The following assessment has 38 questions. Once you have
responded, you will be given an idea of what process is appropriate in your
case and an estimated cost. Please respond to all questions if children are
involved. If no children are involved, you may skip questions 33 through 38.
Where are you in the separation
process?
Moved into separate residences
more than six months ago
Moved into separate residences
more than two months ago, but less than six months ago
Moved into separate residences
within the last two months
Still living together, but have
a plan for separating
Still living together, having
trouble deciding how to separate
2.
How comfortable are you
discussing difficult issues about issues surrounding the separation with your
spouse?
I am completely comfortable
talking about issues with my spouse
I am mostly comfortable talking
about issues with my spouse, but some issues are difficult
I am somewhat comfortable
talking about issues with my spouse, but many issues are difficult
I am not comfortable talking
about issues with my spouse
I cannot talk about separation
with my spouse
3.
How comfortable is your spouse
discussing difficult issues about separating with you?
My spouse is completely
comfortable talking about issues with me
My spouse is mostly comfortable
talking about issues with me, but some issues are difficult
My spouse is somewhat
comfortable talking about issues with me, but many issues are difficult
My spouse is not comfortable
talking about issues with me
My spouse cannot talk about
separation with me
4.
What is the level of conflict
between you and your spouse in the last three months?
Overall our conversations have
been calm and rational
We have had more than one, but
fewer than three heated conversations in which emotions ran high
We have had more than three, but
fewer than six heated conversations in which emotions ran high
We have had more than six heated
conversations in which emotions ran high
We cannot talk without fighting
How well have you and your
spouse been cooperating in the last three months?
We cooperate well
We cooperate most of the time
We cooperate some of the time
Cooperation is rare
No cooperation is possible
6.
How well have you and your
spouse been communicating in the last three months?
We communicate easily and can
talk freely about anything
We communicate well most of the
time, but sometimes have misunderstandings
We communicate with some
difficulty, and some subjects lead to arguments
We seldom communicate without an
argument or misunderstanding
We are not talking
How would you describe your over
all ability to communicate effectively during the entire marriage?
We have generally communicated
well
We communicated well with
occasional misunderstandings
We communicated with some
difficulty and had arguments frequently
We seldom communicated without
an argument or misunderstanding
We stopped communicating at some
point in our marriage
How would you describe your
current level of trust in your spouse?
I trust my spouse in all matters
of importance
I trust my spouse in most things
I have little or no trust in my
spouse
How would you describe your
level of trust in general throughout your marriage?
I had trusted my spouse in all
matters of importance
I generally trusted my spouse,
but not always
I have not been able to trust my
spouse throughout the marriage
How would your spouse describe
his or her current level of trust in you?
My spouse trusts me in all
matters of importance
My spouse trusts me in most
things
My spouse has little or no trust
in me
11.
How would your spouse describe
his or her level of trust in you in general throughout your marriage?
My spouse had trusted me in all
matters of importance
My spouse trusted me in most
things
My spouse has never had much
trust in me
How important is it to you that
you and your spouse maintain a relationship with trust into the future?
Trust is important to me into
the future
Trust is not important to me as
long as we can maintain a business-like relationship
I do not care about trusting my
spouse into the future
Do you know or suspect your
spouse of infidelity (having an affair)?
No
Yes
Does
your spouse know or suspect you of infidelity (having an affair)?
No
Yes
Are there matters other than
infidelity that may be relevant to your separation or divorce that you do not
wish to share with your spouse?
No
Yes
16.
Do either you or your spouse
have a history of clinical depression, personality disorder, or mental
illness?
No
Yes, but we both agree that it
is in the past and has no impact on current functioning
Yes, but it is being treated,
and we both agree that it will have only a minor impact on our parenting
arrangement after separation or divorce
Yes, it will be a significant
issue with respect to our parenting arrangement.
Yes, it will make reaching a
parenting arrangement very difficult
17.
Do you have concerns about
substance abuse by your spouse? (alcohol, drugs, prescription medications)
No, I have no concerns about
substance abuse
I have no current concerns,
except that a former substance abuse problem might reoccur
I have current concerns, but my
spouse is in treatment
I have current concerns about
substance abuse, but my spouse would deny that his use impacts his parenting
ability
My spouse
has a severe and ongoing substance abuse problem
18.
Does your spouse have concerns
about substance abuse by you? (alcohol, drugs, prescription medications)
No, my spouse has no concerns
about substance abuse by me
My spouse has no current
concerns, except that a former substance abuse problem might reoccur
My spouse has no current
concerns, but I am in treatment
My spouse has current concerns
about substance abuse, but they are unfounded
My spouse thinks that I have an
ongoing substance abuse problem that impairs my ability to parent, but I am
not impaired in my ability to parent
Have either you or your spouse
reported a domestic violence incident to the police or the courts?
