Living Room Therapy
Therapy & Counseling
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Therapy & Counseling
My Blog
Workshops
Schedule
Living Room Therapy
Getting Started Worksheet
Start where you are, start now.
Name
*
Email Address
*
My relationship all work and none of the “good stuff.”
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Me and my partner are not seeing eye-to-eye on finances, sex, or parenting.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Communication is becoming more and more frustrating.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
My partner just doesn’t get understand me anymore.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I feel like it's too much work to try to stabilize my relationship.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I don't need to understand my partner, I just need them to change.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Our passion and satisfaction is probably gone for good.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
We are in a frustrating cycle of difficulties and differences.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
We are not able to enjoy life together.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
IN DEPTH: Agree / Strongly Agree
If you agreed or strongly agreed with any of the above statements, please explain more about the situation.
My gender
Female
Male
prefer not to say
Children?
none
one
two
three or more
Relationship Status
check all that apply
short-term (less than 1 yr)
long-term (more than 2 yrs)
dating
living together
engaged
married
separated
calling it quits
Additional comments or questions
Submitted successfully!
If you would like a copy of this worksheet, please contact Me.
