*Marriage Questionnaire*

This questionnaire is meant to draw out information on the status of a marriage relationship in the context of counselling. As a counsellor I can get back to you for further discussions and hopefully help you to come out of problem situations. Please answer the questions truthfully, because that is the only way you can get an appropriate feedback. Remember that there is no need to impress me, and you don't get anything by fooling me.

Please be assured that as a counsellor I give you guarantee of keeping things confidential.

Your name
Your email address
Your faith	Christian  Other
Your gender	Male  Female
Your country
Your age (years completed)
Your age at the time of marriage
Present marital status	Married  SeparatedDivorced  Widowed
If remarried, number of marriages
If remarried, number of years between marriages
Number of children
Income level of the family	Poor  Lower middleUpper middle  Rich
Type of husband’s work	Own business  Employed  Unemployed
Husband’s qualifications	School  GraduateMasters  Doctorate
Husband’s income	Nil  Low  MediumHigh
Husband’s working hours	Normal  LongExtra long
Husband’s work pattern	Regular  Shifts
Type of wife’s work	Housewife  Working from home  Working outside
Wife’s qualifications	School  GraduateMasters  Doctorate
Wife’s income	Nil  Low  MediumHigh
Wife’s working hours	Normal  LongExtra long
Wife’s work pattern	Regular  Shifts
Are you staying together with your spouse?	Yes  No
If ‘No’, is it because your spouse is working in another place?	Yes  No
Number of hours per day when husband and wife are together at home
Number of waking hours per day husband and wife spend together
Do you share the same religious faith as your spouse?	Yes  No
Do you eat together?	Rarely  Now and then  Often
Do you watch TV together?	Rarely  Now and then  Often
Do you work together in the kitchen?	Rarely  Now and then  Often
Do you go out together for walks?	Rarely  Now and then  Often
Do you go out together for social/cultural events?	Rarely  Now and then  Often
How much do you talk together per day?	Up to 15 min  30 min  1 hour  2 hours  More than 2 hours
Do you get upset with each other?	Very little  Now and then  Often  Very often
Do you quarrel with each other?	Very little  Now and then  Often  Very often
Is there physical violence between both of you?	Never  Sometimes  Often  Very often
When you get upset with your spouse do you wish to do something violent?	Never  Sometimes  Often  Very often
What happens after a quarrel?	Make up quickly  Stop talking for a long time  Talk to others about it  Ignore it and carry on  Discuss and settle it
Do you discuss problem issues together?	Rarely  Sometimes  Often  Very often
Are you afraid to address problem issues with spouse?	Yes  No  Sometimes  Very often
Do you think your spouse is the major cause of your problems?	Yes  No
If you made a mistake, do you apologise to your spouse?	Yes  No  Sometimes  Very often
Do you share with your spouse about things that bother you?	Rarely  Now and then  Often
Do you think your spouse has time to listen to you?	Rarely  Now and then  Often
Do you think you have time to listen to your spouse when he/she comes to talk about his/her problems?	Rarely  Now and then  Often
Do you tell your spouse about the things you appreciate about him/her?	Rarely  Now and then  Often
How long ago did you express your appreciation about your spouse in front of others?	Days  Weeks  Long ago
How long ago did you express your unhappiness about your spouse in front of others?	Days  Weeks  Long ago
Do you have fun or share jokes with your spouse?	Rarely  Now and then  Often
Do you make fun of your spouse in private?	Rarely  Now and then  Often
Do you make fun of your spouse in front of others?	Rarely  Now and then  Often
Do you talk together before making major decisions?	Rarely  Now and then  Often
Do you feel your spouse does not really understand you?	Rarely  Sometimes  Often
Do you think you understand your spouse well?	To a large extent  Moderately  To a small extent
Can you anticipate what your spouse will say or do?	Rarely  Sometimes  Often
Do you try to correct/train/teach your spouse?	Rarely  Sometimes  Often
Does your spouse appreciate the way you try to correct/train/teach him/her?	Rarely  Sometimes  Often
Do/Did you and your spouse agree on the number of children you would like to have?	Yes  No
Do/Did you or your spouse think that children are burdens on your life?	Yes  No
Do/Did you or your spouse think that children are a drain on your income?	Yes  No
Do/Did you and your spouse agree on the way to discipline/train your children?	Yes  No
