Use this worksheet
to assess the valuable aspects of a special present or past relationship,
and aspects that cause you tension or distress.
Suggestions:
-
Print one or several copies of this worksheet;
-
Get in an undistracted space, and allot at
least 30" to do this worksheet and reflect;
-
Check
to see if your
is
your other subselves
If not, see
and be alert for
-
Have extra paper, if you feel like
writing impressions, thoughts, or reactions;
-
Use colored markers to hilight any
special points;
-
Adopt the
open, curious "mind of a student,"
and remind yourself this is not about blaming or faultfinding. Rather this information
can be valuable raw material for both affirmations and problem-solving.
-
If questions don't apply, re-word or skip
them.
-
Review this summary about the ingredients for
a healthy relationship, and note your
reactions.
-
Pick the current or past
relationship with a special adult you want to evaluate;
-
You can also guess how your partner
would respond to a given item by using "x" or another symbol.
-
Remind yourself of your
right to disclose
and discuss your results here or not;
-
There are no
"correct" answers other
than yours!
The
goal here is to give you and a partner a chance to
clarify aspects of your
relationship, affirm the good parts, and
identify things that could
strengthen it.
Relationship
Factors:
[+]
= strength;
[o]
= neither
[-]
=
stressor
Wholistic Health
1) I'm usually
by my
or I am committed to increasing true-Self guidance via
some form
of
("parts work") (+ / o / -
)
2) I have _
myself honestly for false-self
and am _ committed to making
significant progress
those that I found (+ / o / -
)
3) I am committed
to maintaining healthy exercise and diet, and balancing work, play, and rest
(+ / o / -
)
4) In calm and
stressful times, I'm consistently _ aware of and _ assertive of my needs and
personal
rights as a valuable,
lovable, unique person; (+ / o / -
)
5) I am evolving a
healthy
which nourishes and guides me in calm and stressful times
(+ / o / -
)
6) You are usually
by your
or you are clearly committed to increasing true-Self
guidance via some form of
("parts work") (+ / o / -
)
7)
You have _
honestly for false-self
and _ are firmly committed to making significant
progress
those that s/he found (+ / o / -
)
8)
You are committed to maintaining
healthy exercise and diet, and balancing work, play, and rest
(+ / o / -
)
9) In calm and
stressful times, my partner is consistently _ aware of and _ assertive of
his / her
needs and personal rights
as a valuable, lovable, unique person (+ / o / -
)
10) You are
evolving a healthy
which nourishes and guides you in calm and stressful times
(+ / o / -
)
Love
11)
I am able to form genuine, healthy
with you and other people (+ / o / -
)
12)
You are able to form genuine, healthy
bonds with me and other people (+ / o / -
)
13)
I consistently feel healthy
(vs. egotism)
(+ / o / -
)
14)
You consistently feel healthy self-love
(vs. egotism) (+ / o / -
)
15)
I feel deeply and consistently
loved by you
often enough
(+ / o / -
)
16)
I love you despite
your shortcomings and limitations (+ / o / -
)
17) You feel deeply
and consistently loved by me often enough (+ / o / -
)
18) You genuinely
love me despite my shortcomings and limitations (+ / o / -
)
19) I’m comfortable enough with the love and/or
respect you show my kid/s (+ / o / -
)
20) I feel enough love and/or respect for
your
child/ren (if any) (+ / o / -
)
21) I’m OK enough with your feelings about your
ex-spouse
(if any) (+ / o / -
)
22) (other)
______________________________________________________________ (+ / o / -
)
23) (other)
______________________________________________________________ (+ / o / -
)
Affection,
Appreciation, and
Support
24) You spontaneously express these to me often
enough (+ / o / -
)
25) I like the way/s you express them
(+ / o / -
)
26) You touch / hug / caress me often enough
(+ / o / -
)
27) I feel truly and consistently
supported enough
by you (+ / o / -
)
28) (other)
______________________________________________________________ (+ / o / -
)
29) (other)
______________________________________________________________ (+ / o / -
)
Our
30) I feel you usually
understand my major _ feelings, _ thoughts, and _ needs (+ / o / -
)
31) I feel clear on your _ feelings, _ needs, and
_ opinions, often enough (+ / o / -
)
32) We handle most of our conflicts
promptly and fairly
enough (+ / o / -
)
33)
We
_
resolve our major disagreements - including
- well enough, and
_ they usually stay resolved. (+ / o / -
)
34)
We
vs. argue, fight, or avoid,
consistently enough. (+ / o / -
)
35) You
share enough of your
_ ideas, _ fears, _ dreams,
and _ emotions with me. (+ / o / -
)
36) I feel you really
to me respectfully, often enough.