No
Yes
Has your spouse ever hit you or
otherwise tried to physically hurt you?
No
Yes
Have you ever hit or otherwise
tried to physically hurt your spouse?
No
Yes
Do you have concerns that your
spouse may behave violently toward you.
No
Yes
Has your spouse hired an
attorney? (Hired means actually entered into a contract for legal service and
typically means having paid a retainer to cover fees)
No
Yes
24.
Identify the annual salary range
in which your family falls (generally this would be your family's gross total
income as shown on line 22 of a federal Form 1040 tax return)
Below $50,000
Between $50,000 and $74,900
Between $75,000 and $99,900
Between $100,000 and $199,000
Between $200,000 and $499,000
Above $500,000
Do you think your net worth
(yours and your spouse's combined) is greater than $500,000?
No
Yes
Do you think your net worth
(yours and your spouse's combined) is greater than $1,500,000?
No
Yes
27.
Which of the following
statements most closely describes the relationship you and your spouse have
in regard to financial matters?
My spouse and I have shared
equally the responsibility for family finances and are equally comfortable
dealing with money, debts, and investments.
One of us has taken more
responsibility than the other for handling the family money, debts, and
investments, but the other spouse is knowledgeable and comfortable dealing
with these matters.
One of us has taken more
responsibility that the other for handling the family money, debts, and
investments, and the other spouse is not very knowledgeable and is not very
comfortable dealing with these matters.
One of us has taken primary
responsibility for handling the family money, debt, and, investments, and the
other spouse is very uncomfortable that he or she can effectively deal with
these matters.
Only one of us has handled the
family money, debt, and investments, and the other spouse is at a complete
loss to understand it.
28.
Which of the following
statements most closely describes your family's non-mortgage debt obligations
(such as credit cards, personal loans, car loans, medical bills, etc.)?
We pay off our credit cards each
month and carry no debt.
We have some debt that we are
paying, but it is not significant given our income.
We have substantial debt, but it
is manageable given our income.
We
have substantial debt, and we are struggling to make payments.
We are
currently unable to make all of our debt payments.
Do you and/or your spouse have a
family owned business?
No
Yes
Do you and/or your spouse own a
professional practice?
No
Yes
Do you have at least one minor
child?
No
Yes
Do you have any minor children
14 years of age or younger?
No
Yes
33.
Are you or your spouse speaking
negatively about the other in the presence of the minor children (in
connection with the separation or divorce)?
Never
A few times, but not more than
three times
More than three times, but not
more than six times
More than six times
Constantly
34.
Which of the following most
accurately states how important you would say your spouse is to the welfare
of your child or children?
My spouse is very important (has
many valuable things to offer as a parent)
My spouse is important (has some
valuable things to offer as a parent)
My spouse is somewhat important
(has valuable things to offer, but also has some significant limitations or
problems as a parent)
My spouse is not very important
(has little to offer and significant limitations or problems as a parent)
My
spouse has nothing to offer as a parent and has severe problems as a parent
35.
Which of the following most
accurately states how important your spouse would say you are to the welfare
of your child or children (regardless of whether you agree or disagree)?
My spouse would say I am very
important (have many valuable things to offer as a parent)
My spouse would say I am
important (have some valuable things to offer as a parent)
My spouse would say I am
somewhat important (have valuable things to offer, but also have some
significant limitations or problems as a parent)
My spouse would say I am not
very important (have little to offer and significant limitations or problems
as a parent)
My
spouse would say that I have nothing to offer as a parent and have severe
problems as a parent
Has there ever been a reported
instance of possible child abuse/neglect in your home?
No
Yes
Do you or your spouse anticipate
relocating more than 25 miles away?
No
Yes
How would you describe the
compatibility of the parenting styles you and your spouse each prefer?
We generally agree on what rules
to establish for children, how to discipline children, and when to discipline
children.
We don't always agree on what
rules to establish for children, how to discipline children, and when to
discipline children, but we respect each other's viewpoint and generally
support each other's decisions.
We sometimes disagree on what
rules to establish for children, how to discipline children, and when to
discipline children, and we sometimes seem to work at cross purposes.
We often disagree on what rules
to establish for children, how to discipline children, and when to discipline
children, and we are often at odds over how to best parent children.
We constantly disagree on what
rules to establish for children, how to discipline children, and when to
discipline children and it is a source of major frustration.
