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Marriage Guidance Counsellor Template

Couples Intake Interview - 2024

A professional Marriage Guidance Counsellor template for healthcare professionals.
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Specialty

Marriage Guidance Counsellor

Used

34 times

Type

Note

Last edited

6/16/2025

Created by

Gabe Roywright

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About this template

The Couples Intake Interview template is an essential tool for marriage guidance counsellors to assess and document the dynamics of a couple's relationship. This comprehensive template covers various aspects such as presenting problems, relationship history, conflict behaviors, and intimacy issues. It helps counsellors gather detailed insights into the couple's interactions, emotional connections, and shared commitments. By using this template, professionals can effectively identify areas of concern and develop tailored strategies for relationship improvement. Ideal for therapists focusing on couples therapy, this template ensures a structured and thorough intake process.

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Presenting Problem: - Partner A: Feels that communication has broken down and desires to rebuild trust and understanding. - Partner B: Wants to address frequent arguments and improve emotional connection. Relationship History: - Partner A: Together for 8 years, initially attracted by shared interests in travel and music. - Partner B: Became partners after a year of friendship, drawn to Partner A's sense of humor. Similarity and Difference: - Partner A: Both value family but differ in communication styles. - Partner B: Similar in career ambitions but different in handling stress. Sources of Hurt: - Partner A: Feels neglected when Partner B prioritizes work over relationship. - Partner B: Hurt by Partner A's dismissive attitude during disagreements. Conflict Behaviors: - Partner A: Tends to withdraw and become silent. - Partner B: Becomes defensive and raises voice. Conflict Repair: - Partner A: Often initiates repair by suggesting a calm discussion. - Partner B: Apologizes and tries to make amends through small gestures. External Relationship Conflicts: - Partner A: Conflict with Partner B's family due to differing cultural values. - Partner B: Tension with Partner A's friends who are perceived as intrusive. Sexual Initiation: - Partner A: Usually initiates sexual activity. - Partner B: Prefers to wait for Partner A to initiate. Intimacy Signaling: - Partner A: Uses physical touch and compliments. - Partner B: Prefers verbal affirmations and quality time. Intimacy Cessation: - Partner A: Noticed a decline in intimacy after the birth of their child. - Partner B: Attributes cessation to increased stress and lack of time. Bonding Moments: - Partner A: Enjoys cooking together and sharing meals. - Partner B: Values evening walks and deep conversations. Relationship Fulfillment: - Partner A: Most fulfilled by shared adventures, least by unresolved conflicts. - Partner B: Finds joy in shared goals, but feels unfulfilled by lack of communication. Shared Commitments: - Partner A: Jointly involved in a community garden project. - Partner B: Committed to raising their child with shared values. Commitment Impact: - Partner A: Believes shared commitments strengthen their bond. - Partner B: Feels they sometimes add stress but ultimately bring them closer. Active Relationship Building: - Partner A: Initiates weekly date nights to maintain connection. - Partner B: Suggests attending workshops to improve communication skills. Parenthood Transition: - Partner A: Felt overwhelmed but supported by Partner B. - Partner B: Experienced increased stress but values Partner A's involvement. Parental Relationship Influence: - Partner A: Parents had a distant relationship, strives for more closeness. - Partner B: Parents were affectionate, aims to replicate that warmth. Love Maps and Rituals of Connection: - Partner A: Knows Partner B's career aspirations and stressors. - Partner B: Aware of Partner A's hopes and fears. - Emotional Contact: Share a morning coffee ritual to connect. - Rituals of Connection: Weekly movie nights to unwind together. Security and Safety Needs: - Partner A: Needs reassurance of love and commitment. - Partner B: Desires more open communication and transparency. Additional Notes: - Therapist observed a willingness from both partners to work on issues. Conflict Discussion Analysis: - You Statements: Frequent use noted during arguments. - Critiques: Partner B often criticizes Partner A's approach to conflict. - Defensiveness: Both partners exhibit defensive behaviors. - Process vs Emotion: Discussions often focus on events rather than emotions. - Meta-Emotion Mismatch: Partner A's expressed emotions differ from felt emotions. - Unmet Bids: Partner B's bids for connection often go unnoticed. - Physiological Arousal: Partner A shows signs of stress during conflict. - Body Language: Partner B displays aggressive postures. - Accept Influence: Partner A shows openness to Partner B's suggestions. - Use of Humor: Partner B uses humor to diffuse tension. - Repair Attempts: Both partners make efforts to repair post-conflict. - I Statements: Partner A uses "I" statements to express feelings. - Accept Responsibility: Partner B acknowledges mistakes and takes responsibility. - Soothing Attempts: Partner A attempts to soothe Partner B during arguments. - Emotional Verbalization: Partner B verbalizes emotional needs clearly. - Calm Body Language: Partner A maintains calm demeanor during discussions. - Observational Comments and Themes: Therapist notes a pattern of miscommunication and unmet emotional needs.

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