We camouflage our true being before others to protect ourselves against criticism or rejection. This protection comes at a steep price. When we are not truly known by the other people in our lives, we are misunderstood. When we are misunderstood, especially by family and friends, we join the "lonely crowd." Worse, when we succeed in hiding our being from others, we tend to lose touch with our real selves. This loss of self contributes to illness in its myriad forms. - Sidney Jourard
Here are a series of questionnaires and handouts on couples, sexuality, parenting, attachment, and abuse. The first sequence of 20 or so handouts are from a two day workshop I run - for more details including downloadable copies of the slides, see the blog post "Psychotherapy with couples & other close relationships". Listed below these are further relevant handouts & questionnaires.
General couple assessment: Currently I use five questionnaires at the start of therapy: the PPS, CSI-16, demographic, couple & problem areas questionnaires. Additionally the PPS & weekly questionnaires are used before each session, the SRS is used towards the end of each session, and the CSI-16 again at the end of therapy. Communication pattern & perceived criticism scales are of occasional use.
Overview of 5 questionnaires used by Andrew Christensen (Integrative Behavioral Couple Therapy - IBCT - expert) with scoring details: CSI-16, demographic, couple, problem areas & weekly questionnaires (see next four items listed below). The excellent IBCT website gives access to questionnaires too and other resources.
CSI-16: the couple satisfaction index comes in various lengths; here's the 16-item version which Andrew Christensen uses as a pre/post therapy measure.
Demographic questionnaire: developed by Andrew Christensen, this measure describes basic demographic information about the couple (e.g. age, years together, children, etc.) and will be used in the first session to get to know the couple.
Couple questionnaire: used at the start of therapy to assess three areas - a.) CSI-4 which is also included in the Weekly questionnaire (see below). b.) intimate partner violence. c.) commitment to the relationship.
Problem areas questionnaire: again an assessment phase instrument to help in clarifying a couple's main areas of difficulty.
Communication patterns questionnaire - short form: can be useful in assessing conflict tactics.
Perceived partner criticism scale: again can be a useful measure with many couples.
Weekly questionnaire: given to each partner at the end of every therapy session to be completed and brought in for the next session. The questionnaire tracks couple satisfaction with the CSI-4 and also asks about emerging issues that help to structure the next therapy session.
PPS: personal primary problems scale assesses key issues highlighted by couples themselves.
SRS: the session rating scale (here in NRS rather than VAS format) used towards the end of each appointment to track & (for example if any scores are less than 8) encourage discussion of the therapeutic alliance. For more on the key importance of this kind of routine outcome/alliance monitoring see the blog post "Psychotherapists & counsellors who don't monitor their outcomes are at risk of being both incompetent & potentially dangerous".
Assessment sexual function: ASEX men - the male version of the 5 question Arizona sexual experiences scale can be helpful in assessing and monitoring problems with libido, arousal and orgasm.
Assessment sexual function: ASEX women - a female version of the scale.
Assessment sexual function: scoring - the scoring sheet gives limited but useful suggestions on assessment.
Life events questionnaire (the majority are relationship-related)
And below are a further series of relevant handouts & questionnaires:
Intimate bond measure scale & scoring handout page 1 & page 2 - this is the scale I use most often when assessing quality of couple relationships. I often get people to score the IBM both as they are currently actually experiencing their relationship and also as they would ideally like it to be. Obviously the discrepancies between actual and ideal answers to the various questions provide a potential rich source for discussion and for change intentions. In couples' therapy it's reasonably straightforward to get both partners to fill in this scale. Sometimes when working with individual clients, I will ask them to get their partner to fill in IBM for how they experience my client in their relationship. Sometimes, in more "delicate" situations, I will simply ask my client to fill in the IBM guessing how their partner would score them. The scoring handouts, I usually print out as 2-slides-to-a-page Powerpoint handouts. Page 1 provides a useful scoring grid, so that one can see how one scores in comparison to findings from research studies using the IBM. Page 2 illustrates that staying in a couple relationship, where the care score continues at less than 20, may interfere with recovery from depression. This latter seems less applicable for melancholic depressions (criteria in second slide on page 2).
Relationship need satisfaction scale - a 9-item scale assessing satisfaction of autonomy, competence & relatedness needs in a chosen relationship such as with a partner, friend, parent, or child. The scale can also be used for assessing one's relationship network in general. It's good to be scoring in the upper half of the scale for your averaged scores. See the Good Knowledge handouts section on Well-being, time management & self-determination for more on this and related scales.
Relationship need satisfaction background - a handout giving background to self-determination theory and the relationship need satisfaction scale.
Dyadic adjustment scale & scoring - Spanier's Dyadic Adjustment Scale was published in the mid 1970's. I think it's a bit "creaky" as a questionnaire, but it still pulls out quite a lot of helpful information that can be pretty useful.
Dyadic happiness scale (0 - 6) - Goodwin in a classic paper entitled "Overall just how happy are you? The magical question 31 of the Spanier dyadic adjustment scale" showed that the very simple question 31 of the original Spanier scale (see above) gave a quick and surprisingly accurate estimate of how a person would be likely to score when taking the much more time-consuming full scale. It can be useful particularly, for example, when tracking progress week by week during couples' therapy.
Relationships difficulties, development & maintenance - here is a diagram I put together that encourages an overview of relationship difficulties.
