The following statements explore how you typically feel in emotionally intimate relationships, both past and present.

This does not necessarily need to be a romantic relationship, but should be an individual with whom you feel (or have felt) the most connection.

For example, it can be your primary “go-to” person, a friend, or even a work colleague on whom you rely if you’re sick, in trouble, want to celebrate with, or call with good news.

Respond to each statement by selecting a number to indicate how much you agree or disagree with the statement.

(1 - Strongly Disagree, 2 - Disagree, 3 - Neutral, 4 - Agree, 5 - Strongly Agree)

First Name *

Email *

I often feel that I’m not good enough to be in my relationship and question why my partner would want to be with me. *

I respect my partner’s needs and boundaries and am comfortable setting my own. *

I often use physical closeness (like hugging) to reduce my anxiety in relationships *

I can maintain a healthy balance between intimacy and independence in relationships. *

I need control and security in my relationships, but I don’t know how to achieve this. *

I rely heavily on my partner’s approval and validation to feel good about myself. *

The person I want to go to for safety is often the same person I’m frightened to be close to. *