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Secrets to Successful Intimate Relationships - Toronto


Instruction: Please answer all of the questions in this questionnaire to the best of your ability.

指示：请尽最大努力回答所有的问题。

Personal Information / 个人信息

Information in this section will be encrypted when stored on our server, but it is recommended that you submit this form over a private (e.g. home) network.
這部分的資料會被加密存儲在我們的服務器,但建議你通過專用網絡(例如家裡的網絡)提交此表格。

Family Assessment Instrument / 家庭評估量表

For each of the items describing your view of your current family, please select the response that best represents how you feel. Please answer every question.

对于每个描述你对你目前家庭的看法的项目，请选择最能代表你感受的选项。请回答每个问题。

Very similar / 是:十分相似Somewhat similar / 是:有點相似Similar and dissimilar / 介乎有點相似與有點不相似之間Somewhat dissimilar / 否:有點不相似Very dissimilar / 否:十分不相似
1. Family members support each other. / 家庭成員互相支持 *
2. Family members love each other. / 家庭成員相親相愛 *
3. Family members lack mutual concern. / 家人互不關心 *
4. Family members take care of each other. / 家庭成員彼此照顧 *
5. Family members have mutual consideration. / 家庭成員互相體諒 *
6. Family members understand each other. / 家人懂得體諒其他家庭成員的處境 *
7. Family members talk to each other often. / 家人經常交談 *
8. Family members plan family activities often. / 家人經常安排一些家庭活動 *
9. Family members are united. / 家人是團結一致的 *
10. Family members enjoy getting together. / 家庭成員喜歡聚在一起(喺埋一齊) *
11. There are not many barriers among family members. / 家庭成員之間沒有很大隔膜 *
12. There is much friction among family members. / 我們有很多磨擦 *
13. Family members fight frequently. / 家庭成員在家中經常打架 *
14. Family members quarrel infrequently. / 我們很少吵架(鬧交) *
15. Family members get along well. / 我的家人和洽相處 *
16. Family members lack harmony. / 家人的相處並不融洽 *
17. Family relationships are good. / 我的家人相處得很好 *
18. Family members tolerate each other. / 家庭成員互相忍讓 *
19. Family members are patient with each other. / 家庭成員互相容忍 *
20. Family members accommodate each other. / 家庭成員彼此遷就 *
21. Family members trust each other. / 家庭成員互相信任 *
22. Parents love their children. / 總的來說,父母愛護子女 *
23. Parents do not care about their children. / 總的來說,父母不關心子女 *
24. Parents take care of their children. / 總的來說,父母盡心照顧子女 *
25. Parents know their children's needs. / 總的來說,父母知道子女的需要 *
26. Parents understand their children's mind. / 總的來說,父母明白子女的想法 *
27. Parents often talk to their children. / 總的來說,父母和子女經常交談 *
28. Parents share their children's concerns. / 總的來說,父母分擔子女的心事 *
29. Parents often scold and beat their children. / 總的來說,父母常打罵子女 *
30. Parents often force children to do things that they don't want to do. / 總的來說,父母經常強迫子女做一些子女不願意做的事情 *
31. Parental control is too harsh. / 總的來說,父母對子女的管教過分嚴厲 *
32. The children honor their parents. / 總的來說,子女懂得孝順父母 *
33. The parent's marital relationship is poor. / 父母的婚姻關係欠佳 *

Psychosocial Screen / 心理與社交健康的評估表

This questionnaire provides you with a means of reporting problems that you may be having as an individual or in your relationships with your family and others whom you know or work with. It is not a test, so there are no right or wrong answers. Answer each item as carefully and as accurately as you can.

這問卷是用來量度你個人所面對的困難或你與家人,同儕,朋友或同事之間的人際關係的問題。這不是一個測驗,所以沒有對或錯的答案。請盡量小心並準確和誠實地選出最適合的答案。

