Couples Intake Questionnaire

1. Chronic communication breakdown, escalating arguments regarding household division of labor, and decreased emotional/physical intimacy over the past 18 months.

2. Together for 8 years; married for 5 years (DOM: 14/06/2019), cohabiting for 6.5 years.

3. Partner's sense of humor, professional ambition, and initial attentiveness to my emotional needs.

4. Harmonious, high emotional connection, frequent shared activities, and minimal conflict. This honeymoon phase lasted approximately 2 years.

5. Partner prioritized work promotions over shared time after we bought our house, leading to me feeling neglected. This resulted in me withdrawing emotionally and initiating fewer conversations.

6. Approximately 2 years.

Increased work stress, birth of our first child (18 months ago), chronic sleep deprivation, and unprocessed resentment regarding parenting duties.

7. Alike: Both value career success, financial stability, and family loyalty. Different: I am extroverted, anxious-preoccupied, and prefer immediate conflict resolution; partner is introverted, avoidant, and prefers processing internally before speaking.

8. I pursue and demand immediate discussion, often raising my voice. Partner shuts down, avoids eye contact, and leaves the room to go to the home office.

9. I become critical, sarcastic, and bring up past unresolved grievances. Partner stonewalls, gives the silent treatment for 24–48 hours, and over-focuses on work or phone.

10. My strengths: Willingness to address issues directly and apologize quickly. My weaknesses: Emotional reactivity and difficulty respecting timeouts. Partner’s strengths: Remains calm, rarely uses insults. Partner’s weaknesses: Avoidance, deflection, and failure to re-engage after taking space.

11. Yes. I enjoy running, attending yoga classes, and having dinner with close friends.

12. Moderately uncomfortable (6/10); I often feel resentful if partner goes out with friends because I feel left behind to manage childcare alone.

13. Yes, conflict regarding my mother. Partner feels she is overly critical and intrusive with our parenting and that I fail to set adequate boundaries with her.

14. 8/10. I am highly aware of when I feel anxious, sad, or overwhelmed, though these feelings frequently manifest as irritability before I can verbalize the underlying vulnerability.

15. 4/10. I used to be an 8, but currently withhold deep feelings due to fear of rejection, dismissal, or triggering another argument.

16. Finances and sexual dissatisfaction. Discussing money triggers acute anxiety for me, and discussing sex makes my partner visibly defensive and withdrawn.

17. Rarely; partner usually offers pragmatic solutions rather than the emotional validation I need. When partner needs support, I try to listen empathetically, though lately I have been dismissive due to my own burnout.

18. Infrequent (once every 6–8 weeks). Most satisfying: Physical closeness when it does happen. Dislike: Lack of foreplay, feeling like it is a chore, and partner never initiating. Previously spontaneous and frequent (3x/week) during the first 3 years; declined sharply post-partum.

19. Most satisfied: Weekend mornings when we are rested and playing with our child together without distractions. Most frustrated: Weekday evenings (18:00–21:00) during dinner/bedtime routines when we operate like silent, resentful roommates.

20. 8/10. Despite high distress, I believe in our marriage vows, want a stable two-parent home for our child, and strongly hope therapy will help us rebuild.

21. 7/10. Deep attachment and care remain, though romantic feelings are currently dulled by daily resentment and emotional distance.

22. 8/10. I deeply admire partner's work ethic, integrity, and dedication as a provider, even if I disagree with how time is currently prioritized.

23. I naggingly micromanage household tasks, criticize how partner cares for the baby, and escalate minor disagreements by refusing to let partner take space to de-escalate.

24. Title: "Two Ships in the Night." Ending: The couple learns to navigate the storm together, restores communication, and reaches a peaceful harbor.