Instructions
In every relationship there are behaviors one or both partners seek to
change. Behaviors may
occur either too often or not often enough. For example, a partner may
be dissatisfied because
the other takes out the garbage only once a week. The desired change would
be for this havior
to occur more often. On the other hand, one might be dissatisfied because
too much time was
being spent cleaning up the house; in this case the desired change would
be for this behavior o
occur less often. In other words, a person's dissatisfaction with partner
performance of a
particular behavior can be expressed as a desire for a behavior to occur
either more or less
often.
The following pages list typical behaviors which can cause relationship
dissatisfactions.
As you read each item, decide whether you are satisfied with your
partner's
performance described in that item. If you are satisfied with your
partner's performance
or if an item is not relevant to you, check the zero point
on the scale, meaning
"NO CHANGE DESIRED."
I want my partner to: Part I
|
||||||||
It would please
my partner if I:
Part II |
Major Item: | |||||||
1.. .particiapted in decisions about spending money | -3 | -2 | -1 | 0 | +1 | +2 | +3 | [ ] |
much | less | somewhat | somewhat | more | much | |||
less | less | more | more | |||||
2. spent time keeping the house clean | +3 | +2 | +1 | 0 | -1 | -2 | -3 | [ ] |
much | more | somewhat | somewhat | less | much | |||
more | more | less | less | |||||
3. ..had meals ready in time | +3 | +2 | +1 | 0 | -1 | -2 | -3 | [ ] |
much | more | somewhat | somewhat | less | much | |||
more | more | less | less | |||||
4. ...paid attention to his/her appearance | -3 | -2 | -1 | 0 | +1 | +2 | +3 | [ ] |
much | more | somewhat | somewhat | more | much | |||
less | less | more | more | |||||
5. .hit him/her | +3 | +2 | +1 | 0 | -1 | -2 | -3 | [ ] |
much | more | somewhat | somewhat | l ess | much | |||
more | more | less | less | |||||
6. ..got together with his/her friends | +3 | +2 | +1 | 0 | -1 | -2 | -3 | [ ] |
much | more | somewhat | somewhat | less | much | |||
more | more | less | less | |||||
7. ..paid the bills on time | -3 | -2 | -1 | 0 | +1 | +2 | +3 | [ ] |
much | less | somewhat | somewhat | more | much | |||
less | less | more | more | |||||
8. ..prepared interesting meals | -3 | -2 | -1 | 0 | +1 | +2 | +3 | [ ] |
much | less | somewhat | somewhat | more | much | |||
less | less | more | more | |||||
9. ..started interesting conversations with me | +3 | +2 | +1 | 0 | -1 | -2 | +3 | [ ] |
much | more | somewhat | somewhat | less | much | |||
more | more | less | less | |||||
10. ..went out with me | -3 | -2 | -1 | 0 | +1 | +2 | +3 | [ ] |
much | less | somewhat | somewhat | more | much | |||
less | less | more | more | |||||
11. ..showed appreciation for things he/she does well | +3 | +2 | +1 | 0 | -1 | -2 | -3 | [ ] |
much | more | somewhat | somewhat | less | much | |||
more | more | lesss | less | |||||
12. ..got together with his/her relatives | -3 | -2 | -1 | 0 | +1 | +2 | +3 | [ ] |
much | less | somewhat | somewhat | more | much | |||
less | less | more | more | |||||
13. had sexual relations with him/her | +3 | +2 | +1 | 0 | -1 | -2 | -3 | [ ] |
much | more | somewhat | somewhat | less | much | |||
more | more | less | less | |||||
14. ..drank | +3 | +2 | +1 | 0 | -1 | -2 | -3 | [ ] |
much | more | somewhat | somewhat | less | much | |||
more | more | less | less | |||||
15. worked late... | -3 | -2 | -1 | 0 | +1 | +2 | +3 | [ ] |
much | less | somewhat | somewhat | more | much | |||
less | less | more | more |
It would please my partner if I: | ||||||||
Major Item: | ||||||||
16. ..got together with our friends | -3 | -2 | -1 | 0 | +1 | +2 | +3 | [ ] |
much | less | somewhat | somewhat | more | much | |||
less | less | more | more | |||||
17. ..helped with housework when asked | -3 | -2 | -1 | 0 | +1 | +2 | +3 | [ ] |
much | less | somewhat | somewhat | more | much | |||
less | less | more | more | |||||
18. ...argued with me | +3 | +2 | +1 | 0 | -1 | -2 | -3 | [ ] |
much | more | somewhat | somewhat | less | much | |||
more | more | less | less | |||||
19. ...disciplined children | -3 | -2 | -1 | 0 | +1 | +2 | +3 | [ ] |
much | more | somewhat | somewhat | more | much | |||
less | less | more | more | |||||
20. ...engaged in extra-marital sexual
relationships |
+3 | +2 | +1 | 0 | -1 | -2 | -3 | [ ] |
much | more | somewhat | somewhat | l ess | much | |||
more | more | less | less | |||||
21. ...spent time in outside activities | +3 | +2 | +1 | 0 | -1 | -2 | -3 | [ ] |
much | more | somewhat | somewhat | less | much | |||
more | more | less | less | |||||
22. ...paid attention to my sexual needs | -3 | -2 | -1 | 0 | +1 | +2 | +3 | [ ] |
much | less | somewhat | somewhat | more | much | |||
less | less | more | more | |||||
23. ...spent time with children | -3 | -2 | -1 | 0 | +1 | +2 | +3 | [ ] |
much | less | somewhat | somewhat | more | much | |||
less | less | more | more | |||||
24...gave him/her attention when he/she needs it | +3 | +2 | +1 | 0 | -1 | -2 | +3 | [ ] |
much | more | somewhat | somewhat | less | much | |||
more | more | less | less | |||||
25. assumed responsibility for finances | -3 | -2 | -1 | 0 | +1 | +2 | +3 | [ ] |
much | less | somewhat | somewhat | more | much | |||
less | less | more | more | |||||
26. ..left him/her to himself/herself | +3 | +2 | +1 | 0 | -1 | -2 | -3 | [ ] |
much | more | somewhat | somewhat | less | much | |||
more | more | lesss | less |
Retrun to Self-Report |