Emotional Needs Questionnaire
This questionnaire is designed to help you determine your most important emotional needs and evaluate your spouse's effectiveness in meeting those needs. Answer all the questions as candidly as possible. Do not try to minimize any needs that you feel have been unmet.
1. AFFECTION
The nonsexual expression of extraordinary care through words, cards, gifts, hugs, kisses, and courtesies.
A. Need for affection: indicate how much you need affection by selecting the appropriate number.
B. Evaluation of spouse's affection: indicate your satisfaction with your spouse's affection by selecting the appropriate number.
My spouse gives me all the affection I need.
If your answer is no, how often would you like your spouse to be affectionate with you?
I like the way my spouse provides affection.
If your answer is no, which of the following would you like to see improved?
If you selected any of these, explain how your need for affection in each example could be better satisfied in your marriage.