Love Extinguishers Questionnaire Form

Date

Month Day Year

Full Name

First Name Last Name

E-mail (we'll send you a copy of your responses)

SCOREKEEPER–Does your spouse keep track of who “won” or who has done the chore more times? Does your marriage feel like a competition?
How often does your spouse do this extinguisher? 1=EVERY DAY!! 2=Often 3=Neutral 4=Rarely 5=EXTREMELY rarely!

	1	2	3	4	5

1 is Worst, 5 is Best

SCOREKEEPER - How much does this extinguish your love for your spouse? 1=VERY MUCH! 2=Some 3=Neutral 4=Very little 5=NONE at all

	1	2	3	4	5

1 is Worst, 5 is Best

FAULT FINDER–Does your spouse make a practice of discovering your faults and then pointing them out to you over and over? Criticize everything you do?
How often does your spouse do this extinguisher? 1=EVERY DAY!! 2=Often 3=Neutral 4=Rarely 5=EXTREMELY rarely!

	1	2	3	4	5

1 is Worst, 5 is Best

FAULT FINDER - How much does this extinguish your love for your spouse? 1=VERY MUCH! 2=Some 3=Neutral 4=Very little 5=NONE at all

	1	2	3	4	5

1 is Worst, 5 is Best

MY WAY OR THE HIGHWAY (CONTROLLING)-Does your spouse manipulate every situation to their benefit? Center your existence around them? Tell you where you can and can not go, for how long, and with whom?
How often does your spouse do this extinguisher? 1=EVERY DAY!! 2=Often 3=Neutral 4=Rarely 5=EXTREMELY rarely!

	1	2	3	4	5

1 is Worst, 5 is Best

CONTROLLING - How much does this extinguish your love for your spouse? 1=VERY MUCH! 2=Some 3=Neutral 4=Very little 5=NONE at all

	1	2	3	4	5

1 is Worst, 5 is Best

BOTTOMLESS PIT (ENOUGH IS NEVER ENOUGH)–No matter what you do to try to please your spouse, do they want more? Are they unable to express gratitude or pleasure?
How often does your spouse do this extinguisher? 1=EVERY DAY!! 2=Often 3=Neutral 4=Rarely 5=EXTREMELY rarely!

	1	2	3	4	5

1 is Worst, 5 is Best

BOTTOMLESS PIT - How much does this extinguish your love for your spouse? 1=VERY MUCH! 2=Some 3=Neutral 4=Very little 5=NONE at all

	1	2	3	4	5

1 is Worst, 5 is Best

WILL NOT FORGIVE–Did you do something wrong a long time ago, and they are STILL holding it over your head ? Even if you do everything they tell you, they never let you off the hook?
How often does your spouse do this extinguisher? 1=EVERY DAY!! 2=Often 3=Neutral 4=Rarely 5=EXTREMELY rarely!

	1	2	3	4	5

1 is Worst, 5 is Best

WILL NOT FORGIVE - How much does this extinguish your love for your spouse? 1=VERY MUCH! 2=Some 3=Neutral 4=Very little 5=NONE at all

	1	2	3	4	5

1 is Worst, 5 is Best

LACK OF PERSONAL TRANSPARENCY–Does your spouse hide their cell phone from you and close the screen on their PC when you walk in the room? Do they keep you at arm's length and hide themselves and their life from you?
How often does your spouse do this extinguisher? 1=EVERY DAY!! 2=Often 3=Neutral 4=Rarely 5=EXTREMELY rarely!

	1	2	3	4	5

1 is Worst, 5 is Best

LACK OF PERSONAL TRANSPARENCY - How much does this extinguish your love for your spouse? 1=VERY MUCH! 2=Some 3=Neutral 4=Very little 5=NONE at all

	1	2	3	4	5

1 is Worst, 5 is Best

SMOKE AND MIRRORS–Does you spouse give you false information with the express intent of making you doubt yourself, your memory or your sanity?
How often does your spouse do this extinguisher? 1=EVERY DAY!! 2=Often 3=Neutral 4=Rarely 5=EXTREMELY rarely!

	1	2	3	4	5

1 is Worst, 5 is Best

SMOKE AND MIRRORS - How much does this extinguish your love for your spouse? 1=VERY MUCH! 2=Some 3=Neutral 4=Very little 5=NONE at all

	1	2	3	4	5

1 is Worst, 5 is Best

DISRESPECTFUL JUDGEMENTS–Does your spouse act like they are "straightening you out"? Do they lecture you instead of discussing respectfully? Are you afraid to discuss your point of view with your spouse?
How often does your spouse do this extinguisher? 1=EVERY DAY!! 2=Often 3=Neutral 4=Rarely 5=EXTREMELY rarely!

