Appendix C
Love Busters Questionnaire

© 1992, 2013 by Willard F. Harley, Jr.

Name __________ Date __________

This questionnaire is designed to help identify your spouse’s Love Busters. Your spouse engages in a Love Buster whenever one of his or her habits causes you to be unhappy. By causing your unhappiness, your spouse withdraws love units from your Love Bank, and that, in turn, threatens your romantic love for him or her.

There are six categories of Love Busters. Each category has its own set of questions in this questionnaire. Answer all the questions as candidly as possible. Do not try to minimize your unhappiness with your spouse’s behavior. If your answers require more space, use and attach a separate sheet of paper.

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.

When you have completed this questionnaire, rank the six Love Busters in order of their importance to you. When you have finished ranking the Love Busters, you may find that your answers to the questions regarding each Love Buster are inconsistent with your final ranking. This inconsistency is common. It often reflects a less-than-perfect understanding of your feelings. If you notice inconsistencies, discuss them with your spouse to help clarify your feelings.

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

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Ranking Love Busters

The six basic categories of Love Busters are listed below. There is also space for you to add other categories of Love Busters that you feel contribute to your marital unhappiness. In the space provided in front of each Love Buster, write a number from 1 to 6 that ranks its relative contribution to your unhappiness. Write a 1 before the Love Buster that causes you the greatest unhappiness, a 2 before the one causing the next greatest unhappiness, and so on, until you have ranked all six.

_______ Selfish Demands

_______ Disrespectful Judgments

_______ Angry Outbursts

_______ Annoying Habits

_______ Independent Behavior

_______ Dishonesty

_______ ______________________

_______ ______________________