Form 15.6 Survey

OMB #: 0925-0593

OMB Expiration Date: 8/31/2014

Personal Assessment of Intimacy in Relationships (PAIR) (CASI), Phase 2g

OMB Specification

Personal Assessment of Intimacy in Relationships (PAIR) (CASI)

Event Category:	Time-Based
Event:	18M
Instrument Target:	Primary Caregiver
Instrument Respondent:	Primary Caregiver
Domain:	Neuro-Psychosocial
Document Category:	Scored Assessment
Method:	Self-Administered
Mode (for this instrument*):	In-Person, CAI
OMB Approved Modes:	In-Person, CAI
Estimated Administration Time:	9 minutes
Multiple Child/Sibling Consideration:	Per Event
Special Considerations:	N/A
Version:	1.0
MDES Release:	4.0

​*This instrument is OMB-approved for multi-mode administration but this version of the instrument is designed for administration in this/these mode(s) only.

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Personal Assessment of Intimacy in Relationships (PAIR) (CASI)

TABLE OF CONTENTS

GENERAL PROGRAMMER INSTRUCTIONS: 1

TRAINING SCREENS 3

PAIR QUESTIONNAIRE 7

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Personal Assessment of Intimacy in Relationships (PAIR) (CASI)

GENERAL PROGRAMMER INSTRUCTIONS:

WHEN PROGRAMMING INSTRUMENTS, VALIDATE FIELD LENGTHS AND TYPES AGAINST THE MDES TO ENSURE DATA COLLECTION RESPONSES DO NOT EXCEED THOSE OF THE MDES. SOME GENERAL ITEM LIMITS USED ARE AS FOLLOWS:

DATA ELEMENT FIELDS	MAXIMUM CHARACTERS PERMITTED	DATA TYPE	PROGRAMMER INSTRUCTIONS
ADDRESS AND EMAIL FIELDS	100	CHARACTER
UNIT AND PHONE FIELDS	10	CHARACTER
_OTH AND COMMENT FIELDS	255	CHARACTER	Limit text to 255 characters
FIRST NAME AND LAST NAME	30	CHARACTER	Limit text to 30 characters
ALL ID FIELDS	36	CHARACTER
ZIP CODE	5	NUMERIC
ZIP CODE LAST FOUR	4	NUMERIC
CITY	50	CHARACTER
DOB AND ALL OTHER DATE FIELDS (E.G., DT, DATE, ETC.)	10	NUMERIC CHARACTER	DISPLAY AS MM/DD/YYYY STORE AS YYYY-MM-DD HARD EDITS: MM MUST EQUAL 01 TO 12 DD MUST EQUAL 01 TO 31 YYYY MUST BE BETWEEN 1900 AND CURRENT YEAR.
TIME VARIABLES	TWO-DIGIT HOUR AND TWO-DIGIT MINUTE, AM/PM DESIGNATION	NUMERIC	HARD EDITS: HOURS MUST BE BETWEEN 00 AND 12; MINUTES MUST BE BETWEEN 00 AND 59

Instrument Guidelines for Participant and Respondent IDs:

PRENATALLY, THE P_ID IN THE MDES HEADER IS THAT OF THE PARTICIPANT (E.G. THE NON-PREGNANT WOMAN, PREGNANT WOMAN, OR THE FATHER).

POSTNATALLY, A RESPONDENT ID WILL BE USED IN ADDITION TO THE PARTICIPANT ID BECAUSE SOMEBODY OTHER THAN THE PARTICIPANT MAY BE COMPLETING THE INTERVIEW. FOR EXAMPLE, THE PARTICIPANT MAY BE THE CHILD AND THE RESPONDENT MAY BE THE MOTHER, FATHER, OR ANOTHER CAREGIVER. THEREFORE, MDES VERSION 2.2 AND ALL FUTURE VERSIONS CONTAIN A R_P_ID (RESPONDENT PARTICIPANT ID) HEADER FIELD FOR EACH POST-BIRTH INSTRUMENT. THIS WILL ALLOW ROCs TO INDICATE WHETHER THE RESPONDENT IS SOMEBODY OTHER THAN THE PARTICIPANT ABOUT WHOM THE QUESTIONS ARE BEING ASKED.

