Forms Gottman 17 Area Scale

Gottman 17-Areas Scale

Name
First Last
Date
MM slash DD slash YYYY
Please take the time to read each area below that reflects your life together with your partner. Tell us if this area is fine or needs improvement. Check the boxes that you think applies to your relationship right now. At the end of each area add any comments. If things are fine describe how you are managing this area of your life. If things are not fine, describe obstacles you see to improving this area of your relationship
1. CONNECTION
- Staying emotionally connected
- Becoming emotionally distant
Just simply talking to each other.
- Not a problem
- A problem
Staying emotionally in touch with each other.
- Not a problem
- A problem
Feeling taken for granted?
- Not a problem
- A problem
Don't feel my spouse knows me very well right now.
- Not a problem
- A problem
Spouse is (or I am) emotionally disengaged.
- Not a problem
- A problem
Spending time together.
- Not a problem
- A problem
Comments: Connection
If things are fine describe how you are managing this area of your life. If things are not fine, describe obstacles you see to improving this area of your relationship
2. JOB AND OTHER STRESSES
- Handling job and other stresses effectively
- Experiencing the "spill over" of non-marital stresses
Helping each other reduce daily stresses
- Not a problem
- A problem
Talking about these stresses together.
- Not a problem
- A problem
Talking together about stress in a helpful manner.
- Not a problem
- A problem
Spouse listening with understanding about my stresses and worries.
- Not a problem
- A problem
Spouse takes job or other stress out on me.
- Not a problem
- A problem
Spouse takes job or other stresses out on the children or others in our life.
- Not a problem
- A problem
Comments: Job and other stresses
If things are fine describe how you are managing this area of your life. If things are not fine, describe obstacles you see to improving this area of your relationship
3. ISSUES or DISAGREEMENTS
- Handling issues or disagreements well
- Gridlocking on one or more issues
Differences have arisen between us that feel very basic.
- Not a problem
- A problem
These differences seem unresolvable.
- Not a problem
- A problem
We are living day-to-day with hurts.
- Not a problem
- A problem
Our positions are getting entrenched.
- Not a problem
- A problem
It looks like I will never get what I hope for.
- Not a problem
- A problem
I am very worried that these issues may damage our relationship.
- Not a problem
- A problem
Comments: Issues or Disagreements
If things are fine describe how you are managing this area of your life. If things are not fine, describe obstacles you see to improving this area of your relationship
4. ROMANCE AND PASSION
- The marriage is romantic and passionate.
- It is becoming passionless; the fire is going out.
My spouse has stopped being verbally affectionate.
- Not a problem
- A problem
My spouse expresses love or admiration less frequently.
- Not a problem
- A problem
We rarely touch each other.
- Not a problem
- A problem
My spouse (or I) have stopped feeling very romantic.
- Not a problem
- A problem
We rarely cuddle.
- Not a problem
- A problem
We have few tender or passionate moments.
- Not a problem
- A problem
Comments: Romance and Passion
If things are fine describe how you are managing this area of your life. If things are not fine, describe obstacles you see to improving this area of your relationship
5. SEX LIFE
- Our sex life is fine.
- It is becoming passionless; the fire is going out.
The frequency of sex.
- Not a problem
- A problem
The satisfaction I (or my spouse) get from sex.
- Not a problem
- A problem
Being able to talk about sexual problems.
- Not a problem
- A problem
The two of us wanting different things sexually.
- Not a problem
- A problem
Problems of desire.
- Not a problem
- A problem
The amount of love in our lovemaking.
- Not a problem
- A problem
Comments: Sex Life
If things are fine describe how you are managing this area of your life. If things are not fine, describe obstacles you see to improving this area of your relationship
6. IMPORTANT LIFE EVENT
- An important life event (life birth of a child, changes in job, job loss, an illness, death of a loved one) has occurred in our lives.
- The marriage is dealing with this well.
- The marriage is NOT dealing with this well.