Do/Did you share the responsibility of bringing up your children?	Yes  No
Does/Did your spouse share the responsibility of bringing up your children?	Yes  No
Do/Did you both depend to a major extent on others to bring up your children?	Yes  No
Do you think your children are generally doing well?	Yes  No
Do you have a well-adjusted sex life?	Yes  No
How often did you have sexual relations immediately after you got married?	Rarely  Often  Very often
How often do you have sexual relations now?	Rarely  Often  Very often
Do you think your spouse is asking for too much sex?	Yes  No
Do you think your spouse is not cooperating with you enough in sexual relationships?	Yes  No
Do you think your spouse is asking you to do things you don’t like?	Yes  No
If you are a wife, are you afraid of childbirth?	Yes  No
Are you happy that your spouse is also earning?	Yes  No
How do you manage your incomes?	Separately  As one income  Separately, with mutual understanding
Do you and your spouse know how much you are both earning?	Yes  No
Do you and your spouse know how much you are spending?	Yes  No
Do you discuss expenditure/savings/strategies?	Yes  No
Are you able to manage within your income?	Yes  No
Do you wish you could have more happiness even at the cost of less income?	Yes  No
What would you rate as the best point in your wife?	Attractive looking  Good cook  Takes care of home  Takes care of children  Sexual relationship  Good friend to talk to  Careful with money  Your best fan  A good balance for you  A good partner in life  Nothing special
What would you rate as the second best point in your wife?	Attractive looking  Good cook  Takes care of home  Takes care of children  Sexual relationship  Good friend to talk to  Careful with money  Your best fan  A good balance for you  A good partner in life  Nothing special
What would you rate as the third best point in your wife?	Attractive looking  Good cook  Takes care of home  Takes care of children  Sexual relationship  Good friend to talk to  Careful with money  Your best fan  A good balance for you  A good partner in life  Nothing special
What would you rate as the worst point in your wife?	Does not cooperate in sex  Spends too much  Wants to talk all the time  Complaining  Quarrelling  Nagging  Domineering  Negligent in appearance  Disinterested cook  Not taking care of the home  Too tired all the time  Nothing special
What would you rate as the second worst point in your wife?	Does not cooperate in sex  Spends too much  Wants to talk all the time  Complaining  Quarrelling  Nagging  Domineering  Negligent in appearance  Disinterested cook  Not taking care of the home  Too tired all the time  Nothing special
What would you rate as the third worst point in your wife?	Does not cooperate in sex  Spends too much  Wants to talk all the time  Complaining  Quarrelling  Nagging  Domineering  Negligent in appearance  Disinterested cook  Not taking care of the home  Too tired all the time  Nothing special
What would you rate as the best point in your husband?	Understanding  Affectionate  Considerate  Listens to me  Earns well  Helps at home  Helps with the children  A good friend  Handsome  Respected in society  Nothing special
What would you rate as the second best point in your husband?	Understanding  Affectionate  Considerate  Listens to me  Earns well  Helps at home  Helps with the children  A good friend  Handsome  Respected in society  Nothing special
What would you rate as the third best point in your husband?	Understanding  Affectionate  Considerate  Listens to me  Earns well  Helps at home  Helps with the children  A good friend  Handsome  Respected in society  Nothing special
What would you rate as the worst point in your husband?	Too much sex  No time for conversation  Not interested in the home  No time for children  No respect for me  Does not understand my problems  I don’t know if he loves me  Too lazy to work  Abusive  Womanising  Nothing special
What would you rate as the second worst point in your husband?	Too much sex  No time for conversation  Not interested in the home  No time for children  No respect for me  Does not understand my problems  I don’t know if he loves me  Too lazy to work  Abusive  Womanising  Nothing special
What would you rate as the third worst point in your husband?	Too much sex  No time for conversation  Not interested in the home  No time for children  No respect for me  Does not understand my problems  I don’t know if he loves me  Too lazy to work  Abusive  Womanising  Nothing special
Overall: how would you rate your marriage? (1-Hopeless 10-Excellent)
Any other comments you would like to offer
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