bit—it’s always in the background

C

Somewhat—it comes and goes

D

A little

Can you feel this is affecting your overall wellbeing?

*

A

Emotionally

B

Physically

C

mentally

D

A combination of the above

E

All of the above

How long has this pattern been present in your relationship?

*

Would you say things are improving, staying the same, or getting worse?

*

A

Getting worse

B

Staying the same and not improving

C

Slightly improving

D

Significantly improving

What have you already tried to improve things?

*

How effective have those efforts been?

*

A

Not effective at all

B

Slightly helpful, but didn’t last

C

Some improvement in some areas, but other issues remain

D

Quite helpful

E

Helpful for one person but not the other

If nothing changes, what concerns you most?

*

A

Growing further apart

B

Constant conflict becoming normal

C

Losing the relationship entirely

D

Feeling stuck and unhappy long-term

E

Impact on family/kids

How important is it for you to improve this relationship?

*

A

Extremely important. We are willing to do what It takes to save our relationship

B

Very important. We are prepared to take some steps to improving things.

C

Somewhat important. We would appreciate some guidance but its not urgent.

D

Not that important. I am just curious at this stage

In this relationship, what is it that you really want to experience instead?

*

If your relationship improved in all the ways you really want, how would it impact your life?

*

A

I’d feel more relaxed and at peace

B

I’d feel happier day-to-day

C

I’d have more energy and focus

D

I’d feel more confident and secure

E

My family would be happier and healthier

F

All of the above

How ready are you to start focusing on improving your relationship?

*

A

I’m ready now

B

I’m open but unsure where to start

C

I’m thinking about it

D

I’m not ready yet

Would you be open to guidance from a relationship specialist?

*

A

Yes, absolutely

B

Possibly, if it feels right

C

Not sure

D

Probably not

What kind of support do you think your ready for?

*

A

Regular (weekly / fortnightly) therapy sessions with a relationship specialist

B

Free reading material only at this stage, but maybe I would be keen for therapy later

C

Only free reading material only at this stage

D

I am not really wanting any

Who will we send these results to (name)?

*

What email should we send your results to?

*

What is your phone number

*