A REMINDER:

ALL RESPONDENTS MUST BE CONSENTED AND HAVE RECORDS IN THE PERSON, PARTICIPANT, PARTICIPANT_CONSENT AND LINK_PERSON_PARTICIPANT TABLES, WHICH CAN BE PRELOADED INTO EACH INSTRUMENT. ADDITIONALLY, IN POST-BIRTH QUESTIONNAIRES WHERE THERE IS THE ABILITY TO LOOP THROUGH A SET OF QUESTIONS FOR MULTIPLE CHILDREN, IT IS IMPORTANT TO CAPTURE AND STORE THE CORRECT CHILD P_ID ALONG WITH THE LOOP INFORMATION. IN THE MDES VARIABLE LABEL/DEFINITION COLUMN, THIS IS INDICATED AS FOLLOWS: EXTERNAL IDENTIFIER: PARTICIPANT ID FOR CHILD DETAIL.

TRAINING SCREENS

(TIME_STAMP_TS_ST).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

• PRELOAD PARTICIPANT ID (P_ID) OR RESPONDENT ID (R_P_ID) FOR PARENT/CAREGIVER.

• PRELOAD PARTICIPANT/RESPONDENT AGE

• FOR SECTION TS, ALLOW PARTICIPANT/RESPONDENT TO PROGRESS THROUGH THE SECTION BY SELECTING “NEXT” EVEN IF THEY HAVE NOT SELECTED A RESPONSE TO THE QUESTION.

 

CASI FORMATTING INSTRUCTIONS

• DISPLAY NCS CASI BANNER THROUGHOUT QUESTIONNAIRE.

• CONFIGURE QUESTIONNAIRE BASED ON CASI BEST PRACTICES AND GUIDELINES.

• DISPLAY ONE QUESTION/ITEM PER SCREEN THROUGHOUT.

• “NEXT” BUTTONS SHOULD BEGIN ON THE FIRST SCREEN AND SHOULD BE DISPLAYED AT THE BOTTOM RIGHTHAND CORNER OF THE SCREEN.

• “BACK” BUTTONS SHOULD BEGIN ON THE SECOND SCREEN AND SHOULD BE DISPLAYED AT THE BOTTOM LEFTHAND CORNER OF THE SCREEN.

• DISPLAY “LANGUAGE” AND “HELP” BUTTONS AT THE TOP OF EACH SCREEN.

• RESPONSE OPTIONS SHOULD BE DISPLAYED WITHIN THE ANSWER FIELD AND SHADED TO DISTINGUISH FROM OTHER FIELDS.

• ALL PARTICIPANT INSTRUCTIONS SHOULD BE DISPLAYED IN RED TEXT BETWEEN THE QUESTION FIELD AND ANSWER FIELD.

• USE FONT CALIBRI, SIZE 18, BOLD FOR ALL QUESTIONS, INSTRUCTIONS, AND ANSWERS

• EACH SCREEN SHOULD CONTAIN AT MINIMUM A QUESTION BOX AND AN ANSWER BOXES. IF INDICATED, PLACE AN INSTRUCTIONS BOX BETWEEN THE QUESTION BOX AND ANSWER BOX.

• ANSWER BOXES SHOULD BE SHADED LIGHT PURPLE.

• “BACK” AND “NEXT” BUTTONS SHOULD HAVE A BLACK LINE BORDER AND BE LOCATED AT THE BOTTOM LEFT AND BOTTOM RIGHT (RESPECTIVELY) OF THE SCREEN.

• “HELP” BUTTON WITH BLACK LINE BORDER LOCATED AT TOP LEFT OF SCREEN.

• LANGUAGE TOGGLE “ENGLISH/ESPAGNOL” WITH BLACK LINE BORDER LOCATED AT TOP RIGHT OF SCREEN.

• EACH NEW ITEM NUMBER TRIGGERS A NEW SCREEN

TS01000/(TRAINING_1). Now we want to teach you how to use complete a computerized interview. The interviewer will be here to answer any questions you have. The computer will ask you a series of questions.  Some people may consider some of the following questions to be personal, so you will answer these on your own in complete privacy.  Like all other questions that you have answered today, your responses will be kept confidential.  If you are not sure about an answer, choose the best option. Answer each question by selecting your response on the screen.  After you answer a question, go to the next question by clicking the button marked NEXT in the lower right-hand corner of the screen. Try clicking that button now to move on.

