How Does My Relationship Affect My Life?


  • Does s/he encourage you to do well in school?
  • Have your grades improved, fallen, or stayed the same?
  • Does s/he pressure you to quit school?
  • Have you avoided a school function so you could spend time with this person?
  • Does this person support your goal of attending college?


  • Have you missed or been late to work because of a fight?
  • Does this person pressure you to neglect responsibilities?
  • Do you talk on the phone so much while at work that it gets in the way?
  • Has this person ever shown up to “check up” on you?
  • Has this person pressured you to quit your job?

Physical Health

  • Have you ever been harmed as a result of a fight?
  • Have you ever been so upset that you become physically ill?
  • Does this person threaten you or do dangerous things when you’re present?

Emotional Health

  • Do you feel better or worse about yourself in this relationship?
  • Do you ever think “I am nothing” without this person?
  • Do you feel more stressed, depressed or anxious?
  • Do you cry more since you’ve been in this relationship?
  • Do you have issues with sleeping since you’ve been in this relationship?

Use of Substances

  • Have you started or increased use of substances?
  • Does this person pressure you to use drugs or alcohol?
  • Do you ever use substances to help yourself calm down after a fight?
  • Do you use substances to “loosen you up” around this person?

Family & Friendships

  • How do your friends and family feel about this person?
  • Have you grown apart from friends and family?
  • Does this person ever act jealous of your friends or family?
  • Has this person ever gotten into a verbal or physical fight with your friends or family?
  • Do you find yourself lying to your friends and family about this person?
  • Do you spend time with your friends?

Being Independent

  • Do you have control of your money?
  • Does this person make negative comments about the clothes you wear?
  • Do you think you’ve become dependent on this person?
  • Do you feel that you couldn’t “make it” without this person?
  • In what other ways has this relationship affected your life?