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_______ |
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Were
either you or your spouse physically abused in childhood?
If so, in what way? |
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_______ |
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Were
either of you emotionally abused during childhood? |
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______
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Was
there a history of violence in either of your families? |
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______ |
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If
so, was the violence directed at the children, or was
it directed at one parent by the other? |
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______ |
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Does
either your spouse treat or his/her parents abuse alcohol?
Do you? Does your parents? |
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_______ |
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Has
your spouse ever hit his/her parents, brothers, or sisters? |
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_______ |
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Has
your spouse ever threatened to harm you? |
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_______ |
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Are
your spouse's problems usually blamed on you or others? |
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_______ |
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Have
you been attacked or blamed when your spouse got angry? |
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_______ |
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Are
you afraid of your spouse's temper? |
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|
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|
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_______ |
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When
drinking, does your spouse get rough or violent? |
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|
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_______ |
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Has
your spouse ever hurt you? When? What happened? |
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|
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_______
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Did
your spouse ever hit a former spouse or lover? |
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|
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_______
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Has
your spouse ever deliberately hurt or killed a pet? |
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|
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|
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_______
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Does
your spouse have a Dr. Jekyll and Mr. Hyde personality? |
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|
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_______
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Do
you usually give in to settle arguments? |
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|
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|
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_______
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Are
your children afraid when your spouse is angry? |
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_______
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Have
you felt free to invite family or friends to visit you? |
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|
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_______
|
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Are
you socially active or more socially isolated? |
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|
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|
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_______
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Does
your spouse listen in when you're talking on the phone? |
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|
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|
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_______
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Does
your spouse insist on going everywhere with you? |
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|
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|
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_______
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Is
your spouse suspicious of your every move? |
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|
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|
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_______
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Is
your spouse an extremely jealous person? |
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|
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|
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_______
|
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Has
your spouse ever forced you to have sex even though you
did not want to? |
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|
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|
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_______
|
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Have
you ever called, or thought of calling, the police because
an argument was getting out of control? |
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|
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|
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_______
|
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Have
your neighbors or friends ever called the police because
of your situation? |
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|
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|
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_______
|
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If
the police were called, was your spouse arrested or given
a citation? |
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|
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|
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_______
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Does
your spouse ever threaten to take the children where you
could not find them? Did this ever occur? |
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