SOURCE

New

PARTICIPANT INSTRUCTIONS

• Touch the box beside your answer.

• Then touch the NEXT button to go to the next page.

• Touch the BACK button to go back to the previous page.

• Press the HELP button to get helpful tips for completing the questions.

TS02000/(TRAINING_2). If you want to go back and change your answer to an earlier question, click the button marked BACK in the lower left-hand corner of the screen.  Touch the BACK button now to return to the last screen.  Then touch the NEXT button to return to this screen and again to move on.

SOURCE

New

TS03000/(TRAINING_3). These first questions are practice questions and are not part of the study.  These practice questions will help you learn how to complete this computerized interview. 

 

If you want to change your answer to a multiple choice question, you may simply select another option.

 

What is your favorite season of the year?

Label	Code	Go To
Spring	1
Summer	2
Fall	3
Winter	4

SOURCE

New

TS04000/(TRAINING_4). Another type of question requires a number response. Answer by pressing the number buttons on the keypad.

 

If a question asks you to enter a number onto a keypad, and you would like to change your answer after you have already entered a number, you can select the “CLEAR” button to erase the answer and enter your new response. 

 

Answer the following question.  Then try selecting “CLEAR”  and entering your answer again.

 

 

How many hours did you sleep last night?

 

|___|___| 

HOURS

SOURCE

New

TS05000/(TRAINING_5). If you skip a question for any reason, the computer will say you didn't answer the question, and will ask whether you really meant to answer, would rather not answer, or don't know the answer.  If you choose, I really meant to answer, the screen will go back so you can answer the question.

PROGRAMMER INSTRUCTIONS

INSERT SCREENSHOT OF REDO SCREEN

TS06000/(TRAINING_6). Sometimes you will be asked a question that refers to a particular time period like the last 30 days.  Be sure to think only about the specific time period asked in that question.  

TS07000/(TRAINING_7). If you answer a question with a response that is not valid, a message will appear on the screen. For example, the question below asks about your activities during the last 90 days.  If your response was greater than 90, the following message would appear. 

 

How many days in the past 90 did you ride the bus?

 

|___|___|

NUMBER OF DAYS

SOURCE

New

PROGRAMMER INSTRUCTIONS

INSERT SCREENSHOT OF HARD EDIT: The number of days must be between 0 and 90. Please enter the number of days.

TS08000. Some questions may ask you to consider the contrast between one time or situation and another time or situation.  Think of the statement in the first situation and answer it according to that situation, then think of the same statement in the other situation.  For this type of question, you will be putting down two answers, which may be different or may be the same.  For example, the question below asks about the number of children you want or hope to have, and how that may have changed since you were young:

 

How many children did you want or hope to have . . . 

SOURCE

New

(TRAINING_8) When you were 16?

                                     |_____|

(TRAINING_9) At the present?

                                |_____|

TS09000/(TRAINING_10). If there is anything that you do not understand, or if you have any problems during the interview, please ask the interviewer to help you.  If you are ready to begin the interview, press the NEXT button now.

(TIME_STAMP_TS_ET).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

PAIR QUESTIONNAIRE

(TIME_STAMP_PQ_ST).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

 

INSTRUCTIONS FOR HARD EDITS

• HARD EDITS SHOULD BE PROGRAMMED AS POP-UP SCREENS.

PQ01000. DISPLAY IN QUESTION FIELD: You did not select an answer to the question on the previous page {INSERT QUESTION BOX TEXT FROM PREVIOUS QUESTION}. Would you like to go back to the previous page and answer the question?

PROGRAMMER INSTRUCTIONS

INSTRUCTIONS FOR REDO/RF/DK SCREENS:

• CASI VARIABLE ANSWER OPTIONS SHOWN TO THE PARTICIPANT DO NOT INCLUDE “REFUSED” OR “DON’T KNOW”.

• IF A PARTICIPANT ATTEMPTS TO MOVE ON TO THE NEXT ITEM (BY SELECTING THE “NEXT” BUTTON AT THE BOTTOM RIGHT OF SCREEN) WITHOUT ENTERING A VALID ANSWER, DISPLAY CASI REDO SCREEN.

• CASI REDO SCREENS FOLLOW THE FOLLOWING FORMAT:

Label	Code	Go To
Yes, I would like to go back and answer the question	1
No, I do not want to answer the question	2
No, I do not know the answer to that question	3

PROGRAMMER INSTRUCTIONS

• IF = 1, ROUTE RESPONDENT BACK TO PREVIOUS SCREEN.

