Communication Questionnaire

This Communication Questionnaire is not intended to be a diagnostic tool but instead is meant to give you and I a better idea what the communication looks like in your relationship.

Answer the questions below to the best of your ability.

Rate your answers as follows:

(1) Sometimes
(2) Often
(3) Never - or I don't know

1. My partner and I strongly agree on most long term goals.

1	2	3

2. When my partner and I have a discussion or argument, we almost always stay on one issue at a time.

1	2	3

3. Overall, my partner and I are equal in how much influence we have in decisions.

1	2	3

4. A couple should almost never argue or disagree if they have a truly happy relationship.

1	2	3

5. When I discuss an important issue with my partner, I go ahead and tell him/her almost exactly what I am thinking and feeling, even though it might upset him/her.

1	2	3

6. In our conversations, one partner usually talks quite a bit more than the other.

1	2	3

7. I always consult with my partner before making even small decisions.

1	2	3

8. I have told my partner almost everything about myself.

1	2	3

9. If my partner makes a decision concerning his/her own personal matters, and I do not agree with it, I am usually supportive and encouraging.

1	2	3

10. My partner and I both rarely use negative labels or call each other names (such as "dumb", "weak", "selfish", or "inconsiderate") even when we are angry with each other.

1	2	3

11. I do not feel very comfortable telling my partner about my weaknesses or mistakes.

1	2	3

12. I frequently do not know what my partner wants or feels.

1	2	3

13. My partner and I have some goals which are not the same.

1	2	3

14. Our communication is open, nondefensive, and honest.

1	2	3

15. We usually discuss what is really bothering us, the underlying issues, instead of just the surface issues.

1	2	3

16. If one of us tries to teach the other how to do something, we usually end up having an argument.

1	2	3

17. My partner is always kind, no matter how upset he/she is.

1	2	3

Congratulations on completing this questionnaire. Enter your contact information below and I will contact you within the next day to discuss your results and find out if you would like to schedule an appointment.

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Dr. Randi Fredricks Ph.D. is a Psychotherapist and licensed as a Marriage Family Therapist MFC 47803. Dr. Fredricks is not licensed with the California Medical
Board or the California Bureau of Naturopathic Medicine. © 2012 Randi Fredricks, Marriage and Family Therapist, Inc. All rights reserved. Serving
San Jose, Sunnyvale, Santa Cruz, Palo Alto, Monte Sereno, Los Gatos, Cupertino, Mountain View, Scotts Valley, Campbell, Willow Glen, and Milpitas CA.