(+ / o / -
)
37) We usually don't confuse listening with agreeing.
(+ / o / -
)
38) We have no major topics that aren't
safe to discuss
honestly and directly (+ / o / -
)
39) You're willing to talk about
us in the present,
(vs. past or future) enough (+ / o / -
)
40) I usually feel
safe enough with you to
tell you my thoughts, needs, and hopes (+ / o / -
)
41) We can spot and resolve key
communication problems well
enough (+ / o / -
)
Our Goals and Expectations
42) We're usually clear enough on what we
expect from each other (+ / o / -
)
43) We agree enough on what I expect of you in our
relationship (+ / o / -
)
44) We agree enough on what you expect of me in our
relationship (+ / o / -
)
45) I feel our main life-goals and relationship-goals are
compatible enough (+ / o / -
)
46) I like the mix
of your goals, mine, and ours (+ / o / -
)
47) (other)
______________________________________________________________ (+ / o / -
)
48) (other)
______________________________________________________________ (+ / o / -
)
Socializing and Friends
49) I like the mix and balance of your friends, mine, and
ours (+ / o / -
)
50) We spend enough
time with _ your friends, _ mine,
and _ ours (+ / o / -
)
51) Our
and limits with our friends are
comfortable enough for me (+ / o / -
)
52) I like the way we usually socialize together
(+ / o / -
)
53) (other)
______________________________________________________________ (+ / o / -
)
54) (other)
______________________________________________________________ (+ / o / -
)
Our
In-laws,
and Ex In-Laws
55) I get along well enough with
your parent/s,
sib/s, and other relatives (+ / o / -
)
56) I
like your attitude about
my parent/s,
sibling/s, and other kin (+ / o / -
)
57) We spend enough
time with _ your family and _ mine (+ / o / -
)
58) Our boundaries and limits with our families are
comfortable enough for me (+ / o / -
)
59) (other)
________________________________________________________________
(+ / o / -
)
60) (other)
________________________________________________________________
(+ / o / -
)
Our Interests and Activities
61) I enjoy the range of interests we have in common
(+ / o / -
)
62) I like the mix of your interests, mine, and ours
(+ / o / -
)
63) I feel good enough about the
time we allocate to doing
things together (+ / o / -
)
64) (other)
______________________________________________________________ (+ / o / -
)
65) (other)
______________________________________________________________ (+ / o / -
)
Sensuality and
Sexual Intimacy
66)
I'm satisfied well enough with our lovemaking _ frequency and _ usual pace
(+ / o / -
)
67) I
_ usually feel
satisfied enough, and _ really enjoy satisfying you
(+ / o / -
)
68) Our balance of
who initiates sensual intimacy is
OK enough (+ / o / -
)
69) The variety of our sensual experiences together is
satisfying enough (+ / o / -
)
70) We usually can
talk freely enough about
our sensual needs together (+ / o / -
)
71) You’re aware of and
responsive enough to my
sensual needs (+ / o / -
)
72) (other)
____________________________________________________________ (+ / o / -
)
73) (other) ____________________________________________________________
(+ / o / -
)
Our Power and Status Balances
74) We balance leading and following well
enough (+ / o / -
)
75) Neither of us is too
on, or too
independent from, the other (+ / o / -
)
76) You willingly go along with
my preferences often enough
(+ / o / -
)
77) I feel our ability to
compromise and
flex when we have
to is a real asset (+ / o / -
)
78) I feel that we’re clearly
partners, vs. opponents,
often enough (+ / o / -
)
79) I’m satisfied enough with
who makes our major
life-decisions now (+ / o / -
)
80) (other)
_____________________________________________________________ (+ / o / -
)
81) (other)
_____________________________________________________________ (+ / o / -
)
Continued
on page 2
The Web
address of this two-page inventory is
http://sfhelp.org/08/strnx-strssrs.htm