spouse`s Emotional Needs Questionnaire

MARRIAGEBUILDERS.COM
Emotional Needs Questionnaire
Copyright © 1986 by Willard F. Harley‚ Jr.
Name__________________________________ Date__________________________
This questionnaire is designed to help you determine your most important emotional needs and evaluate your spouse’s effectiveness in meeting those needs. Answer all the questions as candidly as possible. Do not try to minimize any needs that you feel have been unmet. If your answers require more space use and attach a separate sheet of paper.
Your spouse should complete a separate Emotional Needs Questionnaire so that you can discover his or her needs and evaluate your effectiveness in meeting those needs.
When you have completed this questionnaire‚ go through it a second time to be certain your answers accurately reflect your feelings. Do not erase your original answers‚ but cross them out lightly so that your spouse can see the corrections and discuss them with you.
The final page of this questionnaire asks you to identify and rank five of the ten needs in order of their importance to you. The most important emotional needs are those that give you the most pleasure when met and frustrate you when unmet. Resist the temptation to identify as most important only those needs that your spouse is not presently meeting. Include all your emotional needs in your consideration of those that are most important.
1. Affection (the expression of love in words‚ cards‚ gifts‚ hugs‚ kisses‚ and courtesies; creating an environment that clearly and repeatedly expresses love).
A. Need for affection: Indicate how much you need affection by circling the appropriate number:
0
1
2
3
4
5
6
I have no need for affection
 
 
I have a moderate need for affection
 
 
I have a great need
for affection
 
How often would you like your spouse to be affectionate to you?
_______________   times each day/week/month (circle one).
If you are not shown affection by your spouse as often as you indicated above‚ how does it make you feel (circle the appropriate letter)?
      a. Very unhappy.               c. Neither happy nor unhappy.
      b. Somewhat unhappy.      d. Happy not to be shown affection.
B. Evaluation of spouse’s affection: Indicate your satisfaction with your spouse’s affection toward you by circling the appropriate number.
-3
-2
-1
0
1
2
3
I am extremely dissatisfied
 
 
I am neither satisfied nor dissatisfied
 
 
I am extremely
satisfied
 
My spouse gives me (circle the appropriate letter)
     a. all the affection I need‚ and I like the way he/she does it.
     b. not enough affection‚ but when he/she does it‚ it is the way I like it.
     c. all the affection I need‚ but it is not the way I like it.
     d. not enough affection‚ and when he/she tries‚ it is not the way I like it.
Explain how your need for affection could be better satisfied in your marriage.
…………………………………………………………………………………………………
………………………………………………………………………………………………… 
…………………………………………………………………………………………………
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2. Sexual Fulfillment (a sexual experience that brings out a predictably enjoyable sexual response in both of you that is frequent enough for both of you).
A. Need for sexual fulfillment: Indicate how much you need sexual fulfillment by circling the appropriate number.
0
1
2
3
4
5
6
I have no need for for sexual fulfillment
 
 
I have a moderate need for for sexual fulfillment
 
 
I have a great need
for for sexual fulfillment
How often would you like your spouse to engage in sexual relations with you?
____________   times each day/week/month (circle one)
If your spouse does not engage in sexual relations with you as often as you indicated above‚ how does it make you feel (circle the appropriate letter)?
              a. Very unhappy.                c. Neither happy nor unhappy.
              b. Somewhat unhappy.       d. Happy not to engage in sex.
B. Evaluation of sexual relations with your spouse: Indicate your satisfaction with your spouse’s sexual relations with you by circling the appropriate number.
-3
-2
-1
0
1
2
3
I am extremely dissatisfied
 
 
I am neither satisfied nor dissatisfied
 
 
I am extremely
satisfied
My spouse gives me (circle the appropriate letter)
      a. all the sex I need‚ and I like the way he/she does it.
      b. not enough sex‚ but when he/she does it‚ it is the way I like it.
      c. all the sex I need‚ but it is not the way I like it.
      d. not enough sex‚ and when we do have sex‚ it is not the way I like it.
Explain how your need for sexual fulfillment could be better satisfied in your marriage.
…………………………………………………………………………………………………
………………………………………………………………………………………………… 
…………………………………………………………………………………………………
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3. Conversation (talking about events of the day‚ personal feelings‚ and plans for the future; showing interest in your favorite topics of conversation; balancing conversation; using it to inform‚ investigate‚ and understand you; and giving you undivided attention).
A. Need for conversation: Indicate how much you need conversation by circling the
0
1
2
3
4
5
6
I have no need for conversation
 
