Couples Schema Questionnaire

The following questionnaire will help you determine which schemas are most
relevant
for you in your relationship. After reading each statement, rate each statement
according
to how well it describes you, using the scale provided.
Place your answer in the box next to the question. At the end, a brief guide will
help
you assess your responses.

0—Disagree
1—Neither agree nor disagree
2—Slightly agree
3—Agree
4—Strongly agree

1. Ab/In

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_ 1. I don’t feel like I can rely and depend on my partner.
_ 2. I’m often attracted to partners who are unable to commit to me.

_3. I feel insecure and unstable in my relationship.

_4. My relationship feels fragile, like it can end at any minute.
_5. I can’t count on my partner to always be there for me.
_6. I’m constantly afraid that my partner will leave me.
_7. I often worry that my partner will find someone else they prefer to be with.
_8. I get scared spending time away from my partner or when my partner needs
space.
_9. When my partner is not around I worry about his/her commitment to me.
_10. I’m often afraid of being abandoned by or losing my partner.

2. M/A
_1. I often worry that my partner is taking advantage of me or using me.
_2. I worry that my partner will hurt or betray me.
_3. It’s difficult for me to trust my partner and give him/her the benefit of the
doubt.
_4. Most people cannot be trusted.

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_5. I need to protect myself and stay on guard in order to feel safe in my
relationship.
_6. I am often suspicious of my partner’s intentions and motives.
_7. I can’t count on my partner to follow through on his/her word.
_8. I have to be on the lookout for my partner lying or breaking promises.
_9. I feel afraid that my partner will mistreat me or become abusive.
_10. I often wonder whether my partner is deceiving me or fooling me in
some way.

3. ED
1. I don’t get the love and care that I truly need from my partner.
2. My partner doesn’t understand me or provide me with the nurturing that
I need.
3. I feel unsatisfied in my romantic relationship.
4. I wish my partner was more emotionally present and available to meet
my needs.

5. It’s been difficult for me to feel taken care of by my partners.

6. My partners have often responded to my emotional needs in a cold and
distant way.
7. I’ve always needed more attention and affection than my partners have

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been able to provide.
8. I often feel deprived by my partner and left wanting more.
9. It’s difficult for me to depend on my partner for emotional support.
10. I often feel alone or lonely even when I’m with my partner.

4. D/S
1. If my partner really knew me, he/she would be disappointed by me.
2. I worry that if my partner saw all my flaws and defects he/she wouldn’t
accept me.
3. I worry that if I reveal too much about myself my partner won’t love me.
4. I feel fundamentally bad or broken.
5. I try to figure out what’s wrong with me so I can fix myself.
6. I worry that if I expose myself fully with my partner he/she will reject me.
7. I often think my partner is too good for me and that he/she could find
somebody better.
8. My partner wouldn’t want to be with me if he/she knew the real me.
9. I have often been a disappointment to most of my partners.
10. I can’t share my deepest insecurities with my partner.

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5. SI/A
1. I don’t feel a sense of belonging with my partner or my community.
2. I frequently feel left out of groups and like an outsider.
3. My partner and I struggle with fitting in well with our group of friends.
4. I feel awkward and different when I try to connect with my partner’s
friends and/or family.
5. I worry that my partner and I are too different or we live in separate
worlds.
6. I worry that my partner doesn’t want to include me in social situations.

7. I feel excluded when I’m in social situations with my partner.

8. I worry that my partner feels embarrassed or ashamed of me in social
situations.
9. I worry that I don’t fit in well with my partner’s friends and/or family.
10. I feel embarrassed or self-conscious when I’m in social situations with
my partner.

6. De
1. It’s difficult for me to get things done without my partner’s help.
2. I prefer for my partner to make most of the decisions.
3. It’s difficult for me to be alone for long periods of time.
4. I need my partner’s help with many issues that I can’t handle on my own.

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5. It’s difficult for me to make my own decisions without my partner’s
feedback.
6. I depend heavily on my partner for help and/or advice.
7. I can’t handle most problems without my partner’s support.
8. I often feel helpless or at a loss concerning what to do.
9. I need assistance and reassurance from my partner to solve everyday
problems.
10. I fear that I will make mistakes and reach the wrong decisions without
my partner’s advice.

7. Fa
1. I worry that I will not meet my partner’s expectations.
2. I’ve been a disappointment to most of my partners.
3. I’ve failed at most of my relationships.
4. I don’t trust myself to make good decisions.
5. When my partner asks me to do something, I usually end up messing it
up.
6. I’m afraid I won’t measure up to my potential.
7. I always fall short in my accomplishments.
8. I’m constantly failing and disappointing my partner.

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9. I don’t live up to my partner’s standards.
10. I mess up everything I attempt.

8. En
1. I get angry when I don’t get what I want from my partner.
2. I often feel that my partner needs too much from me.
3. I usually get what I want in my relationship.
4. I don’t accept my partner telling me what to do.
5. I often feel frustrated by my partner constraining me.
6. I shouldn’t have to put my partner’s needs before my own.
7. My partner shouldn’t stop me from doing what I want.
8. I feel that I shouldn’t have to accept some of the limitations placed on
me by my partner.
9. When it comes to the good things in life, I mostly get what I deserve.

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10. I am good at convincing my partner to do things my way.

9. Su/SS
1. It’s difficult for me to get my needs met in relationships.
2. I feel guilty if I put my own needs before my partner’s.
3. I feel afraid to disagree with or say no to my partner.
4. I find myself usually going along with my partner’s plans.
5. I often agree to do things for my partner that I realize I didn’t want to do.
6. I feel afraid that if I don’t meet my partner’s needs he/she will retaliate
against me or punish me.
7. It’s difficult for me to identify what I want in the moment.
8. I try hard to please my partner, and put his/her needs before my own.
9. It’s difficult for me to stand up for myself or advocate for my own needs
in my relationship.
10. I have trouble making my own wants and needs known.

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10. US

1. I set very high standards for my partner and myself.

2. Very little of what I do satisfies me; I usually think I could do better.
3. It’s easier for me to see my partner’s shortcomings than the way he/she
contributes to my life.

4. I easily feel like I’m stagnating if I don’t accomplish enough.

5. I get critical when my partner or I make a mistake.
6. Failure is very upsetting to me.
7. I often feel disappointed that my partner isn’t meeting my expectations.
8. I notice the ways my partner could be better or could have done something
better.
9. I set high expectations of my partner and myself.
10. I never get enough done.

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