INURTURE MARITAL HEALTH CHECK

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- Step 1 of 4

Name *

First

Last

Email Address *

Phone

Age *

Gender *

Male
Female

How long have you been married? *

Birth Order (E.g. 1/5; or 2/5; or 5/5; etc) *

State briefly why you married your spouse. *

Your Intention for this exercise *

A. ATTACHMENT DYNAMICS

Read the list of statements and, using the scale below, pick the number that you feel corresponds to your viewpoint.

1. I find it relatively easy to get emotionally close to others. *

Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree

2. I often worry about being abandoned or not loved by my partner. *

Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree

3. I find it difficult to fully trust others, even my partner. *

Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree

4. I feel conflicted about being close to others—I want connection but also fear it. *

Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree

5. I feel comfortable depending on others and having others depend on me. *

Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree

6. I feel insecure if my partner doesn’t immediately respond to me. *

Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree

7. I prefer not to rely on others and feel uncomfortable when they depend on me. *

Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree

8. I sometimes push people away even though I deeply want their attention. *

Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree

9. I am comfortable sharing my thoughts and feelings with my partner. *

Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree

10. I tend to crave a lot of reassurance and affection in my relationships. *

Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree

11. I often feel the need to keep emotional distance from others to feel safe. *

Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree

12. I experience sudden mood changes in relationships, going from feeling secure to scared or confused. *

Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree

13. I feel confident that my partner will support me when I need them. *

Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree

14. I sometimes feel that I am more invested in the relationship than my partner. *

Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree

15. I am uncomfortable with too much closeness and often push people away. *

Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree

16. I have difficulty trusting people and fear they will hurt or abandon me. *

Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree

17. I trust my relationships to be stable and secure, even when there’s temporary distance. *

Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree

18. I often feel anxious when my partner is not available, even for short periods. *

Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree

19. I value my independence and sometimes avoid sharing my feelings with my partner. *

Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree

20. I often feel overwhelmed by emotions and struggle to express them clearly in relationships. *

Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree

21. I am generally satisfied with the level of closeness in my relationships *

Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree

22. I fear that my partner might not care about me as much as I care about them. *

Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree

23. I find it challenging to be emotionally vulnerable, even with people I care about. *

Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree

24. I tend to experience intense emotional reactions when I feel rejected or ignored. *

Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree

B. MARITAL ASSESSMENT

Read the list of statements and, using the scale below, pick the number that you feel corresponds to your viewpoint.

