Rate your level of satisfaction with each of the listed qualities in your relationship by selecting a number from 0 to 5.                                                              

0 – None            1 – Very little         2 – Marginal          3 – Moderate            4 – High             5 – Very high

Trust                                                                                          Caring                                                  

Sense of humor                                                                       Ability to listen                                    

Honesty                                                                                     Empathy                                   

Respect                                                                                      Talkative                                              

Fairness                                                                                     Tolerance                                              

Common interests                                                                   Problem – solving                      

Loyalty                                                                                        Playfulness                                            

Attitude                                                                                       Protective                                                  

Generosity                                                                                   Openness                                    

Acceptance                                                                                 Time spent together                               

Communication                                                                          Expression of feelings                          

Managing Stress                                                                        Appreciation                                 

Commitment                                                                               Ability to forgive                                      

Love                                                                                              Teamwork                                                

Security                                                                                         Ability to compromise                           

Financial security                                                                         Feeling loved                                         

Contentment                                                                                 Sharing                                       

Pleasure                                                                                          Passion                                                 

Emotional support                                                                        Happiness                                             

Affection / intimacy                                                                     Dependability                                        

Emotional control                                                                        Safety                                                      

Friendship                                                                                     Independence                                        

Leadership                                                                                    Encouragement                                      

Understanding needs                                                                  Patience                                        

Compassion                                                                                  Independence                              

Level of Relationship Wealth:                                                       

High:                150 – 250                                                                      

Moderate:          100 – 150                                                                      

Marginal:           50 – 100                                                                      

Distressed:         Below 50