• IF = 2, SET ANSWER TO PREVIOUS QUESTION AS = -1 (“REFUSED”).

• IF = 3, SET ANSWER TO PREVIOUS QUESTION AS = -2 (“DON’T KNOW”).

INTERVIEWER INSTRUCTIONS

• LAUNCH CASI MODULE AND THEN SET UP PARTICIPANT SO THEY ARE SITTING DOWN IN FRONT OF THE COMPUTER SCREEN.

• AFTER CASI HAS STARTED, TURN THE TABLET TOWARDS THE PARTICIPANT AND ASSIST WITH PRACTICE QUESTIONS IF NEEDED.

• EXPLAIN CASI SAQ TO PARTICIPANT AND DEMONSTRATE HOW PARTICIPANT CAN RESPOND TO ITEMS USING THE COMPUTER.

PQ02000. We would like to know the extent to which the following statements describe your relationship.  In the first column, please write the number (0-4) from the following scale which best describes how true each statement is of your relationship AT PRESENT. In the second column, write the number which best describes how true each statement is of your relationship AS YOU WOULD LIKE IT TO BE.

 

 

            0                1              2             3              4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

PQ03000. My partner listens to me when I need someone to talk to.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(LISTENS_NOW) At present:

 

                              |_____|

(LISTENS_WISH) As I’d like it to be:

                            |_____|

PQ04000. We enjoy spending time with other couples.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981).Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy,1, 47-60.

(COUPLES_NOW) At present:

 

                              |_____|

(COUPLES_WISH) As I’d like it to be:

                            |_____|

PQ05000. I am satisfied with our sex life.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(SATISFIED_NOW) At present:

                              |_____|

(SATISFIED_WISH ) As I’d like it to be:

 

                              |_____|

PQ06000. My partner helps me clarify my thoughts.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(CLARIFY_NOW) At present:

                              |_____|

(CLARIFY_WISH) As I’d like it to be:

 

                              |_____|

PQ07000. We enjoy the same recreational activities.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(RECREATION_NOW) At present:

 

                              |_____|

(RECREATION_WISH) As I’d like it to be:

                            |_____|

PQ08000. I can state my feelings without him/her getting defensive.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(DEFENSIVE_NOW) At present:

 

                              |_____|

(DEFENSIVE_WISH) As I’d like it to be:

                            |_____|

PQ09000. We usually “keep to ourselves.”

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(KEEPSELVES_NOW) At present:

 

                              |_____|

(KEEPSELVES_WISH ) As I’d like it to be:

                            |_____|

PQ10000. I feel our sexual activity is just routine.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(ROUTINE_NOW) At present:

 

                              |_____|

(ROUTINE_WISH) As I’d like it to be:

                            |_____|

PQ11000. When it comes to having a serious discussion itseems that we have little in common.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(COMMON_NOW) At present:

 

                              |_____|

(COMMON_WISH ) As I’d like it to be:

                            |_____|

PQ12000. I share in very few of my partner’s interests.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(INTERESTS_NOW) At present:

 

                              |_____|

(INTERESTS_WISH) As I’d like it to be:

                            |_____|

PQ13000. There are times when I do not feel a great dealof love and affection for my partner.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(TIMES_NOW) At present:

 

                              |_____|

(TIMES_WISH) As I’d like it to be:

                            |_____|

PQ14000. I often feel distant from my partner.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(DISTANT_NOW) At present:

 

                              |_____|

(DISTANT_WISH) As I’d like it to be:

                            |_____|

PQ15000. We have very few friends in common.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(FEW_FRIENDS_NOW) At present:

 

                              |_____|

(FEW_FRIENDS_WISH ) As I’d like it to be:

                            |_____|

PQ16000. I am able to tell my partner when I want sexualintercourse.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(ABLE_TELL_NOW) At present:

 

                              |_____|

(ABLE_TELL_WISH) As I’d like it to be:

                            |_____|

PQ17000. I feel “put-down” in a serious conversation withmy partner.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer,M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory.Journal of Marital and Family Therapy, 1, 47-60.