 
I have a moderate need for conversation
 
 
I have a great need
for conversation
How often would you like your spouse to talk with you?
_______________ times each day/week/month (circle one).
If your spouse does not talk with you as often as you indicated above‚ how does it make you feel (circle the appropriate letter)?
                           a. Very unhappy.                  c. Neither happy nor unhappy.
                           b. Somewhat unhappy.         d. Happy not to talk with my spouse.
B. Evaluation of conversation with your spouse: Indicate your satisfaction with your spouse’s conversation with you by circling the appropriate number.
-3
-2
-1
0
1
2
3
I am extremely dissatisfied
 
 
I am neither satisfied nor dissatisfied
 
 
I am extremely
satisfied
My spouse gives me (circle the appropriate letter)
       a. all the conversation I need‚ and I like the way he/she does it.
       b. not enough conversation‚ but when he/she does it‚ it is the way I like it.
       c. all the conversation I need‚ but it is not the way I like it.
       d. not enough conversation‚ and when we do‚ it is not the way I like it.
Explain how your need for conversation could be better satisfied in your marriage.
…………………………………………………………………………………………………
………………………………………………………………………………………………… 
…………………………………………………………………………………………………
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4. Recreational Companionship (developing interest in your favorite recreational activities‚ learning to be proficient in them‚ and joining you in those activities).
A. Need for recreational companionship: Indicate how much you need recreational
0
1
2
3
4
5
6
I have no need for recreational companionship
 
 
I have a moderate need for recreational companionship
 
 
I have a great need
for recreational companionship
How often would you like your spouse join you in recreational activities?
_______________times each day/week/month (circle one).
If your spouse does not join you in recreational activities as often as you indicated above‚ how does it make you feel (circle the appropriate letter)?
                       a. Very unhappy.                  c. Neither happy nor unhappy.
                       b. Somewhat unhappy.        d. Happy not to join spouse in recreation.
B. Evaluation of recreational companionship with your spouse: Indicate your satisfaction with your spouse’s recreational companionship with you by circling the appropriate number.
-3
-2
-1
0
1
2
3
I am extremely dissatisfied
 
 
I am neither satisfied nor dissatisfied
 
 
I am extremely
satisfied
My spouse gives me (circle the appropriate letter)
      a. all the recreational companionship I need‚ and I like the way he/she does it.
      b. not enough recreational companionship‚ but when he/she does it‚ it is the way I like it.
      c. all the recreational companionship I need‚ but it is not the way I like it.
      d. not enough recreational companionship‚ and when he/she tries‚ it is not the way I like it.
Explain how your need for recreational companionship could be better satisfied in your marriage.
…………………………………………………………………………………………………
………………………………………………………………………………………………… 
…………………………………………………………………………………………………
…………………………………………………………………………………………………
 
 
5. Honesty and Openness (revealing positive and negative feelings‚ events of the past‚ daily events and schedule‚ plans for the future; not leaving a false impression; answering questions truthfully and completely).
A. Need for honesty and openness: Indicate how much you need honesty by circling the
0
1
2
3
4
5
6
I have no need for honesty openness
 
 
I have a moderate need for honesty openness
 
 
I have a great need
for honesty openness
Which of the following areas of honesty and openness would you like from your spouse (circle the letter(s) that apply to you)?
     a. Sharing positive and negative emotional reactions to significant aspects of life.
     b. Sharing information regarding his/her personal history.
     c. Sharing information about his/her daily activities.
     d. Sharing information about his/her future schedule and plans.
If your spouse fails to be open and honest in those areas that you indicated above‚ how does it make you feel (circle the appropriate letter)?
                 a. Very unhappy.                        c. Neither happy nor unhappy.
                 b. Somewhat unhappy.              d. Happy not to have honesty and openness.
B. Evaluation of spouse’s honesty and openness: Indicate your satisfaction with your spouse’s honesty and openness with you by circling the appropriate number.
-3
-2
-1
0
1
2
3
I am extremely dissatisfied
 
 
I am neither satisfied nor dissatisfied
 
 
I am extremely
satisfied
My spouse is (circle the appropriate letter)
     a. honest and open with me‚ and I like the way he/she does it.
     b. not honest and open enough with me‚ but when he/she does it‚ it is the way I like it.
     c. honest and open with me‚ but it is not the way I like it.
     d. not honest and open with me‚ and when he/she tries‚ it is not the way I like it.
Explain how your need for honesty & openness could be better satisfied in your marriage.
…………………………………………………………………………………………………
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6. An Attractive Spouse (keeping physically fit with diet and exercise‚ wearing hair and clothing in a way that you find attractive and tasteful).
A. Need for an attractive spouse: Indicate how much you need an attractive spouse by circling the appropriate number:
0
1
2
3
4
5
6
I have no need for an attractive spouse
 