Does not apply / 與我無關None of the time / 極少A little of the time / 些少Some of the time / 有時Good part of the time / 頗多Most or all of the time / 時常
1. I feel depressed. / 我感到情緒低落。 *
2. I have a low sense of self-esteem. / 我感到自卑。 *
3. I feel unhappy. / 我感到不快樂。 *
4. I feel afraid. / 我感到懼怕。 *
5. I feel anxious. / 我感到擔憂。 *
6. I feel nervous. / 我感到緊張。 *
7. I have disturbing thoughts or fantasies. / 我有令我感到不安的思想或幻想。 *
8. I have problems with my own anger. / 我有憤怒或暴躁的問題。 *
9. I have nightmares. / 我夜間做惡夢。 *
10. I have a problem with my own sense of identity. / 我對我的身份感到有問題。 *
11. I have problems with my personal sex life. / 我在我個人的性生活上感到有困難。 *
12. The quality of my work is poor. / 我工作的質素是差的。 *
13. I have problems in my relationships with friends. / 我與我朋友的關係有困難。 *
14. I have problems with people I work with. / 我與我同事的關係有困難。 *
15. There are problems in our family relationships. / 我們的家庭關係有困難。 *
16. I have problems with one or more of my children. / 我與我子女的關係有困難。 *
17. My partner and I have problems in our relationship. / 我與我配偶的關係有困難。 *
18. My partner and I have problems with our sexual relationship. / 我與我配偶的性關係有困難。 *
19. My mother and I have problems in our relationship. / 我與我母親的關係有困難。 *
20. My father and I have problems in our relationship. / 我與我父親的關係有困難。 *

Problem checklist / 问题询问表

Please check any of the following items that are currently problems for you. If none apply, check "None of the above" at the bottom of the list.

请勾选任何以下对你目前有关的问题。如果没有项目跟你有关，在列表的底部勾选“以上皆无”。

Experiences in Close Relationships / 親密關係體驗量表

Instruction: The statements below concern how you feel in emotionally intimate relationships. We are interested in how you generally experience relationships, not just in what is happening in a current relationship. Respond to each statement by selecting the option that best indicates how much you agree or disagree with the statement.

以下的這些陳述是有關你在親密關係中可能有的感受。如果你有親密關係的經驗,我們想知道的是通常你在這親密關係中對你的依附對象所持有的想法和感受,而不是只針對你和現在的依附對象的關係。如果你沒有親密關係的經驗,則想像你在親密關係中可能有的想法和感受來回答。請根據你對每一個陳述同意的程度作答,並選出適當的數字來代表。

Strongly Disagree / 非常地不同意Disagree / 不同意Slightly Disagree / 有一點不同意Neutral / 不確定Slightly Agree / 有一點同意Agree / 同意Strongly Agree / 非常地同意
1. It helps to turn to ________ in times of need. / 在我需要幫忙的時候,去找 ________ 是有用的 *
2. I need a lot of reassurance that I am loved by ________. / 我需要 ________ 一再地保証他(她)是愛我的 *
3. I want to get close to ________, but I keep pulling back. / 我想要親近 ________ ,但我總是退卻不前 *
4. I find that ________ doesn't want to get as close as I would like. / 我發現 ________ 對我們之間的期待,並不如我想要的一般親近 *
5. I turn to ________ for many things, including comfort and reassurance. / 我會為了很多事情去找 ________,包括尋求他(她)的安慰和保證 *
6. My desire to be very close sometimes scares ________ away. / 我想要和別人非常親近的這個念頭,有時會嚇跑他們 *
7. I try to avoid getting too close to ________. / 我試著避免和 ________ 變得太親近 *
8. I do not often worry about being abandoned by ________. / 我不會常擔心會被 ________ 拋棄 *
9. I usually discuss my problems and concerns with ________. / 我常常和 ________ 討論我所遭遇的問題和煩惱 *
10. I get frustrated if ________ is not available when I need him/her. / 當我需要 ________ 時,他(她)卻沒有空,我會覺得挫折 *
11. I am nervous when ________ gets too close to me. / 當 ________ 太親近我的時候,我會很緊張 *
12. I worry that ________ won't care about me as much as I care about him/her. / 我擔心 ________ 不像我在乎他(她)一樣地在乎我 *

Relationship Satisfaction Scale / 關係滿足程度

Select the category that best describes the amount of satisfaction you feel in your relationship with your attachment figure. / 請選出你與你的依附對象的關係中所感到的滿足程度。 (0=extremely dissatisfied / 絕對不滿; 1=very dissatisfied / 非常不滿; 2=moderately dissatisfied / 相當不滿; 3=dissatisfied / 頗為不滿; 4=slightly dissatisfied / 有些不滿; 5=neutral / 中立; 6=slightly satisfied / 有些滿足; 7=satisfied / 頗為滿足; 8=moderately satisfied / 相當滿足; 9=very satisfied / 非常滿足; 10=extremely satisfied / 絕對滿足)

Note: Although this test assesses your marriage or most intimate relationship, you can also use it to evaluate your relationship with a friend, family member, or colleague. / 雖然這問卷是用來評估你的婚姻或最親密的關係,也可以用來評估你與朋友、家人、同學和同事之間的關係。

