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MARITAL INTERVENTION (MI 326)
PATHFINDING PROCESS
MARITAL INTERVENTION (MI-324)
RISING BEYOND
LET LOVE FIND YOU
Family
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MARITAL HEALTH CHECK
MARITAL HEALTH CHECK
By
juwonodutayo
July 1, 2023
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First
Last
Email Address
*
Gender
*
Male
Female
Phone
A. MARITAL ASSESSMENT
Read through the list of statements and, using the scale below, pick the number that you feel corresponds to your viewpoint.
1. My partner and I share same beliefs and values
*
0 (Never True)
1 (Rarely True)
2 (Occasionally True)
3. (Usually True)
4 (Always True)
2. My partner listens to my point of view even when we disagree
*
0 (Never True)
1 (Rarely True)
2 (Occasionally True)
3. (Usually True)
4 (Always True)
3. My partner is my first dial when I experience a great moment of joy or an unexpected moment of sadness
*
0 (Never True)
1 (Rarely True)
2 (Occasionally True)
3. (Usually True)
4 (Always True)
4. Growing up my parents/guardians respected my uniqueness and encouraged me in my developments
*
0 (Never True)
1 (Rarely True)
2 (Occasionally True)
3. (Usually True)
4 (Always True)
5. My partner constantly gives me their full and undivided attention when I feel like expressing myself.
*
0 (Never True)
1 (Rarely True)
2 (Occasionally True)
3. (Usually True)
4 (Always True)
6. We are able to apologize and forgive when one of us has hurt the other
*
0 (Never True)
1 (Rarely True)
2 (Occasionally True)
3. (Usually True)
4 (Always True)
7. My parents/guardians have/had a strong loving relationship
*
0 (Never True)
1 (Rarely True)
2 (Occasionally True)
3. (Usually True)
4 (Always True)
8. My partner listens to my opinions without interrupting or criticizing me
*
0 (Never True)
1 (Rarely True)
2 (Occasionally True)
3. (Usually True)
4 (Always True)
9. We have a marital coach we both respect and always listen to
*
0 (Never True)
1 (Rarely True)
2 (Occasionally True)
3. (Usually True)
4 (Always True)
10. My partner is sensitive towards my sexual needs and makes effort to meet them
*
0 (Never True)
1 (Rarely True)
2 (Occasionally True)
3. (Usually True)
4 (Always True)
11. My partner encourages me in all I do and my spiritual growth
*
0 (Never True)
1 (Rarely True)
2 (Occasionally True)
3. (Usually True)
4 (Always True)
12. Our home has a clear vision & values that is both known to us and everyone in the home
*
0 (Never True)
1 (Rarely True)
2 (Occasionally True)
3. (Usually True)
4 (Always True)
13. Growing up my parents/guardians spent ample time with me (play with me, talk with me)
*
0 (Never True)
1 (Rarely True)
2 (Occasionally True)
3. (Usually True)
4 (Always True)
14. We agree on our sexual practices
*
0 (Never True)
1 (Rarely True)
2 (Occasionally True)
3. (Usually True)
4 (Always True)
15. We discuss new ideas with each other and make decisions together
*
0 (Never True)
1 (Rarely True)
2 (Occasionally True)
3. (Usually True)
4 (Always True)
16. My partner shows me care and comfort through regular non-sexual touching
*
0 (Never True)
1 (Rarely True)
2 (Occasionally True)
3. (Usually True)
4 (Always True)
17. We are able to talk about strong emotions such as excitement, hope, grief and anxiety
*
0 (Never True)
1 (Rarely True)
2 (Occasionally True)
3. (Usually True)
4 (Always True)
18. I was raised with increasing freedom and boundaries appropriate for my age
*
0 (Never True)
1 (Rarely True)
2 (Occasionally True)
3. (Usually True)
4 (Always True)
19. My partner is good at meeting my emotional needs
*
0 (Never True)
1 (Rarely True)
2 (Occasionally True)
3. (Usually True)
4 (Always True)
20. I am able to talk to my partner about my hopes for the future without fear
*
0 (Never True)
1 (Rarely True)
2 (Occasionally True)
3. (Usually True)
4 (Always True)
21. My parents/guardians remain/remained faithful to each other through thick and thin
*
0 (Never True)
1 (Rarely True)
2 (Occasionally True)
3. (Usually True)
4 (Always True)
22. I am happy about the frequency of our love-making
*
0 (Never True)
1 (Rarely True)
2 (Occasionally True)
3. (Usually True)
4 (Always True)
23. We have joint goals, interests and vision that we pursue together
*
0 (Never True)
1 (Rarely True)
2 (Occasionally True)
3. (Usually True)
4 (Always True)
24. We support each other in the goals we have for our family life
*
0 (Never True)
1 (Rarely True)
2 (Occasionally True)
3. (Usually True)
4 (Always True)
25. I am able to talk to my partner about my sexual hopes and desires
*
0 (Never True)
1 (Rarely True)
2 (Occasionally True)
3. (Usually True)
4 (Always True)
26. My partner considers and respects me in their choices and actions
*
0 (Never True)
1 (Rarely True)
2 (Occasionally True)
3. (Usually True)
4 (Always True)
27. We make it a priority to go out together at least once a fortnight
*
0 (Never True)
1 (Rarely True)
2 (Occasionally True)
3. (Usually True)
4 (Always True)
28. We have a family constitution that guides our conduct which we both respect
*
0 (Never True)
1 (Rarely True)
2 (Occasionally True)
3. (Usually True)
4 (Always True)
29. We share and create beautiful memories together as a couple
*
0 (Never True)
1 (Rarely True)
2 (Occasionally True)
3. (Usually True)
4 (Always True)
