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Relationship Assessment

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PhoneWe will really appreciate if you can kindly drop your number so that we reach you faster. Thank you for understanding

How would you like us to deliver your results? (You can choose options you are cool with)CallTextWhatsappEmailWe recommend Call (Direct/via whatsapp) so that your assigned psychotherapist can directly brief you on your results and offer personalized recommendations based on your submission. You would be sent a reminder text/email when your results are ready (usually within 60 minutes), then schedule an available time for your assigned psychotherapist call. We will not charge you for this call. Thank you very much.

General Relationship Satisfaction

How satisfied are you with your current relationship(s)?

Do you often experience emotional pain or distress in your relationships?RarelyOccasionallyFrequentlyAlmost always

Conflict and Communication

How often do conflicts or misunderstandings occur in your relationships?

When conflict arises, how well are you able to resolve it?Very well, we resolve issues quicklyIt takes time, but we usually resolve itWe struggle to resolve conflictsConflicts often remain unresolved

Do you feel heard and understood in your relationship(s)?Yes, I always feel heardSometimes, but not alwaysRarely, I often feel misunderstoodNo, I never feel heard or understood

Emotional Pain and Trust

Have you experienced feelings of betrayal in your relationship(s)?No, NeverYes, once or twiceYes, frequently

How strongly do feelings of rejection or insecurity impact your relationship(s)?

How trusting do you feel in your current relationship(s)?Fully trustingMostly trustingSomewhat trustingI have little to no trust

Emotional Support

Do you feel supported emotionally by your partner or loved ones?Yes, I always feel supportedSometimes, but not consistentlyNo, I rarely feel supportedNo, I don’t feel supported at all

When you are in emotional pain, do you share this with your partner or loved ones?Yes, I feel comfortable sharingSometimes, but it’s difficultNo, I don’t feel comfortable sharing my feelings

Healing and Improvement

Are you open to seeking guidance (therapy, counseling, etc.) to address relationship issues?Yes, I’m open and willingMaybe, but I’m unsureNo, I don’t think I need it

What aspects of your relationship(s) would you like to improve the most?CommunicationTrustEmotional connectionConflict resolution

other

Summary of Emotional Pain

Which emotions best describe your current experience in your relationship(s)? (Choose all that apply)AngerLonelinessBetrayalRejectionConfusionHurt

other

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