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.

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1. Affection (the expression of love in words, cards, gifts, hugs, kisses, and courtesies; creating an environment that clearly and repeatedly expresses love).

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

0	1	2	3	4	5	6

________________________________________________________________________	
I have  no  need	I have a moderate need	I have a great need	
for affection	for affection	for affection	

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)?

a.	Very  unhappy. c.   Neither happy nor unhappy. 

b.	Somewhat  unhappy. d.   Happy not to be shown affection. 

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

-3	-2	-1	0	1	2	3

________________________________________________________________________	
I am extremely	I am neither	I am extremely	
dissatisfied	satisfied nor dissatisfied	satisfied	

My spouse gives me (circle the appropriate letter)

a.	all the affection I need, and I like  the  way  he/she  does  it. 

b.	not enough affection, but when he/she does it, it is the way I like it. 

c.	all the affection I need, but it is  not the  way  I  like  it. 

d.	not enough  affection,  and  when  he/she  tries,  it  is  not the way I like it. 

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

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2. Sexual Fulfillment (a sexual experience that brings out a predictably enjoyable sexual response in both of you that is frequent enough for both of you).

A.  Need for sexual fulfillment:	Indicate how much you need sexual fulfillment by		
	circling the appropriate number.				
0	1	2	3	4	5	6	
________________________________________________________________________	
I have no need	I have a moderate need	I have a great need	
for sexual fulfillment	for sexual fulfillment	for sexual fulfillment	

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)?

a.	Very  unhappy. c.   Neither happy nor unhappy. 

b.	Somewhat  unhappy. d.   Happy not to engage in sex. 

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

-3	-2	-1	0	1	2	3

________________________________________________________________________	
I am extremely	I am neither	I am extremely	
dissatisfied	satisfied nor dissatisfied	satisfied	

My spouse gives me (circle the appropriate letter)

a.	all the sex I need, and I like the way he/she does it. 

b.	not enough sex, but when he/she does it, it is the way I like it. 

c.	all the sex I need, but it is  not the way I like it. 

d.	not enough sex, and when we do have sex, it is  not the way I like  it. 

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

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3. Conversation (talking about events of the day, personal feelings, and plans for the future; showing interest in your favorite topics of conversation; balancing conversation; using it to inform, investigate, and understand you; and giving you undivided attention).

A.  Need for conversation:	Indicate how much you need conversation by circling the		
	appropriate number:						
0	1	2	3	4	5	6	
________________________________________________________________________	
I have no need	I have a moderate need	I have a great need	
for conversation	for conversation	for conversation	

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)?

a.    Very  unhappy.	c.   Neither happy nor unhappy.

b.	Somewhat  unhappy. d.   Happy not to talk with my spouse. 

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

-3	-2	-1	0	1	2	3

________________________________________________________________________	
I am extremely	I am neither	I am extremely	
dissatisfied	satisfied nor dissatisfied	satisfied	

My spouse gives me (circle the appropriate letter)

a.	all the conversation I need, and I like the way he/she does it. 

b.	not enough conversation,  but  when  he/she  does  it,  it  is  the  way  I  like  it. 

c.	all the conversation I need, but it is  not the  way  I  like  it. 

d.	not enough conversation, and when we do, it is  not the way I like it. 

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

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4. Recreational Companionship (developing interest in your favorite recreational activities, learning to be proficient in them, and joining you in those activities).

A. Need for recreational companionship: Indicate how much yo u need recreational companionship by circling the appropriate number:

0	1	2	3	4	5	6

________________________________________________________________________	
I have no need	I have a moderate need	I have a  great  need	
for recreational	for recreational	for recreational	
companionship	companionship	companionship	

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)?

a.    Very  unhappy.	c.   Neither happy nor unhappy.

b.	Somewhat  unhappy. d.   Happy not to join spouse in recreation. 

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

-3	-2	-1	0	1	2	3

________________________________________________________________________	
I am extremely	I am neither	I am extremely	
dissatisfied	satisfied nor dissatisfied	satisfied	

My spouse gives me (circle the appropriate letter)

a.	all the recreational companionship I need, and I like the way he/she does it. 

b.	not enough recreational companionship, but when he/she does it, it is the way I like it. 

c.	all the recreational companionship I need, but it is  not the way I like it. 

d.	not enough recreational companionship, and when he/she tries, it is not the way I like it. 

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

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5. Honesty and Openness (revealing positive and negative feelings, events of the past, daily events and schedule, plans for the future; not leaving a false impression; answering questions truthfully and completely).

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

0	1	2	3	4	5	6

________________________________________________________________________	
I have no need	I have a moderate need	I have a great need	
for honesty and	for honesty and	for honesty and	
openness	openness	openness	

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

a.	Sharing positive and negative emotional reactions to significant aspects of life. 

b.	Sharing  information  regarding  his/her  personal  history. 

c.	Sharing information about his/her daily activities. 

d.	Sharing information  about his/her future schedule and plans. 

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)?

a.	Very  unhappy. c.   Neither happy nor unhappy. 

b.	Somewhat  unhappy. d.   Happy  not  to  have  honesty  and  openness. 

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. 

-3	-2	-1	0	1	2	3

________________________________________________________________________	
I am extremely	I am neither	I am extremely	
dissatisfied	satisfied nor dissatisfied	satisfied	

My spouse is (circle the appropriate  letter)

a.	honest and open with me, and I like the way he/she does it. 

b.	not honest and open enough with me, but when he/she does it, it is the way I like it. 

c.	honest and open with me, but it is  not the way I like it. 

d.	not honest and open with me, and when he/she tries, it is  not the way I like it. 

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

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6. An Attractive Spouse (keeping physically fit with diet and exercise, wearing hair and clothing in a way that you find attractive and tasteful).