1. My partner is my first dial when I experience a great moment of joy or an unexpected moment of sadness *

Never True
Rarely True
Occasionally True
Usually True
Always True

2. We are able to apologize and forgive when one of us has hurt the other *

Never True
Rarely True
Occasionally True
Usually True
Always True

3. My partner is good at meeting my emotional needs *

Never True
Rarely True
Occasionally True
Usually True
Always True

4. My partner considers and respects me in their choices and actions *

Never True
Rarely True
Occasionally True
Usually True
Always True

5. We make it a priority to go out together at least once a fortnight *

Never True
Rarely True
Occasionally True
Usually True
Always True

6. My partner and I share same beliefs and values *

Never True
Rarely True
Occasionally True
Usually True
Always True

7. My partner encourages me in all I do and my spiritual growth *

Never True
Rarely True
Occasionally True
Usually True
Always True

8. I am able to talk to my partner about my hopes for the future without fear *

Never True
Rarely True
Occasionally True
Usually True
Always True

9. We support each other in the goals we have for our family life *

Never True
Rarely True
Occasionally True
Usually True
Always True

10. We share and create beautiful memories together as a couple *

0 (Never True)
Rarely True
Occasionally True
Usually True
Always True

11. My partner listens to my point of view even when we disagree *

Never True
Rarely True
Occasionally True
Usually True
Always True

12. My partner listens to my opinions without interrupting or criticizing me *

Never True
Rarely True
Occasionally True
Usually True
Always True

13. My partner constantly gives me their full and undivided attention when I feel like expressing myself. *

0 (Never True)
Rarely True
Occasionally True
Usually True
Always True

14. We discuss new ideas with each other and make decisions together *

Never True
Rarely True
Occasionally True
Usually True
Always True

15. We are able to talk about strong emotions such as excitement, hope, grief and anxiety *

Never True
Rarely True
Occasionally True
Usually True
Always True

16. Growing up my parents/guardians respected my uniqueness and encouraged me in my developments *

Never True
Rarely True
Occasionally True
Usually True
Always True

17. My parents/guardians have/had a strong loving relationship *

Never True
Rarely True
Occasionally True
Usually True
Always True

18. Growing up my parents/guardians spent ample time with me (play with me, talk with me) *

Never True
Rarely True
Occasionally True
Usually True
Always True

19. I was raised with increasing freedom and boundaries appropriate for my age *

Never True
Rarely True
Occasionally True
Usually True
Always True

20. My parents/guardians remain/remained faithful to each other through thick and thin *

Never True
Rarely True
Occasionally True
Usually True
Always True

21. My partner is sensitive towards my sexual needs and makes effort to meet them *

Never True
Rarely True
Occasionally True
Usually True
Always True

22. We agree on our sexual practices *

Never True
Rarely True
Occasionally True
Usually True
Always True

23. My partner shows me care and comfort through regular non-sexual touching *

Never True
Rarely True
Occasionally True
Usually True
Always True

24. I am happy about the frequency of our love-making *

Never True
Rarely True
Occasionally True
Usually True
Always True

25. I am able to talk to my partner about my sexual hopes and desires *

Never True
Rarely True
Occasionally True
Usually True
Always True

26. We have a marital coach we both respect and always listen to *

Never True
Rarely True
Occasionally True
Usually True
Always True

27. Our home has a clear vision & values that is both known to us and everyone in the home *

Never True
Rarely True
Occasionally True
Usually True
Always True

28. We have joint goals, interests and vision that we pursue together *

Never True
Rarely True
Occasionally True
Usually True
Always True

29. We have a family constitution that guides our conduct which we both respect *

Never True
Rarely True
Occasionally True
Usually True
Always True

30. Our marriage has a purpose. *

Never True
Rarely True
Occasionally True
Usually True
Always True

C. PERSONALITY ASSESSMENT

Read the list of statements and, rate yourself from 0 to 10, with 0 being the statement that least describes you and 10 being the statement that most bescribes you.

1. Many people think I am unemotional and blunt in relating with people and handling issues. *

2. My work rate is high, able to work under pressure, taking risks or projects others think can’t be done. *

3. I easily take the lead wherever I find myself and could get upset when goals are not met. *

4. I usually ignore how people feel when I am chasing a goal or trying to get results. *

5. I am very opinionated, and I can make decisions for others easily. *

6. I love people and always want to make them happy. *

7. I encourage people to work together and easily let go offences so we can move on *

8. People notice me easily and love me because I am the life of the party wherever I find myself *

9. I can motivate people to get things done. *

10. I dislike rules and regulations that promotes dogma & tradition because I know there are other ways to get the job done *

11. I naturally hate to offend people so I may be slow to confront issues because I am waiting for the right time to do it. *

12. People see me as a slow starter and they think I don’t like change but I am steady, dependable, controlled *

13. I love to work from the background without making noise about my accomplishment *

14. I withdraw from aggressive situations, would rather allow peace reign than be confrontational *

15. I am ambitious but I take my time and work at my pace *

16. I am a perfectionist to the core, I can’t stand disorganized people. *

17. I love to work based on rules and regulations and predetermined standards. *

18. I need time to think and plan before embarking on any project of journey. I rarely would jump on a trip or any venture without a proper plan and reflection *

19. I could be suspicious and critical of people, always weighing the intentions or motives behind whatever they do. *

20. I am very detailed and thorough in whatever I do, always trying to do things right leaving no room for error *

D. LOVE LANGUAGE ASSESSMENT

How would you describe yourself?

1. I feel more loved, cared for and elated when *

my partner sends me a loving note/text for no particular reason
my partner and I hold hands/hug.

2. I feel more loved, cared for and elated when *

my partner and I get to spend time together alone with no distractions or interruptions
my partner does something practical to help me out..

3. I feel more loved, cared for and elated when *

my partner shows they love me by giving me a gift, no matter how little
my partner and i hang out together - just the two of us

4. I feel more loved, cared for and elated when *

my partner pleasantly surprises me by doing something for me they know I am supposed to do
my partner and I randomly touch each other or lock eyes together

5. I feel more loved, cared for and elated when *

my partner puts their arm around me when we're at a function or an event
my partner surprises me with a gift.

6. I feel more loved, cared for and elated when *

I'm around my partner, even if we're not really doing anything
I hold hands with my partner.

7. I feel more loved, cared for and elated when *

my partner buys or gets me a gift.
my partner tells me "I love you"

8. I feel more loved, cared for and elated when *

I sit close to my partner or stand beside them
I am complimented by my loved one for no apparent reason

9. I feel more loved, cared for and elated when *

I get the chance to just "hang out" with my partner.
I unexpectedly get small gifts from my partner.

10. I feel more loved, cared for and elated when *

I hear my partner tell me, "I'm proud of you."
my partner helps me with a task and takes the burden off me

11. I feel more loved, cared for and elated when *

I get to do things with my partner.
I hear encouraging words from my partner.

12. I feel more loved, cared for and elated when *

my partner does things for me instead of just talking about doing nice things.
I feel connected to my partner through a hug

13. I feel more loved, cared for and elated when *

I hear commendations from my partner.
my partner gives me something that shows they were really thinking about me.

