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Survey Templates Surveys Relationship Variables Survey

Relationship Variables Survey

Relationship Variables


Hello:


You are invited to participate in our survey about relationship communication. In this survey, approximately 250 people will be asked to complete a survey that asks questions about your own committed relationship. It will take approximately 15-20 minutes to complete the questionnaire.


At the end of this survey, you will be given the opportunity to enter a drawing for one $50 gift certificate to Outback Steakhouse, and one $20 gift certificate to Cinemark Movie theater for completing the survey.


Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point.


Your survey responses will be stricly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact Rebecca Greene at 806.742.3911 or by email at [email protected]. This is a Master's Thesis being directed by Dr. Patrick Hughes. He may be reached at (806)742-1174 if you have questions or concerns regarding the survey or procedures.



You must be in a heterosexual relationship (married or committed) two years or longer to complete this survey.

Please think only of your own responses to the questions, not how your partner might respond, unless specifically asked about your partner. Please answer the questions by yourself, without asking someone else's opinion (even your spouse).


Thank you very much for your time and support. You may begin the survey now by clicking on the Continue button below.


Sex:
Please tell your age in years:
What is the length of your relationship commitment in years?
Have you ever been married prior to the relationship you are in now?
If you answered "yes" to the question above, how many times have you been married?
Do you have children?
If you have children, how many?
What are the ages of your children? (Please indicate age in years only.)
 
 
 
 
What is your ethnicity? (Optional)
Highest Level of Education Completed:
Current annual household income(Optional):
Most people have disagreements in their relationship. Please indicate below the approximate extent of agreement or disagreement between you and your partner for each item on the following list.
Always agree
Almost always agree
Occasionally disagree
Frequently disagree
Almost always disagree
Always disagree
Handling familiy finances
Matters of recreation
Religious matters
Demonstration of affection
Friends
Sex relations
Conventionality (correct or proper behavior)
Philosophy of life
Ways of dealing with parents or in-laws
Aims, goals, and things believed important
Always agree
Almost always agree
Occasionally disagree
Frequently disagree
Almost always disagree
Always disagree
Amount of time spent together
Making major decisions
Household tasks
Leisure time interests and activities
Career decisions
All the time
Most of the time
More often than not
Occasionally
Rarely
Never
How often do you discuss or have considered divorce, separation, or terminating your relationship?
How often do you or your mate leave the house after a fight?
In general, how often do you think that things between you and your partner are going well?
Do you confide in your mate?
Do you ever regret that you married? (or lived together)
How often do you and your partner quarrel?
How often do you and your mate "get on each other's nerves?"
Do you kiss your mate:
Do you and your mate engage in outside interests together?

Never
Less than once a month
Once or twice a month
Once or twice a week
Once a day
More often
Have a stimulating exchange of ideas
Laugh together
Calmly discuss something
Work together on a project
There are some things about which couples sometimes agree and sometimes disagree. Indicate if either of the items below caused differences of opinion or were a problem in your relationship during the past few weeks.
Yes
No
Being too tired for sex
Not showing love
The following represent different degrees of happiness in your relationship. The middle point "happy," represents the degree of happiness of most relationships. Please select the answer which best describes the degree of happiness, all things considered in your relationship.
In my relationship, criticism of one another's lifestyle, beliefs, ideas, or activities is a very big issue.
In my relationship, disagreements about spending money is a very big issue.
Please think back to your most recent conflict with your partner. Please answer each of the following questions in terms of the last disagreement you had with your partner. Use the following scale to rate the degree to which the following occurred in your last disagreement.


In your last disagreement:
Not at all
This happened some
Definitely happened
The argument escalated into an ugly fight with accusations, criticisms, name-calling, or bringing up past hurts.
My partner criticized or belittled my opinions, feelings or desires.
My partner seemed to view my words or actions more negatively than I meant them to be.
With the problem we had to solve, it was as though we were on opposite teams.
I held back from telling my partner what I really thought and felt.
I felt lonely in this relationship.
When we argued, one of us withdrew--that is, doesn't want to talk about it anymore or left the scene.

Not a problem at all
Very important
How much of a problem was the subject of this disagreement to you?
How important do you perceive the subject of this disagreement was to your partner?
In my relationship, the decision to have children is a very big issue.
In my relationship, the things we do together are a very big issue.
Select the answer that most closely matches how you feel about each statement.
Strongly disagree
Disagree
Slightly disagree
Neutral
Slightly agree
Agree
Strongly agree
I find it relatively easy to get close to others.
I'm not very comfortable having to depend on other people.
I'm comfortable having others depend on me.
I rarely worry about being abandoned by others.
I don't like people getting too close to me.
I'm somewhat uncomfortable being too close to others.
I find it difficult to trust others completely.
I'm nervous whenever anyone gets too close to me.
Others often want me to be more intimate than I feel comfortable being.
Others often are reluctant to get as close as I would like.
Strongly disagree
Disagree
Slightly disagree
Neutral
Slightly agree
Agree
Strongly agree
I often worry that my partner doesn't really love me.
I rarely worry about my partner leaving me.
I often want to merge completely with others, and this desire sometimes scares them away.
Please select the answer that most closely resembles your thoughts and feelings about your relationship.





How much of a problem in your relationship:
Not at all a problem
Very rarely a problem
Every so often a problem
Sometimes a problem
A problem
An important problem
A very important problem
is criticism of one another's lifestyle, beliefs, ideas or activities?
is affection (e.g. talking, hugging, sex, kissing, etc.)?
are disagreements about spending money?
is one or both of you being irritable, depressed, bossy, or otherwise hard to get along with?
are disagreements about how to spend your leisure time, such as what to do on weekends or vacations, what television programs or movies to watch, what parties to attend, etc?
are things you do together?
is the decision to have children?
is raising children?
Who can you really count on to be dependable when you need help?
 
 
 
 
 
 
 
 
How satified?
Whom can you really count on to help you feel more relaxed when you are under pressure or tense?
 
 
 
 
 
 
 
 
Who accepts you totally, including both your worst and your best points?
 
 
 
 
 
 
 
 
How satified?
Whom can you really count on to care about you, regardless of what is happening to you?
 
 
 
 
 
 
 
 
How satified?
Whom can you really count on to help you feel better when you are feeling generally down in the dumps?
 
 
 
 
 
 
 
 
How satified?
Whom can you count on to console you when you are very upset?
 
 
 
 
 
 
 
 
How satified?
In my relationship, affection (talking, hugging, sex, kissing, etc.) is a very big issue to one or both of us.
In my relationship, one or both of us has been irritable, depressed, bossy, or otherwise hard to get along with, and it is a very big issue.
In my relationship, disagreements about how to spend our leisure time, such as what to do on weekends or vacations, what television programs or movies to watch, what parties to attend, etc., is a very big issue.
In my relationship, decisions about raising children are a very big issue.

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