Offices in Garden City and Rockville Centre
(516) 732-0273
Offices in Garden City and Rockville Centre
info@lipsychologist.com

Individual Relationship Therapy Readiness

Questionnaire

Many people who encounter relationship difficulties and consider individual counseling to address these issues are unsure of whether this process will be beneficial to them. You may wonder, “How can I know who is the right relationship counselor for me?”

This questionnaire is designed to help you determine whether individual relationship counseling with a therapist at Long Island Psychology, utilizing the approach of DEL (see the Our Approach page), can be helpful to you.

Relationship counseling for individuals may be helpful to people with various types of relationship needs. This may include those who are seeking to establish more satisfying interactions, those seeking to reduce anxiety in social situations, those seeking to overcome loss or damage to a relationship, singles looking for to find a partner with whom they can have a healthy relationship, and those who are in a committed relationship but need to resolve issues separately from their partner. No matter what relationship issues you are facing, if you want to establish healthier relationships with others, you must work towards being a healthier individual.

Therefore the focus of your treatment will be on becoming aware of the issues that are interfering with your ability to establish and maintain healthy relationships and the corrective behaviors you can adopt to improve your functioning.

The following questions are samples of the types of issues that may be explored during the evaluation process.

Answering these questions may provide you with a window into the treatment process at Long Island Psychology. A customized treatment plan will be developed based on the particular relationship issues you are experiencing.

For each statement, check the appropriate response. Note that not every statement applies to every relationship. Please check N/A if the statement is not applicable to you.

    1. I often rely on others to make me feel happy.

    2. I tend to do things on my own but would prefer to be more involved with others.

    3. I frequently feel alone and rejected by the world.

    4. I often feel that people don’t meet my expectations of what I would like from them.

    5. I find it difficult to control what I say or how I behave in the presence of others.

    6. I often become overwhelmed in large social situations.

    7. I often become anxious in one-on-one conversations.

    8. I avoid social situations but wish I could be more at ease.

    9. I avoid intimate conversations but wish I could be more open.

    10. I am unsure of whether or not I should end or continue my current relationship.

    11. I want to experience more satisfaction in my current relationship with my significant other.

    12. I have been in several significant relationships that have failed, and I want to understand why this is happening.

    13. I am dating and can’t seem to find the “right one.”

    14. I sometimes feel self-conscious and concerned that no one will want to date/marry me.

    15. When dating, I find myself looking for reasons the relationship won’t work and close myself off to the process of connecting on a deeper level.

    16. I often try to follow dating rules or expectations at the expense of demonstrating who I truly am.

    17. I fear that dedicating myself to someone else will cause me to lose my individuality.

    18. I often have difficulty getting along with others and frequently get into conflicts.

    19. I am concerned that I won’t find love again or that I won’t be able to have another successful relationship as a result of my breakup.

    20. I fear that I won’t be able to trust again because I was betrayed in my relationship.

    If you would like to receive a copy of your answers, please enter your email address below and click "Submit":

    Contact Long Island Psychology Today

    If you have any questions about individual, group, or couples therapy (marriage counseling) or about working with a psychologist/therapist please do not hesitate to call.

    With offices in Garden City and Rockville Centre, NY, we’re available for anyone that needs help on Long Island and in Nassau County.

    Contact:

    (516) 732-0273
    info@lipsychologist.com

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