(PUT_DOWN_NOW) At present:

 

                              |_____|

(PUT_DOWN_WISH) As I’d like it to be:

                            |_____|

PQ18000. We like playing together.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(PLAY_NOW) At present:

 

                              |_____|

(PLAY_WISH) As I’d like it to be:

                            |_____|

PQ19000. Every new thing that I have learned about my partner has pleased me.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(NEW_THINGS_NOW) At present:

 

                              |_____|

(NEW_THINGS_WISH) As I’d like it to be:

                            |_____|

PQ20000. My partner can really understand my hurts and joys.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing

intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(UNDERSTAND_NOW) At present:

 

                              |_____|

(UNDERSTAND_WISH ) As I’d like it to be:

                            |_____|

PQ21000. Having time together with friends is an important part of our shared activities.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(SHARE_FRIENDS_NOW) At present:

 

                              |_____|

(SHARE_FRIENDS_WISH) As I’d like it to be:

                            |_____|

PQ22000. I hold back my sexual interest because my partner makes me feel uncomfortable.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(HOLD_BACK_NOW) At present:

 

                              |_____|

(HOLD_BACK_WISH) As I’d like it to be:

                            |_____|

PQ23000. I feel it is useless to discuss some things with my partner.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(USELESS_NOW) At present:

 

                              |_____|

(USELESS_WISH) As I’d like it to be:

                            |_____|

PQ24000. We enjoy the out-of-doors together.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(OUTDOORS_NOW) At present:

 

                              |_____|

(OUTDOORS_WISH ) As I’d like it to be:

                            |_____|

PQ25000. My partner and I understand each other completely.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(COMPLETE_NOW) At present:

 

                              |_____|

(COMPLETE_WISH) As I’d like it to be:

                            |_____|

PQ26000. I feel neglected at times by my partner.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(NEGLECT_NOW) At present:

 

                              |_____|

(NEGLECT_WISH ) As I’d like it to be:

                            |_____|

PQ27000. Many of my partner’s closest friends are also my closest friends.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(CLOSE_FRIENDS_NOW) At present:

 

                              |_____|

(CLOSE_FRIENDS_WISH) As I’d like it to be:

                            |_____|

PQ28000. Sexual expression is an essential part of our relationship.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(EXPRESSION_NOW) At present:

 

                              |_____|

(EXPRESSION_WISH) As I’d like it to be:

                            |_____|

PQ29000. My partner frequently tries to change my ideas.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(CHANGE_IDEAS_NOW) At present:

 

                              |_____|

(CHANGE_IDEAS_WISH) As I’d like it to be:

                            |_____|

PQ30000. We seldom find time to do fun things together.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(FUN_NOW) At present:

 

                              |_____|

(FUN_WISH) As I’d like it to be:

                            |_____|

PQ31000. I don’t think anyone could possibly be happier than my partner and I when we are with one another.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(HAPPY_NOW) At present:

 

                              |_____|

(HAPPY_WISH) As I’d like it to be:

 

                            |_____|

PQ32000. I sometimes feel lonely when we’re together.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(LONELY_NOW) At present:

 

                              |_____|

(LONELY_WISH) As I’d like it to be:

 

                            |_____|

PQ33000. My partner disapproves of some of my friends.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(DISAPPROVES_NOW) At present:

 

                              |_____|

(DISAPPROVES_WISH) As I’d like it to be:

 

                            |_____|

PQ34000. My partner seems disinterested in sex.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(DISINTERESTED_NOW) At present:

 

                              |_____|

(DISINTERESTED_WISH) As I’d like it to be:

 

                            |_____|

PQ35000. We have an endless number of things to talk about.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(ENDLESS_NOW) At present:

 

                              |_____|

(ENDLESS_WISH) As I’d like it to be:

 

                            |_____|

PQ36000. I think that we share some of the same interests.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(SHARE_NOW) At present:

 

                              |_____|

(SHARE_WISH) As I’d like it to be:

 

                            |_____|

PQ37000. I have some needs that are not being met by my relationship.

 

 

            0                1               2            3               4

  .………...|……………..….|…………………|………………|……………….|….….….

Not at all true                  Somewhat true         Completely true

SOURCE

Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The PAIR Inventory. Journal of Marital and Family Therapy, 1, 47-60.

(NEEDS_UNMET_NOW) At present:

 

                              |_____|

(NEEDS_UNMET_WISH) As I’d like it to be:

 

                            |_____|

(TIME_STAMP_PQ_ET).

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