We have very different points of view on how to handle things.
- Not a problem
- A problem
This event has led my partner to be very distant.
- Not a problem
- A problem
This event has made us both irritable.
- Not a problem
- A problem
I'm worried about how this will all turn out.
- Not a problem
- A problem
We are now taking up very different positions.
- Not a problem
- A problem
Comments: Important Life Event
If things are fine describe how you are managing this area of your life. If things are not fine, describe obstacles you see to improving this area of your relationship
7. CHILDREN
- Major issues about children have arisen.
- The marriage is dealing with this well.
- The marriage is NOT dealing with this well.
We have very different points of view on goals for the children.
- Not a problem
- A problem
We have very different positions on what to discipline the children for.
- Not a problem
- A problem
We have different positions on how to discipline the children.
- Not a problem
- A problem
We are not talking about these issues very well.
- Not a problem
- A problem
There is a lot of tension or anger about these differences.
- Not a problem
- A problem
Comments: Children
If things are fine describe how you are managing this area of your life. If things are not fine, describe obstacles you see to improving this area of your relationship
8. IN-LAW OR RELATIVE(S)
- Major issues or events have arisen about in-laws, a relative or relatives
- The marriage is dealing with this well.
- The marriage is NOT dealing with this well.
I feel unaccepted by my partner's family.
- Not a problem
- A problem
I sometimes wonder which family my spouse is in.
- Not a problem
- A problem
I feel unaccepted by my own family.
- Not a problem
- A problem
There is tension between us about what might happen.
- Not a problem
- A problem
This issue has generated a lot of irritability.
- Not a problem
- A problem
I am worried about how this is going to turn out.
- Not a problem
- A problem
Comments: Issues or Events about in-laws, relative(s)
If things are fine describe how you are managing this area of your life. If things are not fine, describe obstacles you see to improving this area of your relationship
9. EXTRA-MARITAL ATTRACTION
- Being attracted to other people or jealousy is not an issue.
- Spouse is flirtatious is a problem.
- Recent extra-marital affair.
This area is a source of a lot of hurt.
- Not a problem
- A problem
This area is an area that creates insecurity.
- Not a problem
- A problem
I can't deal with the lies.
- Not a problem
- A problem
It is hard to re-establish trust.
- Not a problem
- A problem
There is a feeling of betrayal.
- Not a problem
- A problem
It's hard to know how to heal this.
- Not a problem
- A problem
Comments: Extra-marital attraction/jealousy
If things are fine describe how you are managing this area of your life. If things are not fine, describe obstacles you see to improving this area of your relationship
10. DISAGREEMENTS
- When disagreements arise, we resolve issues well.
- Unpleasant fights have occurred.
There are more fights now.
- Not a problem
- A problem
The fights seem to come out of nowhere.
- Not a problem
- A problem
Anger and irritability has crept in to our marriage.
- Not a problem
- A problem
We get into muddles where we are hurting each other.
- Not a problem
- A problem
I don't feel very respected lately.
- Not a problem
- A problem
I feel criticized.
- Not a problem
- A problem
Comments: Disagreements
If things are fine describe how you are managing this area of your life. If things are not fine, describe obstacles you see to improving this area of your relationship
11. BASIC VALUES AND GOALS
- We are in synchrony on basic values and goals.
- Differences between us in these areas or in desired life style are emerging.
Differences have arisen in life goals.
- Not a problem
- A problem
Differences have arisen about important beliefs.
- Not a problem
- A problem
Differences have arisen on leisure time interests.
- Not a problem
- A problem
We seem to be wanting different things out of life.
- Not a problem
- A problem
We are growing in different directions.
- Not a problem
- A problem
I don't much like who I am with my partner.
- Not a problem
- A problem
Comments: Basic values and goals
If things are fine describe how you are managing this area of your life. If things are not fine, describe obstacles you see to improving this area of your relationship
12. HARD EVENTS
- Very hard events (for example, violence, drugs, an affair) have occurred within the marriage.
