Beliefs About Your Relationship Book An Appointment Beliefs About Your Relationship Please fill out and be sure to hit the 'submit' button when you are done.Name First Last Instructions: for each of the following 15 statements, select the number (1 to 7) of the category that best fits how much you agree or disagree. 1. If a person has any questions about the relationship, then it means there is something wrong with it. 1 - Completely Disagree 2 3 4 - Neither Agree Nor Disagree 5 6 7 - Completely Agree 2. If my partner truly loved me, we would not have any quarrels. 1 - Completely Disagree 2 3 4 - Neither Agree Nor Disagree 5 6 7 - Completely Agree 3. If my partner really cared, he or she would always feel affection for me. 1 - Completely Disagree 2 3 4 - Neither Agree Nor Disagree 5 6 7 - Completely Agree 4. If my partner gets angry at me or is critical in public (or in front of the children), this indicates he or she doesn’t really love me. 1 - Completely Disagree 2 3 4 - Neither Agree Nor Disagree 5 6 7 - Completely Agree 5. My partner should know what is important to me without my having to tell him or her. 1 - Completely Disagree 2 3 4 - Neither Agree Nor Disagree 5 6 7 - Completely Agree 6. If I have to ask for something that I really want, it spoils it. 1 - Completely Disagree 2 3 4 - Neither Agree Nor Disagree 5 6 7 - Completely Agree 7. If my partner really cared, he or she would do what I ask. 1 - Completely Disagree 2 3 4 - Neither Agree Nor Disagree 5 6 7 - Completely Agree 8. A good relationship should not have any problems. 1 - Completely Disagree 2 3 4 - Neither Agree Nor Disagree 5 6 7 - Completely Agree 9. If people really love each other, they should not have to work on their relationship. 1 - Completely Disagree 2 3 4 - Neither Agree Nor Disagree 5 6 7 - Completely Agree 10. If my partner does something that upsets me, I think it is because he/she deliberately wants to hurt me. 1 - Completely Disagree 2 3 4 - Neither Agree Nor Disagree 5 6 7 - Completely Agree 11. When my partner disagrees with me in public (or in front of the children), I think it is a sign that he or she doesn’t care for me very much. 1 - Completely Disagree 2 3 4 - Neither Agree Nor Disagree 5 6 7 - Completely Agree 12. If my partner contradicts me, they think that he or she doesn’t have much respect for me. 1 - Completely Disagree 2 3 4 - Neither Agree Nor Disagree 5 6 7 - Completely Agree 13. If my partner hurts my feelings, I think that is because he or she is mean. 1 - Completely Disagree 2 3 4 - Neither Agree Nor Disagree 5 6 7 - Completely Agree 14. My partner always tries to get his/her own way. 1 - Completely Disagree 2 3 4 - Neither Agree Nor Disagree 5 6 7 - Completely Agree 15. My partner doesn’t listen to what I have to say. 1 - Completely Disagree 2 3 4 - Neither Agree Nor Disagree 5 6 7 - Completely Agree Dr. Chris Regan, Psy.D. (310) 870-1275