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

0	1	2	3	4	5	6

________________________________________________________________________	
I have no need	I have a moderate need	I have a great need	
for an attractive	for an attractive	for an attractive	
spouse	spouse	spouse	

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

a.	Physical fitness and normal weight.	d.	Good physical hygiene.	
b.	Attractive choice of clothes.	e.	Attractive facial makeup.	
c.	Attractive  hairstyle.	f.	Other ______________________	

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

a.    Very  unhappy.	c.   Neither happy nor unhappy.

b.	Somewhat  unhappy. d.   Happy not to have an attractive spouse. 

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

-3	-2	-1	0	1	2	3

________________________________________________________________________	
I am extremely	I am neither	I am extremely	
dissatisfied	satisfied nor dissatisfied	satisfied	

My  spouse  is  (circle  the  appropriate  letter)

a.	attractive to me, and  I like the way he/she does it. 

b.	not attractive  to   me,  but  when  he/she  was,  I  like  the  way  he/she  achieved  it. 

c.	attractive to me, but I do  not like  the  way  he/she  achieves  it. 

d.	not attractive to me, and when he/she was, I did  not like  the  way it was  achieved. 

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

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7. Financial Support (the provision of financial resources to house, feed, and clothe your family at a standard of living acceptable to you, but avoiding travel and working hours that are unacceptable to you).

A.  Need for financial support:	Indicate how much you need financial support by		
	circling the appropriate number:				
0	1	2	3	4	5	6	
________________________________________________________________________	
I have no need	I have a moderate need	I have a great need	
for financial support	for financial support	for   financial support	

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)?

a.	Very  unhappy. c.   Neither happy  nor  unhappy. 

b.	Somewhat  unhappy. d.   Happy not to have my spouse provide support. 

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

-3	-2	-1	0	1	2	3

________________________________________________________________________	
I am extremely	I am neither	I am extremely	
dissatisfied	satisfied nor dissatisfied	satisfied	

My spouse (circle the appropriate letter)

a.	earns enough money to support me, and I like the way he/she earns it. 

b.	does not earn enough to support me, but I like the way he/she earns it. 

c.	earns enough money to support me, but I do  not like the way he/she earns  it. 

d.	does not enough to support me, and I do  not like the way he/she earns it. 

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

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8. Domestic Support (creation of a home environment for you that offers a refuge from the stresses of life; management of the home and care of the children—if any are at home — including but not limited to cooking meals, washing dishes, washing and ironing clothes, housecleaning).

A.  Need for domestic support:	Indicate how much you need domestic support by		
	circling the appropriate number:				
0	1	2	3	4	5	6	
________________________________________________________________________	
I have  no  need	I have a moderate need	I have a great need	
for domestic	for domestic	for domestic	
support	support	support	

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)?

a.    Very  unhappy.	c.   Neither happy  nor  unhappy.

b.	Somewhat  unhappy. d.   Happy not to have domestic support. 

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

-3	-2	-1	0	1	2	3

________________________________________________________________________	
I am extremely	I am neither	I am extremely	
dissatisfied	satisfied nor dissatisfied	satisfied	

My spouse gives me (circle the appropriate letter)

a.	all the domestic support I need, and I like the way he/she does it. 

b.	not enough  domestic  support,  but  when  he/she  does  it,  it  is  the  way  I  like  it. 

c.	all the domestic support I need, but it is  not the  way  I  like  it. 

d.	not enough  domestic  support,  and  when  he/she  tries,  it  is  not the way I like it. 

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

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9. Family Commitment (scheduling sufficient time and energy for the moral and educational development of your children; reading to them, taking them on frequent outings, developing the skill in appropriate child-training methods and discussing those methods with you; avoiding any child-training methods or disciplinary action that does not have your enthusiastic support).

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

0	1	2	3	4	5	6

________________________________________________________________________	
I have no need	I have a moderate need	I have a great need	
for family	for family	for family	
commitment	commitment	commitment	

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)?

a.    Very  unhappy.	c.   Neither happy nor unhappy.

b.	Somewhat  unhappy. d.   Happy not to have family commitment. 

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

-3	-2	-1	0	1	2	3

________________________________________________________________________	
I am extremely	I am neither	I am extremely	
dissatisfied	satisfied nor dissatisfied	satisfied	

My spouse (circle the appropriate letter)

a.	commits enough time to the family, and spends it in ways that I like. 

b.	does not commit enough time to the family, but when he/she does it, it’s spent in ways that I like. 

c.	commits enough time to the family, but does  not spend  it  in  ways  that  I  like. 

d.	does not commit enough time to the family, and when he/she does, it is not spent in ways that I like it. 

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

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10.  Admiration (respecting, valuing and appreciating you clearly and often).

A.  Need for admiration:	Indicate how much you need admiration by circling the		
	appropriate number:						
0	1	2	3	4	5	6	
________________________________________________________________________	
I have no need	I have a moderate need	I have a great need	
for admiration	for admiration	for admiration	

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)?

a.    Very  unhappy.	c.   Neither happy  nor  unhappy.

b.	Somewhat  unhappy. d.   Happy not to be admired. 

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

-3	-2	-1	0	1	2	3

________________________________________________________________________	
I am extremely	I am neither	I am extremely	
dissatisfied	satisfied nor dissatisfied	satisfied	

My spouse gives me (circle the appropriate letter)

a.	all the admiration I need, and I like the way he/she does it. 

b.	not enough admiration, but when he/she does it, it is the way I like it. 

c.	all the admiration I need, but it is  not the way I like it. 

d.	not enough  admiration,  and  when  he/she tries, it is  not the  way  I  like  it. 

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

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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 marriage. 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

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