Answer each item by placing the number in the blank
which most accurately reflects your feelings.
1 = rarely or none of the time
2 = a little of the time
3 = some of the time
4 = a good part of the time
5 = most or all of the time
__ 1. I feel that my partner is affectionate enough.
__ 2. I feel that my partner treats me badly.
__ 3. I feel that my partner really cares for me.
__ 4. I feel that I would not choose the same partner
if I had it to do over.
__ 5. I feel that I can trust my partner.
__ 6. I feel that our relationship is breaking up.
__ 7. I feel that my partner doesn't understand
me.
__ 8. I feel that our relationship is a good one.
__ 9. I feel that ours is a very happy relationship.
__10. I feel that our life together is dull.
__11. I feel that we have a lot of fun together.
__12. I feel that my partner doesn't confide in
me.
__13. I feel that ours is a very close relationship.
__14. I feel that I cannot rely on my partner.
__15. I feel that we do not have enough interests
in common.
__16. I feel that we manage arguments and disagreements
very well.
__17. I feel that we do a good job of managing our
finances.
__18. I feel that I should never had married my
partner.
__19. I feel that my partner and I get along very
well together.
__20. I feel that our relationship is very stable.
__21. I feel that my partner is pleased with me
as a sex partner.
__22. I feel that we should do more things together.
__23. I feel that the future looks bright in our
relationship.
__24. I feel that our relationship is empty.
__25. I feel there is no excitement in our relationship.
This scale measures the degree and nature of dissatisfaction
a spouse or partner has in the relationship. Items
are summed, reverse scoring for items 1,3,5,8,9,11,13,16,17,19,20,21,and
23. Scores above 30 indicate a clinically significant
problem.
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