 
I have a moderate need for an attractive spouse
 
 
I have a great need
for an attractive spouse
Which of the following ch‎aracteristics of attractiveness mean the most to you (circle the letter(s) that apply to you)?
     a. Physical fitness and normal weight.        d. Good physical hygiene.
     b. Attractive choice of clothes.                   e. Attractive facial makeup.
     c. Attractive hairstyle.                                 f. Other ______________________
If your spouse does not have those ch‎aracteristics that you circled above‚ how does it make you feel (circle the appropriate letter)?
               a. Very unhappy.               c. Neither happy nor unhappy.
               b. Somewhat unhappy.     d. Happy not to have an attractive spouse.
B. Evaluation of spouse’s attractiveness: Indicate your satisfaction with your spouse’s attractiveness by circling the appropriate number.
-3
-2
-1
0
1
2
3
I am extremely dissatisfied
 
 
I am neither satisfied nor dissatisfied
 
 
I am extremely
satisfied
My spouse is (circle the appropriate letter)
      a. attractive to me‚ and I like the way he/she does it.
      b. not attractive to me‚ but when he/she was‚ I like the way he/she achieved it.
      c. attractive to me‚ but I do not like the way he/she achieves it.
      d. not attractive to me‚ and when he/she was‚ I did not like the way it was achieved.
Explain how your need for an attractive spouse could be better satisfied in your marriage.
…………………………………………………………………………………………………
………………………………………………………………………………………………… 
…………………………………………………………………………………………………
…………………………………………………………………………………………………
 
 
7. Financial Support (the provision of financial resources to house‚ feed‚ and clothe your family at a standard of living acceptable to you‚ but avoiding travel and working hours that are unacceptable to you).
A. Need for financial support: Indicate how much you need financial support by circling the appropriate number:
0
1
2
3
4
5
6
I have no need for financial support
 
 
I have a moderate need for financial support
 
 
I have a great need
for financial support
How much money would you like your spouse to earn to support you (and your children)? _______________
If your spouse does not earn the amount you indicated above‚ how does it make you feel (circle the appropriate letter)?
          a. Very unhappy.               c. Neither happy nor unhappy.
          b. Somewhat unhappy.      d. Happy not to have my spouse provide support.
B. Evaluation of spouse’s financial support: Indicate your satisfaction with your spouse’s financial support of you by circling the appropriate number.
-3
-2
-1
0
1
2
3
I am extremely dissatisfied
 
 
I am neither satisfied nor dissatisfied
 
 
I am extremely
satisfied
My spouse (circle the appropriate letter)
     a. earns enough money to support me‚ and I like the way he/she earns it.
     b. does not earn enough to support me‚ but I like the way he/she earns it.
    c. earns enough money to support me‚ but I do not like the way he/she earns it.
    d. does not enough to support me‚ and I do not like the way he/she earns it.
Explain how your need for financial support could be better satisfied in your marriage.
…………………………………………………………………………………………………
………………………………………………………………………………………………… 
…………………………………………………………………………………………………
…………………………………………………………………………………………………
 
 
8. Domestic Support (creation of a home environment for you that offers a refuge from the stresses of life; management of the home and care of the children- if any are at home- including but not limited to cooking meals‚ washing dishes‚ washing and ironing clothes‚ housecleaning).
A. Need for domestic support: Indicate how much you need domestic support by circling the appropriate number:
0
1
2
3
4
5
6
I have no need for domestic support
 
 
I have a moderate need for domestic support
 
 
I have a great need
for domestic support
How much time would you like your spouse to be engaged in domestic support?
_______________hours each day/week/month (circle one).
If your spouse does not spend as much time engaged in domestic support as you indicated above‚ how does it make you feel (circle the appropriate letter)?
       a. Very unhappy.                c. Neither happy nor unhappy.
       b. Somewhat unhappy.      d. Happy not to have domestic support.
B. Evaluation of spouse’s domestic support: Indicate your satisfaction with your spouse’s domestic support by circling the appropriate number.
-3
-2
-1
0
1
2
3
I am extremely dissatisfied
 
 
I am neither satisfied nor dissatisfied
 
 
I am extremely
satisfied
My spouse gives me (circle the appropriate letter)
     a. all the domestic support I need‚ and I like the way he/she does it.
     b. not enough domestic support‚ but when he/she does it‚ it is the way I like it.
     c. all the domestic support I need‚ but it is not the way I like it.
     d. not enough domestic support‚ and when he/she tries‚ it is not the way I like it.
Explain how your need for domestic support could be better satisfied in your marriage.
…………………………………………………………………………………………………
………………………………………………………………………………………………… 
…………………………………………………………………………………………………
…………………………………………………………………………………………………
 
9. Family Commitment (scheduling sufficient time and energy for the moral and educational development of your children; reading to them‚ taking them on frequent outings‚ developing the skill in appropriate child-training methods and discussing those methods with you; avoiding any child-training methods or disciplinary action that does not have your enthusiastic support).
A. Need for family commitment: Indicate how much you need family commitment by circling the appropriate number:
0
1
2
3
4
5
6
I have no need for family commitment
 