- We are handling these well.
- They seem to be hard for the marriage to deal with right now.
There has been physical violence between us.
- Not a problem
- A problem
There is a problem with alcohol or drugs.
- Not a problem
- A problem
This is turning into a marriage I hadn't bargained for.
- Not a problem
- A problem
Our marriage "contract" is changing.
- Not a problem
- A problem
I find some of what my partner wants upsetting or repulsive.
- Not a problem
- A problem
I am now feeling somewhat disappointed by this marriage.
- Not a problem
- A problem
Comments: Hard Events
If things are fine describe how you are managing this area of your life. If things are not fine, describe obstacles you see to improving this area of your relationship
13. WORKING AS A TEAM
- We work well as a team.
- We are not working very well as a team right now.
We used to share more in the family's workload.
- Not a problem
- A problem
We seem to be pulling in opposite directions.
- Not a problem
- A problem
Spouse does not share in housework or child care.
- Not a problem
- A problem
Spouse is not carrying weight financially.
- Not a problem
- A problem
I feel alone in managing this family.
- Not a problem
- A problem
Spouse not being very considerate.
- Not a problem
- A problem
Comments: Working as a Team
If things are fine describe how you are managing this area of your life. If things are not fine, describe obstacles you see to improving this area of your relationship
14. POWER OR INFLUENCE
- We are coping well with issues of power or influence.
- We are having trouble in this area.
I don't feel influential in decisions we make.
- Not a problem
- A problem
Spouse has become more domineering.
- Not a problem
- A problem
I have become more demanding.
- Not a problem
- A problem
Spouse has become passive.
- Not a problem
- A problem
Spouse is "spacey", not a strong force in the marriage.
- Not a problem
- A problem
I am starting to care a lot more about who is running things.
- Not a problem
- A problem
Comments: Issues of Power or Influence
If things are fine describe how you are managing this area of your life. If things are not fine, describe obstacles you see to improving this area of your relationship
15. FINANCES
- We are handling issues of finances well.
- We are having trouble in this area.
I, or spouse, just doesn't bring in enough money.
- Not a problem
- A problem
We have differences about how to spend our money.
- Not a problem
- A problem
We are stressed about finances.
- Not a problem
- A problem
Spouse is financially more interested is self than us.
- Not a problem
- A problem
We are not united in managing our finances.
- Not a problem
- A problem
There is not enough financial planning.
- Not a problem
- A problem
Comments: Finances
If things are fine describe how you are managing this area of your life. If things are not fine, describe obstacles you see to improving this area of your relationship
16. HAVING FUN TOGETHER
- We are doing well having fun together.
- We are not having very much fun together these days.
We don't seem to have very much time for fun.
- Not a problem
- A problem
We try but don't seem to enjoy our times together very much.
- Not a problem
- A problem
We are too stressed for fun.
- Not a problem
- A problem
Work takes up all of our time these days.
- Not a problem
- A problem
Our interests are so different now that there are no fun things we like to do together.
- Not a problem
- A problem
We plan fun things to do but they never happen.
- Not a problem
- A problem
Comments: Having fun together
If things are fine describe how you are managing this area of your life. If things are not fine, describe obstacles you see to improving this area of your relationship
17. SPIRITUALITY
- We are feeling close in the area of spirituality together
- We are not doing well in that area these days.
Sharing the same beliefs.
- Not a problem
- A problem
Agreeing about religious ideas and values.
- Not a problem
- A problem
Issues about specific church, mosque, synagogue, etc..
- Not a problem
- A problem
Communicating well about spiritual things.
- Not a problem
- A problem
Issues that are about spiritual growth and change.
- Not a problem
- A problem
Spiritual issues involving family or children.
- Not a problem
- A problem
Comments: Spirituality
If things are fine describe how you are managing this area of your life. If things are not fine, describe obstacles you see to improving this area of your relationship
If there is an area we did not cover, please make your comments about that (or anything else) here:
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