Form V2 Relationship History Questionairre This form is to be completed individually by each person. Step 1 of 13 – Part 1 – Your Relationship 7% Your Name* First Last Your Email* Your Partner's Name* First Last Which Therapist Will You Be Seeing?*Nahum KozakPia JonesRachel HannamJeremy GatesUnsureConfidentiality StatementThese answers are completely confidential and will not be shared with your partner. They are an opportunity for you to be completely honest about your thoughts and feelings without needing to consider how your partner might receive them.*The only time your answers will ever be shared with another person is if you communicate your intention to harm yourself or another person. We have a duty of care to report these matters to the relevant authorities. I Understand Reason for couples therapy.PLEASE NOTE: Answers only need to be a few sentences. We will explore your answers more deeply in individual sessions prior to the marathon. What is your main reason for coming to couples therapy?* The Early DaysWhat memories stand out about when you first met your partner?*How did you meet? What was your first impression? How did you spend your time together in those early days?Where did you go? What did you do? How did you feel when you were with your partner in those early days? Decision to Marry or CommitWhy did you decide to commit to this person?*Was it an easy decision or not? Wedding / Commitment and Honeymoon. (If applicable – if not, skip ahead)What stands out in your memory about your wedding or commitment ceremony?Did you have a honeymoon? What was it like? First Year Adjustments.When you think back to the first year you were married (or living together), what do you remember?*Adjustments to ParenthoodIf applicable – if not, skip aheadWhat was the transition to becoming parents like?What stands out about this time for you? How did it affect your relationship? Good Times.Looking back over the years, what moments stand out as the really good times in your relationship?*What is a ‘good time’ for you as a couple now?*Relationship Ups and Downs.Has your relationship had ups and downs? If so, how?*Hard Times.Looking back over the years, what moments stand out as the really hard times in your relationship?*How did you get through these difficult times? What is your philosophy about how to get through difficult times? Relationship Changes Over Time.How is your relationship different from when you first made a serious commitment to each other?*What do you think makes a 'good relationship'?*Are any of those elements in your current partnership? What are some signs of a 'bad relationship'?*Are any of those elements in your current partnership? Your Parents'/ Carers’ RelationshipWhat was your parents' (or carers’ or guardians’) relationship like?*Are they still together? Are they happy? Would you say it's very similar or different from your own relationship?* Feeling ‘Known’ and Ways of connecting.Do you feel like your partner knows you very well nowadays?*How well do you feel like you know your partner?*How do you stay in touch with one another on a daily basis?*Your goals for your relationship and hopes for couples therapyWhat do you most hope for out of couples therapy?*For example: being able to really feel heard and understood, rebuilding trust, being able to fully commit to the relationship, hoping to end the relationshipWhat is your cost benefit analysis of this relationship – i.e. how do you see as the benefits and costs of staying in the relationship and working on trying to improve it, as opposed to getting out?* Your Individual HistoryWhat are your best memories of growing up?*What are your worst memories at the time?*Which parent/caregiver would you go to if you needed comfort?* School years and beyondWhat was school like for you?*Did you like school? Did you have good friends? Was there any bullying?*What did you do after you left school?*What kind of career have you had? Success? Regrets? Prior relationshipsHave you had relationships prior to meeting your partner that felt the same as your current relationship feels?* Other relevant informationIs there anything else you think is important to know for us to understand yourself, your relationship or partner?EmailThis field is for validation purposes and should be left unchanged.