1. Communication and openness / 溝通與開放

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Relationship satisfaction during the best time (0-10) / 最好時的關係滿足程度(0-10) *
Relationship satisfaction during the worst time (0-10) / 最不好時的關係滿足程度(0-10) *
Current relationship satisfaction (0-10) / 現今的關係滿足程度(0-10) *
Relationship satisfaction hoped for in 1 year's time (0-10) / 期望一年後的關係滿足程度(0-10) *
0=extremely dissatisfied / 絕對不滿; 1=very dissatisfied / 非常不滿; 2=moderately dissatisfied / 相當不滿; 3=dissatisfied / 頗為不滿; 4=slightly dissatisfied / 有些不滿; 5=neutral / 中立; 6=slightly satisfied / 有些滿足; 7=satisfied / 頗為滿足; 8=moderately satisfied / 相當滿足; 9=very satisfied / 非常滿足; 10=extremely satisfied / 絕對滿足

2. Resolving conflicts and arguments / 處理衝突

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Relationship satisfaction during the best time (0-10) / 最好時的關係滿足程度(0-10) *
Relationship satisfaction during the worst time (0-10) / 最不好時的關係滿足程度(0-10) *
Current relationship satisfaction (0-10) / 現今的關係滿足程度(0-10) *
Relationship satisfaction hoped for in 1 year's time (0-10) / 期望一年後的關係滿足程度(0-10) *
0=extremely dissatisfied / 絕對不滿; 1=very dissatisfied / 非常不滿; 2=moderately dissatisfied / 相當不滿; 3=dissatisfied / 頗為不滿; 4=slightly dissatisfied / 有些不滿; 5=neutral / 中立; 6=slightly satisfied / 有些滿足; 7=satisfied / 頗為滿足; 8=moderately satisfied / 相當滿足; 9=very satisfied / 非常滿足; 10=extremely satisfied / 絕對滿足

3. Degree of affection and caring / 感情和關心

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Relationship satisfaction during the best time (0-10) / 最好時的關係滿足程度(0-10) *
Relationship satisfaction during the worst time (0-10) / 最不好時的關係滿足程度(0-10) *
Current relationship satisfaction (0-10) / 現今的關係滿足程度(0-10) *
Relationship satisfaction hoped for in 1 year's time (0-10) / 期望一年後的關係滿足程度(0-10) *
0=extremely dissatisfied / 絕對不滿; 1=very dissatisfied / 非常不滿; 2=moderately dissatisfied / 相當不滿; 3=dissatisfied / 頗為不滿; 4=slightly dissatisfied / 有些不滿; 5=neutral / 中立; 6=slightly satisfied / 有些滿足; 7=satisfied / 頗為滿足; 8=moderately satisfied / 相當滿足; 9=very satisfied / 非常滿足; 10=extremely satisfied / 絕對滿足

4. Intimacy and closeness / 親密與親近

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Relationship satisfaction during the best time (0-10) / 最好時的關係滿足程度(0-10) *
Relationship satisfaction during the worst time (0-10) / 最不好時的關係滿足程度(0-10) *
Current relationship satisfaction (0-10) / 現今的關係滿足程度(0-10) *
Relationship satisfaction hoped for in 1 year's time (0-10) / 期望一年後的關係滿足程度(0-10) *
0=extremely dissatisfied / 絕對不滿; 1=very dissatisfied / 非常不滿; 2=moderately dissatisfied / 相當不滿; 3=dissatisfied / 頗為不滿; 4=slightly dissatisfied / 有些不滿; 5=neutral / 中立; 6=slightly satisfied / 有些滿足; 7=satisfied / 頗為滿足; 8=moderately satisfied / 相當滿足; 9=very satisfied / 非常滿足; 10=extremely satisfied / 絕對滿足

5. Satisfaction with your role in the relationship / 你自己的角色

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Relationship satisfaction during the best time (0-10) / 最好時的關係滿足程度(0-10) *
Relationship satisfaction during the worst time (0-10) / 最不好時的關係滿足程度(0-10) *
Current relationship satisfaction (0-10) / 現今的關係滿足程度(0-10) *
Relationship satisfaction hoped for in 1 year's time (0-10) / 期望一年後的關係滿足程度(0-10) *
0=extremely dissatisfied / 絕對不滿; 1=very dissatisfied / 非常不滿; 2=moderately dissatisfied / 相當不滿; 3=dissatisfied / 頗為不滿; 4=slightly dissatisfied / 有些不滿; 5=neutral / 中立; 6=slightly satisfied / 有些滿足; 7=satisfied / 頗為滿足; 8=moderately satisfied / 相當滿足; 9=very satisfied / 非常滿足; 10=extremely satisfied / 絕對滿足