30. Our marriage has a purpose.
*
0 (Never True)
1 (Rarely True)
2 (Occasionally True)
3. (Usually True)
4 (Always True)
Next
B. 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
Next
C. PERSONALITY ASSESSMENT
Choose the one word that most often applies to you. If you are not sure which word “most applies,” ask a spouse or a friend, and think of what your answer would have been when you were a child.
Part 1
Choose one word that most describes you out of the four listed
1
*
Adventurous
Adaptable
Animated
Analytical
2
*
Persistent
Playful
Persuasive
Peaceful
3
*
Submissive
Self-sacrificing
Sociable
Strong willed
4
*
Considerate
Controlled
Competitive
Convincing
5
*
Refreshing
Respectful
Reserved
Resourceful
6
*
Satisfied
Sensitive
Self-reliant
Spirited
7
*
Planner
Patient
Positive
Promoter
8
*
Sure
Spontaneous
Scheduled
Shy
9
*
Orderly
Obliving
Outspoken
Optimistic
10
*
Friendly
Faithful
Funny
Forceful
11
*
Daring
Delightful
Diplomatic
Detailed
12
*
Cheerful
Consistent
Cultured
Confident
13
*
Idealistic
Independent
Inoffensive
Inspiring
14
*
Demonstrative
Decisive
Dry humour
Deep
15
*
Mediator
Musical
Mover
Mixes easily
16
*
Thoughtful
Tenacious
Talker
Tolerant
17
*
Listener
Loyal
Leader
Lively
18
*
Contented
Chief
Chart Maker
Cute
19
*
Perfectionist
Pleasant
Productive
Popular
20
*
Bouncy
Bold
Behaved
Balanced
Part 2
Choose one word that most describes you out of the four listed
21
*
Blank
Bashful
Brassy
Bossy
22
*
Undisciplined
Unsympathetic
Unenthusiastic
Unforgiving
23
*
Reticent
Resentful
Resistant
Repetitious
24
*
Fussy
Fearful
Forgetful
Frank
25
*
Impatient
Insecure
Indecisive
Interrupts
26
*
Unpopular
Uninvolved
Unpredictable
Unaffectionate
27
*
Headstrong
Haphazard
Hard to please
Hesitant
28
*
Plain
Pessimistic
Proud
Permissive
29
*
Angered easily
Aimless
Argumentative
Alienated
30
*
Naive
Negative attitude
nervy
Nonchallant
31
*
Worrier
Withdrawn
Workaholic
Wants credit
32
*
Too sensitive
Tactless
Timid
Talkative
33
*
Doubtful
Disorganised
Domineering
Depressed
34
*
Inconsistent
Introvert
Intolerant
Indifferent
35
*
Messy
Moody
Mumbles
Manipulative
36
*
Slow
Stubborn
Show-off
Skeptical
37
*
Loner
Lord over others
Lazy
Loud
38
*
Sluggish
Suspicious
Short-tempered
Scatterbrain
39
*
Revengeful
Restless
Reluctant
Rash
40
*
Compromising
Critical
Crafty
Changeable
Next
D. 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 cook for the family.
*
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 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. Our family members should be able to come in anytime they like.
*
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 disrespectful..
*
Agree
Disagree
15. It is not proper for a wife to earn more than her husband because she may become proud.
*
Agree
Disagree
16. A good man must be able to control his wife and cut down her excesses so that she doesn’t disrespect him.
*
Agree
Disagree
17. Family members need to pre-inform us before they show up to enable us plan.
*
Agree
Disagree
18. Whatever couples earn must be open to everyone in the family & no one owns anything privately
*
Agree
Disagree
19. A good wife should hold her husband accountable and must be able to question his actions and decisions.
*
Agree
Disagree
20. There is nothing wrong in a wife earning more than her husband because what they both bring in belongs to the family
*
Agree
Disagree
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