Marriage/couples handout, page 1, page 2 & page 3 - this is an 18 slide talk I gave a number of years ago as part of a much larger two day workshop on relationships. The slides print out fine as three 6-slides-to-a-page handouts. Slide 6 on page 1 - a chart of typical marital satisfaction across the life cycle - is a diagram I quite often use for "reassurance" both to illustrate how it can be quite a challenge on marriages raising children and how the "empty nest syndrome" may be something of an illusion.
Touch, sex & caring - this two page Word handout is rather dated now, but still makes a series of very valid points.
Sexual behaviour, sexual attraction and sexual identity - this two page handout is downloadable both in Word doc and in PDF format. Clicking through to the related blog post will give access to a whole series of internet links.
Sexual interaction inventory - this questionnaire asks about current and desired sexual interactions. It can be very helpful for couples to complete this and discuss how they have scored it. It requires a fair amount of openness to do this, but it can be very worthwhile. This opening-up-the-territory exploration can also be much helped by reading (and discussing) good books on sexuality such as the well known "Guide to getting it on" by Paul Joannides, about which one reviewer commented "It's fair to say that no matter what your level of sexual experience is, or how much of a great lover you might think you are, this book is guaranteed to put a smile on your face - and perhaps someone else's."
IIEF-5 scale & scoring (men) - this is the 5 question version of the International Index of Erectile Function - useful for assessing and monitoring change in ability to achieve and maintain erections.
IC & BS exercises - this is an interesting set of pelvic floor muscle training exercises that can be used to help treat erectile dysfunction non-pharmacologically.
Sensate focus exercises, introduction - this introduction to sensate focus exercises for sexual problems is taken from Greenwood & Bancroft's book "Counselling for sexual problems". I put together this handout when I did a psychosexual training a number of years ago. There are a series of more recently published books on sexual problems that it may be worth looking at. Examples include Ford's "Overcoming sexual problems" (which describes sensate focus and other exercises well), the related book by Crowe "Overcoming relationship problems", and the McCarthys' "Rekindling desire".
Sensate focus exercises, instructions, exercise one, exercise two, exercise three, exercise four, exercise five, exercise six - practical behavoural interventions for sexual problems make very good sense. It's very important not to get caught into only talking about difficulties. In a similar way though, in my experience as a therapist, it's also very important to take time to make time to discuss sensitively and encouragingly issues that are triggered by working with the exercises ... and not to apply the exercises in too much of a one-size-fits-all kind of way. Here Vicki Ford's book (see above) is probably well worth getting hold of. Even in our so-called liberated age, most couples feel cautious about discussing sexual issues. Many couples never openly discuss sex in any kind of detailed way. It's not surprising. This is tender territory where it's easy to end up feel misunderstood or hurt. It's also important territory, where discussion and problem-solving can be tremendously helpful.
Parental bond measure scale & scoring handout - here is another scale (like the Intimate Bond Measure at the top of the page) that I use a lot. Typically this use falls into one of two areas. One is in assessing the quality of parenting a client has experienced earlier in their life. This can be very helpful and it's often important to emphasise that it's fine that this is simply the client's subjective memory of their childhood experience rather than some unachievable recording of what precisely took place. The point is that it is subjective remembered experience that correlates with subsequent effects in us as adults - so it is precisely scores on scales like the PBI that we are interested in. Quite often clients feel "guilty" for negative scores they may give their parents. Part of the therapeutic work is in emotionally processing these feelings, so that we can move on as adults. The second main area where I find it helpful to use the PBI is in assessment of a client's (or our own) behaviour as parents. We can guess - often pretty accurately - how our child would score us. Sometimes we may even ask an older or grown up child to score the questionnaire about us. It's then fascinating to ask them to score how they actually experienced us and how they would ideally like it to be/have been - again providing targets for clarification and change work. Obviously we need to be cautious about potentially setting up parent-child conflicts (or dishonesty) here, but if carefully managed this kind of assessment can be great - quite often in the surprise and joy experienced by a parent when their child actually scores them much better than they'd feared.
Parents & children handout, page 1 & page 2 - here are 12 slides from a talk on parenting I gave a number of years ago. It was part of a much larger two day workshop on relationships. The slides print out well as two 6-slides-to-a-page handouts.
Attachment, compassion & relationships - this is a handout version of a blog posting introducing ideas about attachment and the possibility of working to change attachment style using forms of imagery and meditation.
Relationship questionnaire - a quick adult attachment assessment questionnaire developed by Kim Bartholomew. Useful in introducing four key attachment categories, but less "accurate" than the ECR-R below.
Experiences in Close Relationships - Revised (ECR-R) - this questionnaire (and the related ECR) are currently (2009) probably the best self-report assessment instruments for attachment in adult close relationships.
Abuse screening, child/adult & sexual/physical - here is a helpful brief screening scale for both child & adult experiences of sexual & physical abuse.
Adverse childhood experiences (ACE) scale & background - Adverse experiences in childhood and adolescence are common. In a major US survey of 7 adverse experiences - psychological, physical, or sexual abuse; violence against mother; or living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned - over half those surveyed reported at least one such experience in childhood, and about 25% reported two or more such experiences. Increasing numbers of such experiences in childhood and adolescence is associated with step by step increases in the subsequent adult risk of suffering from depression, alcohol abuse, smoking, obesity, risky sexual behaviour, suicide, heart disease, skeletal fractures, liver disease, chronic lung disease, and cancer. Identifying and helping adults at risk because of such childhood experiences should be a health priority. For more details of the ACE study and the 30 or more research papers published, see www.cdc.gov/nccdphp/ace