Self-Check for your romantic relationship - Psychotherapy, support ... - Free Printable

The image you've uploaded is a questionnaire for evaluating romantic relationships, designed to assess relationship satisfaction across 15 key dimensions. It encourages couples to reflect on their relationship from multiple perspectives and compare their views with their partner's.

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🔍 What This Questionnaire Is For

This tool, created by Martin Hirschbühl (2020) and associated with *mierigi.lv*, helps couples:

- Evaluate their relationship objectively.
- Identify areas of strength and potential conflict.
- Understand differences in perception between partners.
- Improve communication and mutual understanding.

It’s structured so that each person fills out their own version, then compares results.

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📝 How to Use the Questionnaire

#### Step-by-step Instructions:
1. Column A: Rate your own satisfaction for each of the 15 aspects on a scale from 0 to 10:
- 10 = Perfectly developed; totally happy
- 6 = Not perfect but acceptable
- 3 = Needs improvement
- 0 = Unacceptable / no match at all

2. Column D: Guess how your partner would rate themselves in that area.

3. After both partners complete their forms, swap them and:
- Fill in Column C: Your partner’s actual rating (from their form).
- Fill in Column B: What your partner guessed about *your* rating.

4. Compare all four columns to see:
- Where you agree or disagree.
- Where perceptions differ.
- Whether either of you underestimates or overestimates the other’s feelings.

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✔ Key Dimensions Explained

Here’s a brief explanation of each category to help understand what it measures:

| # | Dimension | Focus |
|----|--------|-------|
| 1 | Passion, bodily attraction, sex, Eros | Physical chemistry and sexual intimacy |
| 2 | Closeness, intimacy, affection, similarity | Emotional bonding and shared values |
| 3 | Support, security, enrichment, care, responsibility | Feeling safe and supported emotionally and practically |
| 4 | Practical issues, everyday life, tasks & money | Shared responsibilities like chores, finances, living space |
| 5 | Interests, hobbies, leisure time, fun | Enjoying activities together and shared joy |
| 6 | Investment, time and energy, consistency | Effort put into maintaining the relationship |
| 7 | Commitment, focus, priority | How much the relationship matters in daily life |
| 8 | Respect, acceptance, tolerance, non-violence | Mutual respect and peaceful interaction |
| 9 | Communication, openness, compromise, kindness | Ability to talk honestly and resolve conflicts kindly |
| 10 | Stability, predictability, trust | Reliability and emotional safety |
| 11 | Independence, private space, freedom | Balancing togetherness with personal autonomy |
| 12 | Perspective, common goals, shared future | Vision for the future and alignment on big life decisions |
| 13 | Children, family, projects | Plans regarding kids, extended family, major life projects |
| 14 | Development, change, spirituality, growth | Personal and spiritual evolution within the relationship |
| 15 | Friends, outside contacts, relatives | Integration of social circles and external relationships |

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💡 Why This Tool Works

- Self-awareness: Helps individuals reflect on their needs and expectations.
- Perception gap analysis: Reveals misunderstandings—e.g., one partner may think they’re highly committed, while the other feels neglected.
- Dialogue starter: Encourages open conversations about sensitive topics like sex, money, or future plans.
- Actionable insights: Low scores can point to areas needing attention or discussion.

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🧩 Example Use Case

Suppose someone rates "Communication" (Item 9) as 8 (A), but guesses their partner will say 5 (D). But when they see the real answer (C), it's actually 2. That reveals:
- The person thinks communication is good.
- They underestimated how bad their partner feels.
- This discrepancy suggests a need to improve listening or honesty.

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🛠️ Tips for Best Results

1. Be honest — don’t sugarcoat.
2. Complete separately — avoid influencing each other.
3. Discuss after filling — use the results as a starting point for dialogue.
4. Revisit periodically — track changes over time.

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🌱 Conclusion

This questionnaire is not about assigning blame or judging the relationship—it’s a diagnostic tool for growth and connection. By comparing self-perception, perceived partner perception, and actual partner response, couples gain valuable insight into their dynamic.

> ✔ Solution Summary:
> The "problem" isn't really a problem—it's a relationship assessment tool. To solve the task:
> - Fill out Column A (yourself).
> - Guess Column D (partner’s view).
> - Swap questionnaires with your partner.
> - Enter Columns B and C from their form.
> - Analyze discrepancies and discuss openly.

Let me know if you'd like a sample filled-out version, analysis template, or how to interpret the results!