	1	2	3	4	5

1 is Worst, 5 is Best

DISRESPECTFUL JUDGEMENTS - How much does this extinguish your love for your spouse? 1=VERY MUCH! 2=Some 3=Neutral 4=Very little 5=NONE at all

	1	2	3	4	5

1 is Worst, 5 is Best

NO TENDER TOUCH--Does your spouse touch you in affectionate but non-sexual ways, like hugs, kisses, holding hands or cuddling?
How often does your spouse do this extinguisher? 1=EVERY DAY!! 2=Often 3=Neutral 4=Rarely 5=EXTREMELY rarely!

	1	2	3	4	5

1 is Worst, 5 is Best

NO TENDER TOUCH - How much does this extinguish your love for your spouse? 1=VERY MUCH! 2=Some 3=Neutral 4=Very little 5=NONE at all

	1	2	3	4	5

1 is Worst, 5 is Best

Are you touched in ways that you like?

Yes Sometimes No

TENDER TOUCH - How much do you need to be touched? 1=NOT at all 2=Take it or leave it 3=Neutral 4=I need it! 5=HUGE need!!

	1	2	3	4	5

1 is Worst, 5 is Best

TENDER TOUCH - How well does your spouse fill this need? 1=NOT at all 2=Very little 3=Neutral 4=Some 5=VERY MUCH!!

	1	2	3	4	5

1 is Worst, 5 is Best

WITHHOLDING SEXUAL FULFILLMENT–Within the marriage is the only MORAL place for a man and woman to express themselves sexually. Does your spouse reject you sexually? Have an excuse every day for not having sex? Or when they do, they lay there like a dead fish?
How often does your spouse do this extinguisher? 1=EVERY DAY!! 2=Often 3=Neutral 4=Rarely 5=EXTREMELY rarely!

	1	2	3	4	5

1 is Worst, 5 is Best

WITHHOLDING SEX - How much does this extinguish your love for your spouse? 1=VERY MUCH! 2=Some 3=Neutral 4=Very little 5=NONE at all

	1	2	3	4	5

1 is Worst, 5 is Best

Is the sexual activity in your marriage the way that you like?

Yes Sometimes No

SEXUAL FULFILLMENT - How much do you need sexual fulfillment? 1=NOT at all 2=Take it or leave it 3=Neutral 4=I need it! 5=HUGE need!!

	1	2	3	4	5

1 is Worst, 5 is Best

SEXUAL FULFILLMENT - How well does your spouse fill this need? 1=NOT at all 2=Very little 3=Neutral 4=Some 5=VERY MUCH!!

	1	2	3	4	5

1 is Worst, 5 is Best

ABANDONING PHYSICAL ATTRACTIVENESS–Are you physically attracted to your spouse (their hair, their body, their grooming and their clothing)?
How often does your spouse do this extinguisher? How often does your spouse do this extinguisher?

	1	2	3	4	5

1 is Worst, 5 is Best

ABANDONING PHYSICAL ATTRACTIVENESS - How much does this extinguish your love for your spouse? 1=VERY MUCH! 2=Some 3=Neutral 4=Very little 5=NONE at all

	1	2	3	4	5

1 is Worst, 5 is Best

ONGOING UNEMPLOYMENT THAT IS NOT PART OF A MUTUAL UNDERSTANDING–Was your spouse employed when you met and contributing to the household financially, but once they got laid off now all they do is sleep until noon, play video games or watch Maury, and send out one resume a week?
How often does your spouse do this extinguisher? 1=EVERY DAY!! 2=Often 3=Neutral 4=Rarely 5=EXTREMELY rarely!

	1	2	3	4	5

1 is Worst, 5 is Best

ONGOING UNEMPLOYMENT - How much does this extinguish your love for your spouse? 1=VERY MUCH! 2=Some 3=Neutral 4=Very little 5=NONE at all

	1	2	3	4	5

1 is Worst, 5 is Best

UNWILLING/UNABLE TO LIVE BY A BUDGET–Have you and your spouse gone over the finances, agreed to a budget, and then you found your spouse went on a shopping spree anyway or bought a toy you just could not afford?
How often does your spouse do this extinguisher? How often does your spouse do this extinguisher?