 
I have a moderate need for family commitment
 
 
I have a great need
for family commitment
 
I have no need I have a moderate need I have a great need
How much time would you like your spouse to be engaged in family commitment?
_______________hours each day/week/month (circle one).
If your spouse does not spend as much time engaged in family commitment as you indicated above‚ how does it make you feel (circle the appropriate letter)?
      a. Very unhappy.                c. Neither happy nor unhappy.
      b. Somewhat unhappy.       d. Happy not to have family commitment.
B. Evaluation of spouse’s family commitment: Indicate your satisfaction with your spouse’s family commitment by circling the appropriate number.
-3
-2
-1
0
1
2
3
I am extremely dissatisfied
 
 
I am neither satisfied nor dissatisfied
 
 
I am extremely
satisfied
My spouse (circle the appropriate letter)
     a. commits enough time to the family‚ and spends it in ways that I like.
     b. does not commit enough time to the family‚ but when he/she does it‚ it’s spent in ways that I like.
    c. commits enough time to the family‚ but does not spend it in ways that I like.
    d. does not commit enough time to the family‚ and when he/she does‚ it is not spent in ways that I like it.
Explain how your need for family commitment could be better satisfied in your marriage.
…………………………………………………………………………………………………
………………………………………………………………………………………………… 
…………………………………………………………………………………………………
…………………………………………………………………………………………………
 
 
10. Admiration (respecting‚ valuing and appreciating you clearly and often).
A. Need for admiration: Indicate how much you need admiration by circling the appropriate number:
0
1
2
3
4
5
6
I have no need for admiration
 
 
I have a moderate need for admiration
 
 
I have a great need
for admiration
How often would you like your spouse to admire you?
_______________times each day/week/month (circle one).
If your spouse does not admire you as often as you indicated above‚ how does it make you feel (circle the appropriate letter)?
        a. Very unhappy.                 c. Neither happy nor unhappy.
        b. Somewhat unhappy.       d. Happy not to be admired.
B. Evaluation of spouse’s admiration: Indicate your satisfaction with your spouse’s admiration toward you by circling the appropriate number.
-3
-2
-1
0
1
2
3
I am extremely dissatisfied
 
 
I am neither satisfied nor dissatisfied
 
 
I am extremely
satisfied
My spouse gives me (circle the appropriate letter)
     a. all the admiration I need‚ and I like the way he/she does it.
     b. not enough admiration‚ but when he/she does it‚ it is the way I like it.
     c. all the admiration I need‚ but it is not the way I like it.
     d. not enough admiration‚ and when he/she tries‚ it is not the way I like it.
Explain how your need for admiration could be better satisfied in your marriage.
…………………………………………………………………………………………………
………………………………………………………………………………………………… 
…………………………………………………………………………………………………
…………………………………………………………………………………………………
 
 
Ranking of Your Emotional Needs
The ten basic emotional needs are listed below. There is also space for you to add other emotional needs that you feel are essential to your marital happiness‚ but are not included in the list.
In the space provided in front of each need‚ write a number from 1 to 5 that ranks the need’s most importance to your happiness. Write a “1” before the most important need‚ a “2” before the next most important‚ and so on until you have ranked all five.
To help you rank these needs‚ imagine that you will only have one need met in your arriage.
Which would make you the happiest‚ knowing that all the others would go unmet? That need should be “1.” If only two needs would be met‚ what would your second se‎lection be? Which five needs‚ when met‚ would make you the happiest.
 ____________________ Affection
____________________   Sexual Fulfillment
____________________   Conversation
____________________   Recreational Companionship
____________________   Honesty and Openness
____________________   An Attractive Spouse
____________________   Financial Support
____________________   Domestic Support
____________________   Family Commitment
   Admiration____________________
________________________   ___________________
________________________   ___________________
________________________   ___________________
________________________   ___________________
سایت روان سنجی : فرم باید توسط هر دو زوج تکمیل شود . از روایی و پایایی آن اطلاعی در اختیار سایت نیست.
From: MARRIAGEBUILDERS.COM
   
خرداد 1396
اسفند 1395
آبان 1395
فروردین 1394
خرداد 1393
فروردین 1393
اسفند 1392
بهمن 1392
دی 1390
آذر 1390
تیر 1390
خرداد 1390
اردیبهشت 1390
بهمن 1389
دی 1389
اردیبهشت 1389
دی 1388
آبان 1388
شهریور 1388
مرداد 1388
تیر 1388
خرداد 1388
   
سپاس بیکران به حضور دکتر حمزه گنجی که تست های روان سنجی را به سطح جامعه تعمیم داد .و هنوز قدرش شناخته نشده است .
   
کلیه حقوق به آرین آرانی متعلق است.