6. Satisfaction with the other person's role / 對方的角色

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Relationship satisfaction during the best time (0-10) / 最好時的關係滿足程度(0-10) *
Relationship satisfaction during the worst time (0-10) / 最不好時的關係滿足程度(0-10) *
Current relationship satisfaction (0-10) / 現今的關係滿足程度(0-10) *
Relationship satisfaction hoped for in 1 year's time (0-10) / 期望一年後的關係滿足程度(0-10) *
0=extremely dissatisfied / 絕對不滿; 1=very dissatisfied / 非常不滿; 2=moderately dissatisfied / 相當不滿; 3=dissatisfied / 頗為不滿; 4=slightly dissatisfied / 有些不滿; 5=neutral / 中立; 6=slightly satisfied / 有些滿足; 7=satisfied / 頗為滿足; 8=moderately satisfied / 相當滿足; 9=very satisfied / 非常滿足; 10=extremely satisfied / 絕對滿足

7. Overall satisfaction with your relationship / 普遍的關係滿足

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Relationship satisfaction during the best time (0-10) / 最好時的關係滿足程度(0-10) *
Relationship satisfaction during the worst time (0-10) / 最不好時的關係滿足程度(0-10) *
Current relationship satisfaction (0-10) / 現今的關係滿足程度(0-10) *
Relationship satisfaction hoped for in 1 year's time (0-10) / 期望一年後的關係滿足程度(0-10) *
0=extremely dissatisfied / 絕對不滿; 1=very dissatisfied / 非常不滿; 2=moderately dissatisfied / 相當不滿; 3=dissatisfied / 頗為不滿; 4=slightly dissatisfied / 有些不滿; 5=neutral / 中立; 6=slightly satisfied / 有些滿足; 7=satisfied / 頗為滿足; 8=moderately satisfied / 相當滿足; 9=very satisfied / 非常滿足; 10=extremely satisfied / 絕對滿足

8. Understand and acceptance of the relationship / 對關係的認識和了解

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Relationship satisfaction during the best time (0-10) / 最好時的關係滿足程度(0-10) *
Relationship satisfaction during the worst time (0-10) / 最不好時的關係滿足程度(0-10) *
Current relationship satisfaction (0-10) / 現今的關係滿足程度(0-10) *
Relationship satisfaction hoped for in 1 year's time (0-10) / 期望一年後的關係滿足程度(0-10) *
0=extremely dissatisfied / 絕對不滿; 1=very dissatisfied / 非常不滿; 2=moderately dissatisfied / 相當不滿; 3=dissatisfied / 頗為不滿; 4=slightly dissatisfied / 有些不滿; 5=neutral / 中立; 6=slightly satisfied / 有些滿足; 7=satisfied / 頗為滿足; 8=moderately satisfied / 相當滿足; 9=very satisfied / 非常滿足; 10=extremely satisfied / 絕對滿足

9. Understand and acceptance of yourself / 對自己的認識,了解和接納

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Relationship satisfaction during the best time (0-10) / 最好時的關係滿足程度(0-10) *
Relationship satisfaction during the worst time (0-10) / 最不好時的關係滿足程度(0-10) *
Current relationship satisfaction (0-10) / 現今的關係滿足程度(0-10) *
Relationship satisfaction hoped for in 1 year's time (0-10) / 期望一年後的關係滿足程度(0-10) *
0=extremely dissatisfied / 絕對不滿; 1=very dissatisfied / 非常不滿; 2=moderately dissatisfied / 相當不滿; 3=dissatisfied / 頗為不滿; 4=slightly dissatisfied / 有些不滿; 5=neutral / 中立; 6=slightly satisfied / 有些滿足; 7=satisfied / 頗為滿足; 8=moderately satisfied / 相當滿足; 9=very satisfied / 非常滿足; 10=extremely satisfied / 絕對滿足

10. Understand and acceptance of the other person / 對對方的認識,了解和接納

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Relationship satisfaction during the best time (0-10) / 最好時的關係滿足程度(0-10) *
Relationship satisfaction during the worst time (0-10) / 最不好時的關係滿足程度(0-10) *
Current relationship satisfaction (0-10) / 現今的關係滿足程度(0-10) *
Relationship satisfaction hoped for in 1 year's time (0-10) / 期望一年後的關係滿足程度(0-10) *
0=extremely dissatisfied / 絕對不滿; 1=very dissatisfied / 非常不滿; 2=moderately dissatisfied / 相當不滿; 3=dissatisfied / 頗為不滿; 4=slightly dissatisfied / 有些不滿; 5=neutral / 中立; 6=slightly satisfied / 有些滿足; 7=satisfied / 頗為滿足; 8=moderately satisfied / 相當滿足; 9=very satisfied / 非常滿足; 10=extremely satisfied / 絕對滿足

Brief Accessibility, Responsiveness, and Engagement (BARE) Scale (About)
精簡的可親,回應和投入程度的量表(BARE) (介紹)

A quick A.R.E. tune-up conversation can be prompted by the following brief 12-item questionnaire. Please take a few minutes to answer the questions, then discuss how you can improve as a couple. Remember, the peace, love, and joy that come from experiencing a safe haven and secure base is worth the effort.

