Appendix B
Emotional Needs Questionnaire

© 1986, 2012 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 the most 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.

You have the permission of the publisher to photocopy the questionnaire, enlarging to 8½ × 11, for use in your own marriage.

Ranking 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.

In the space provided before each need, write a number from 1 to 5 that ranks the need’s 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 your five most important needs.

To help you rank these needs, imagine that you will have only 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 will be met, what would your second selection be? Which five needs, when met, would make you the happiest?

_______ Affection

_______ Sexual fulfillment

_______ Intimate conversation

_______ Recreational companionship

_______ Honesty and openness

_______ Physical attractiveness of spouse

_______ Financial support

_______ Domestic support

_______ Family commitment

_______ Admiration

_______ ______________________

_______ ______________________