Emotional Needs Questionnaire

Copyright © 1986 by Willard F. Harley‚ Jr.

Name__________________________________ Date__________________________

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. If your answers require more space use and attach a separate sheet of paper.

Your spouse should complete a separate Emotional Needs Questionnaire so that you can discover his or her needs and evaluate your effectiveness in meeting those needs.

When you have completed this questionnaire‚ go through it a second time to be certain your answers accurately reflect your feelings. Do not erase your original answers‚ but cross them out lightly so that your spouse can see the corrections and discuss them with you.

The final page of this questionnaire asks you to identify and rank five of the ten needs in order of their importance to you. The most important emotional needs are those that give you the most pleasure when met and frustrate you when unmet. Resist the temptation to identify as most important only those needs that your spouse is not presently meeting. Include all your emotional needs in your consideration of those that are most important.

A. Need for affection: Indicate how much you need affection by circling the appropriate number:

How often would you like your spouse to be affectionate to you?

_______________   times each day/week/month (circle one).

If you are not shown affection by your spouse as often as you indicated above‚ how does it make you feel (circle the appropriate letter)?

B. Evaluation of spouse’s affection: Indicate your satisfaction with your spouse’s affection toward you by circling the appropriate number.

My spouse gives me (circle the appropriate letter)

Explain how your need for affection could be better satisfied in your marriage.

A. Need for sexual fulfillment: Indicate how much you need sexual fulfillment by circling the appropriate number.

How often would you like your spouse to engage in sexual relations with you?

____________   times each day/week/month (circle one)

If your spouse does not engage in sexual relations with you as often as you indicated above‚ how does it make you feel (circle the appropriate letter)?

B. Evaluation of sexual relations with your spouse: Indicate your satisfaction with your spouse’s sexual relations with you by circling the appropriate number.

My spouse gives me (circle the appropriate letter)

Explain how your need for sexual fulfillment could be better satisfied in your marriage.

A. Need for conversation: Indicate how much you need conversation by circling the

How often would you like your spouse to talk with you?

_______________ times each day/week/month (circle one).

If your spouse does not talk with you as often as you indicated above‚ how does it make you feel (circle the appropriate letter)?

B. Evaluation of conversation with your spouse: Indicate your satisfaction with your spouse’s conversation with you by circling the appropriate number.

My spouse gives me (circle the appropriate letter)

Explain how your need for conversation could be better satisfied in your marriage.

A. Need for recreational companionship: Indicate how much you need recreational

How often would you like your spouse join you in recreational activities?

_______________times each day/week/month (circle one).

If your spouse does not join you in recreational activities as often as you indicated above‚ how does it make you feel (circle the appropriate letter)?

B. Evaluation of recreational companionship with your spouse: Indicate your satisfaction with your spouse’s recreational companionship with you by circling the appropriate number.

My spouse gives me (circle the appropriate letter)

Explain how your need for recreational companionship could be better satisfied in your marriage.

A. Need for honesty and openness: Indicate how much you need honesty by circling the

Which of the following areas of honesty and openness would you like from your spouse (circle the letter(s) that apply to you)?

If your spouse fails to be open and honest in those areas that you indicated above‚ how does it make you feel (circle the appropriate letter)?

B. Evaluation of spouse’s honesty and openness: Indicate your satisfaction with your spouse’s honesty and openness with you by circling the appropriate number.

My spouse is (circle the appropriate letter)

Explain how your need for honesty & openness could be better satisfied in your marriage.

A. Need for an attractive spouse: Indicate how much you need an attractive spouse by circling the appropriate number:

Which of the following ch‎aracteristics of attractiveness mean the most to you (circle the letter(s) that apply to you)?

If your spouse does not have those ch‎aracteristics that you circled above‚ how does it make you feel (circle the appropriate letter)?

B. Evaluation of spouse’s attractiveness: Indicate your satisfaction with your spouse’s attractiveness by circling the appropriate number.

My spouse is (circle the appropriate letter)

Explain how your need for an attractive spouse could be better satisfied in your marriage.

A. Need for financial support: Indicate how much you need financial support by circling the appropriate number:

How much money would you like your spouse to earn to support you (and your children)? _______________

If your spouse does not earn the amount you indicated above‚ how does it make you feel (circle the appropriate letter)?

B. Evaluation of spouse’s financial support: Indicate your satisfaction with your spouse’s financial support of you by circling the appropriate number.

My spouse (circle the appropriate letter)

Explain how your need for financial support could be better satisfied in your marriage.

A. Need for domestic support: Indicate how much you need domestic support by circling the appropriate number:

How much time would you like your spouse to be engaged in domestic support?

_______________hours each day/week/month (circle one).

If your spouse does not spend as much time engaged in domestic support as you indicated above‚ how does it make you feel (circle the appropriate letter)?

B. Evaluation of spouse’s domestic support: Indicate your satisfaction with your spouse’s domestic support by circling the appropriate number.

My spouse gives me (circle the appropriate letter)

Explain how your need for domestic support could be better satisfied in your marriage.

A. Need for family commitment: Indicate how much you need family commitment by circling the appropriate number:

I have no need I have a moderate need I have a great need

How much time would you like your spouse to be engaged in family commitment?

_______________hours each day/week/month (circle one).

If your spouse does not spend as much time engaged in family commitment as you indicated above‚ how does it make you feel (circle the appropriate letter)?

B. Evaluation of spouse’s family commitment: Indicate your satisfaction with your spouse’s family commitment by circling the appropriate number.

My spouse (circle the appropriate letter)

Explain how your need for family commitment could be better satisfied in your marriage.

A. Need for admiration: Indicate how much you need admiration by circling the appropriate number:

How often would you like your spouse to admire you?

_______________times each day/week/month (circle one).

If your spouse does not admire you as often as you indicated above‚ how does it make you feel (circle the appropriate letter)?

B. Evaluation of spouse’s admiration: Indicate your satisfaction with your spouse’s admiration toward you by circling the appropriate number.

My spouse gives me (circle the appropriate letter)

Explain how your need for admiration could be better satisfied in your marriage.

Ranking of Your Emotional Needs

The ten basic emotional needs are listed below. There is also space for you to add other emotional needs that you feel are essential to your marital happiness‚ but are not included in the list.

In the space provided in front of each need‚ write a number from 1 to 5 that ranks the need’s most importance to your happiness. Write a “1” before the most important need‚ a “2” before the next most important‚ and so on until you have ranked all five.

To help you rank these needs‚ imagine that you will only have one need met in your arriage.

Which would make you the happiest‚ knowing that all the others would go unmet? That need should be “1.” If only two needs would be met‚ what would your second se‎lection be? Which five needs‚ when met‚ would make you the happiest.

____________________ Affection

____________________ Sexual Fulfillment

____________________ Conversation

____________________ Recreational Companionship

____________________ Honesty and Openness

____________________ An Attractive Spouse

____________________ Financial Support

____________________ Domestic Support

____________________ Family Commitment

Admiration____________________

________________________ ___________________

________________________ ___________________

________________________ ___________________

________________________ ___________________