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Preventing, Assessing, and Managing Relapse: Relapse Questionnaire

The Relapse Questionnaire can help couples assess and prevent relapse and understand how to seek additional intervention if relapse occurs.


Let’s check to see if you feel that any gains you made in treatment have relapsed or are in the process of relapsing. Please give your frank evaluation of the following items by writing either, “doing fine” or “a problem now” for each item.

Communicating regularly

Maintaining emotional connection

Physical and verbal affection

Our sexual relationship

Giving appreciations

Feeling appreciated

Talking about issues

Conflict resolution

Having regular fun

Handling finances

Work–family balance

Our spiritual connection

Respect in the relationship

Knowing one another (Love Maps)


Recurring thoughts about divorce

Handling children

Housework and child care

Issues of power and respect

Overall relationship quality

Issues of commitment

Overall lifestyle, values, goals, etc.

Being friends


Please give a description of how you see things in your relationship right now:


Have any thoughts, questions, suggestions, or comments on this article? Broken link? Wondering how to this can be applied, modified, or adapted to your polyamorous, swinging, kink/ BDSM, or otherwise interesting relationship? Feel free to reach out to us here.