通過下面簡單12項的問卷調查進行快速調整關係的A.R.E.對話。請你花幾分鐘時間來回答這些問題,然後討論如何改善你們的夫婦關係。請記住, 從經歷一個安全的避風港和安全的基地而來的和平,愛和喜樂是絕對值得努力爭取的。

Never true /  從來都不是真的Rarely true / 很少是真的Sometimes true / 有時候是真的Usually true / 通常都是真的Always true / 時常都是真的
Accessibility / 可親: 1. I am rarely available to my partner. / 我很少讓配偶情感上找到我。 *
Accessibility / 可親: 2. It is hard for my partner to get my attention. / 配偶很難得到我的注意。 *
Responsiveness / 回應: 3. I listen when my partner shares her / his deepest feelings. / 當配偶分享他/她最深的感受,我會傾聽。 *
Responsiveness / 回應: 4. I am confident I reach out to my partner. / 我有信心我在情感上接觸到我的配偶。 *
Engagement / 投入: 5. It is hard for me to confide in my partner. / 當我要向我的配偶傾訴我的心事,我會感到有困難。 *
Engagement / 投入: 6. I struggle to feel close and engage in our relationship. / 我為了感到親密和投入我們的關係而掙扎。 *
Accessibility / 可親: 7. My partner is rarely available to me. / 我很少情感上能夠找到我的配偶。 *
Accessibility / 可親: 8. It is hard for me to get my partner’s attention. / 要得到我的配偶的注意是困難的。 *
Responsiveness / 回應: 9. My partner listens when I share my deepest feelings. / 當我分享我最深的感受,我的配偶會細心地傾聽。 *
Responsiveness / 回應: 10. I am confident my partner reaches out to me. / 我有信心配偶在情感上接觸到我。 *
Engagement / 投入: 11. It is hard for my partner to confide in me. / 當配偶要向我傾訴他/她的心事,他/她會感到困難。 *
Engagement / 投入: 12. My partner struggles to feel close and engaged in our relationship. / 我的配偶為了感到親密和投入我們的關係而掙扎。 *

Dyadic Adjustment Scale / 配對適應量表

Most persons have disagreements in their relationships. Please indicate below the approximate extent of agreement or disagreement between you and your partner for each item on the following list.

在婚姻關係中,很多人都會與配偶對一些事情有不同的看法。請就著第1至15題所列出的項目,根據你們兩夫婦對它們的看法之一致程度,在每一個項目中,選出你認為最適切的答案。你和配偶對以下事情的看法一致的程度:

Always Agree / 總是一致Almost Always Agree / 幾乎總是一致Occasionally Disagree / 間中不一致Frequently Disagree / 經常不一致Almost Always Disagree / 幾乎總是不一致Always Disagree / 總是不一致
1. Handling family finances / 家庭財政的處理 *
2. Matters of recreation / 娛樂活動 *
3. Religious matters / 宗教信仰 *
4. Demonstrations of affection / 情愛的表示 *
5. Friends / 朋友 *
6. Sex relations / 性關係 *
7. Conventionality (correct or proper behavior) / 傳統觀念和習慣(正確或合宜的行為) *
8. Philosophy of life / 人生觀 *
9. Ways of dealing with parents or in-laws / 與父母/姻親相處的方式 *
10. Aims, goals, and things believed important / 目的,目標和認為重要的事物 *
11. Amount of time spent together / 共同相處時間的多寡 *
12. Making major decisions / 作出重要決定 *
13. Household tasks / 家務工作 *
14. Leisure time interests and activities / 餘暇嗜好和活動 *
15. Career decisions / 有關職業的決定 *

How often would you say the following events occur between you and your mate?
按著你覺得這些事情出現的頻密程度,請選出你認為最能夠代表你們的情況的答案。

These are some things about which couples sometimes agree and sometime disagree. Indicate if either item below caused differences of opinions or were problems in your relationship during the past few weeks.
婦間在某些事情上會有時意見一致,但也有時會持不同的意見。請選出在過去數個星期內,以下的事情曾否引致你們夫婦間有不同的意見,或這些事情已經成為你們婚姻關係中的問題? (請指出是或否)