14. I feel more loved, cared for and elated when *

I'm able to just be around my partner.
I get a back rub or massage from my partner.

15. I feel more loved, cared for and elated when *

my partner reacts positively to something I've accomplished
my partner does something for me that I know they don't particularly enjoy.

16. I feel more loved, cared for and elated when *

my partner and I kiss frequently,
my partner shows interest in the things I care about.

17. I feel more loved, cared for and elated when *

my partner works on special projects with me that I have to complete.
my partner gives me an exciting gift.

18. I feel more loved, cared for and elated when *

I'm complimented by my partner on my appearance
my partner takes the time to listen to me and really understand my feelings.

19. I feel more loved, cared for and elated when *

my partner and I share non-sexual touch in public.
my partner offers to run errands for me.

20. I feel more loved, cared for and elated when *

my partner does a bit more than their normal share of the responsibilities we share (around the house, work-related, etc).
I get a gift that I know my partner put thought into choosing

21. I feel more loved, cared for and elated when *

my partner doesn't check their phone while we're talking
my partner goes out of their way to do something that relieves pressure on me.

22. I feel more loved, cared for and elated when *

I can look forward to a holiday because of a gift I anticipate receiving
I hear the words, "I appreciate you" from my partner.

23. I feel more loved, cared for and elated when *

my partner brings me a little gift after they've been traveling without me.
my partner takes care of something I'm responsible to do but I feel too stressed to do at the time.

24. I feel more loved, cared for and elated when *

my partner doesn't interrupt me while I'm talking.
gift giving is an important part of our relationship.

25. I feel more loved, cared for and elated when *

my partner helps me out when they know I'm already tired.
I get to go somewhere while spending time with my partner.

26. I feel more loved, cared for and elated when *

my partner and I are physically intimate.
my partner gives me a little gift that they picked up in the course of their normal day

27. I feel more loved, cared for and elated when *

my partner says something encouraging to me.
I get to spend time in a shared activity or hobby with my partner

28. I feel more loved, cared for and elated when *

my partner surprises me with a small token of their appreciation
my partner and I touch a lot during the normal course of the day.

29. I feel more loved, cared for and elated when *

my partner helps me out- especially if I know they're already busy.
I hear my partner specifically tell me, "I appreciate you."

30. I feel more loved, cared for and elated when *

my partner and I embrace after we've been apart for a while.
I hear my partner say how much I mean to them

E. BELIEFS ASSESSMENT

Kindly rate each of the statements below to know what you believe by using any of ‘Agree’ or ‘Disagree’

1. A man is superior to a woman and every woman must submit to a man. *

Agree
Disagree

2. I believe a husband is superior to his wife. *

Agree
Disagree

3. I believe it is the duty of a woman to raise and nurture the children. *

Agree
Disagree

4. I believe a real man must be the breadwinner and must provide for his family. *

Agree
Disagree

5. The man should have the final say in every matter that concerns the family. *

Agree
Disagree

6. I believe a man and a woman are the same and none is superior & both man and woman must submit. *

Agree
Disagree

7. I believe a husband and his wife are teammates where the husband takes the lead by serving his family. *

Agree
Disagree

8. I believe who cooks is a means to an end and anyone should be able to cook for the family or we delegate it. *

Agree
Disagree

9. I believe everyone should work & whatever we bring in should collectively serve the interest of the family. *

Agree
Disagree

10. The man needs to consult his wife about her dreams and align with his to create a strategic direction for the family. *

Agree
Disagree

11. I believe the final say in every matter should be based on our expertise in those areas of concern *

Agree
Disagree

12. I believe in making compromises for the sake of the marriage. *

Agree
Disagree

13. A man doesn’t have to disclose what he earns to his wife. *

Agree
Disagree

14. A wife who questions what her husband does is not submissive. *

Agree
Disagree

15. A wife who earns more than her husband will be proud and disrespectful. *

Agree
Disagree

16. A husband who does not allow his wife to work is caring. *

Agree
Disagree

17. A husband who does not allow his wife to work or develop herself is controlling. *

Agree
Disagree

18. Husband and wife must be willing to make sacrifices when necessary for the marriage to work. *

Agree
Disagree

19. Family members need to pre-inform us before they show up at our door. *

Agree
Disagree

20. Whatever couples earn must be open to everyone in the family & no one owns anything privately *

Agree
Disagree

21. A good wife should hold her husband accountable and must be able to question his actions and decisions. *

Agree
Disagree

22. Marital conflict is sometimes unavoidable but no conflict is unresolvable. *

Agree
Disagree

23. A couple should stay in the marriage because of the children even if either of them feels disatisfied. *

Agree
Disagree

24. A couple can find a resolution that satisfies all stakeholders in the marriage when there's conflict. *

Agree
Disagree

25. When a marriage fails, both partners are responsible. *

Agree
Disagree

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