Questionnaire (Relationship Styles)

Hello! Please click the button below to complete a short questionnaire. Doing this regularly is one way we can track how therapy is going. Your responses will be emailed directly to Dr Forzisi.

Please rate each of the following relationship styles according to the extent to which you think each description corresponds to your general relationship style.
Please select one answer for each question, then submit
A. is easy for me to become emotionally close to others. I am comfortable depending on them and having them depend on me. I don’t worry about being alone or having others not accept me. *
1 = Not at all like me; 2; 3; 4 = Somewhat like me; 5; 6; 7 = Very much like me
B. I am uncomfortable getting close to others. I want emotionally close relationships but I find it difficult to trust others completely or depend on them. I worry that I will be hurt if I allow myself to become too close to others. *
1 = Not at all like me; 2; 3; 4 = Somewhat like me; 5; 6; 7 = Very much like me
C. I want to become emotionally intimate with others, but I often find that others are reluctant to get as close as I would like. I am uncomfortable being without close relationships, but I sometimes worry that others don’t value me as much as I value them. *
1 = Not at all like me; 2; 3; 4 = Somewhat like me; 5; 6; 7 = Very much like me
D. I am comfortable without close emotional relationships. It is very important for me to feel independent and self-sufficient, and I prefer not to depend on others or have others depend on me. *
1 = Not at all like me; 2; 3; 4 = Somewhat like me; 5; 6; 7 = Very much like me