	1	2	3	4	5

1 is Worst, 5 is Best

WON'T LIVE BY THE BUDGET - How much does this extinguish your love for your spouse? 1=VERY MUCH! 2=Some 3=Neutral 4=Very little 5=NONE at all

	1	2	3	4	5

1 is Worst, 5 is Best

HIDDEN DEBT–Has your spouse taken out a credit card without telling you and run it all the way up? Have they got hidden creditors that keep jumping out and surprising you?
How often does your spouse do this extinguisher? 1=EVERY DAY!! 2=Often 3=Neutral 4=Rarely 5=EXTREMELY rarely!

	1	2	3	4	5

1 is Worst, 5 is Best

HIDDEN DEBT - How much does this extinguish your love for your spouse? 1=VERY MUCH! 2=Some 3=Neutral 4=Very little 5=NONE at all

	1	2	3	4	5

1 is Worst, 5 is Best

HIDDEN SPENDING OR OVERSPENDING–Has your spouse bought a whole new wardrobe and then brought it into the house piece by piece so you wouldn't notice? Or bought a new "truck" even though you are on the edge of bankruptcy?
How often does your spouse do this extinguisher? 1=EVERY DAY!! 2=Often 3=Neutral 4=Rarely 5=EXTREMELY rarely!

	1	2	3	4	5

1 is Worst, 5 is Best

HIDDEN SPENDING/OVERSPENDING - How much does this extinguish your love for your spouse? 1=VERY MUCH! 2=Some 3=Neutral 4=Very little 5=NONE at all

	1	2	3	4	5

1 is Worst, 5 is Best

I.R.S. OR LEGAL FINANCIAL TROUBLE (JUDGEMENTS, LIENS, ETC.)
How often does your spouse do this extinguisher? 1=EVERY DAY!! 2=Often 3=Neutral 4=Rarely 5=EXTREMELY rarely!

	1	2	3	4	5

1 is Worst, 5 is Best

I.R.S OR LEGAL FINANCIAL TROUBLE - How much does this extinguish your love for your spouse? 1=VERY MUCH! 2=Some 3=Neutral 4=Very little 5=NONE at all

	1	2	3	4	5

1 is Worst, 5 is Best

REFUSING TO LEAVE AND CLEAVE-Is your husband still a 'Mama's Boy'' or does your wife still run to her Mommy every time you two disagree? Are your In-Laws always in your business?
How often does your spouse do this extinguisher? 1=EVERY DAY!! 2=Often 3=Neutral 4=Rarely 5=EXTREMELY rarely!

	1	2	3	4	5

1 is Worst, 5 is Best

REFUSING TO LEAVE AND CLEAVE - How much does this extinguish your love for your spouse? 1=VERY MUCH! 2=Some 3=Neutral 4=Very little 5=NONE at all

	1	2	3	4	5

1 is Worst, 5 is Best

NOT MAKING TIME FOR PERSONAL ADULT TIME (INCLUDING RECREATION)-Does your spouse go to the gym, PTA, board meetings, church activities, and out with their friends...but make no time for you?
How often does your spouse do this extinguisher? 1=EVERY DAY!! 2=Often 3=Neutral 4=Rarely 5=EXTREMELY rarely!

	1	2	3	4	5

1 is Worst, 5 is Best

NOT MAKING PERSONAL ADULT TIME - How much does this extinguish your love for your spouse? 1=VERY MUCH! 2=Some 3=Neutral 4=Very little 5=NONE at all

	1	2	3	4	5

1 is Worst, 5 is Best

NOT MAKING TIME FOR THE KIDS (CHILD REARING)--Does your spouse have so many activities so that they are neglecting spending time with the children? How often does your spouse do this extinguisher? 1=EVERY DAY!! 2=Often 3=Neutral 4=Rarely 5=EXTREMELY rarely!

	1	2	3	4	5

1 is Worst, 5 is Best

NOT MAKING TIME FOR THE KIDS - How much does this extinguish your love for your spouse? 1=VERY MUCH! 2=Some 3=Neutral 4=Very little 5=NONE at all

	1	2	3	4	5

1 is Worst, 5 is Best

INEQUITABLE DISTRIBUTION OF HOUSEHOLD CHORES--Does your spouse expect YOU to do all the household chores (like vacuuming, laundry, dishes and mowing) and never notice or thank you, while they sit and watch TV or relax?
How often does your spouse do this extinguisher? 1=EVERY DAY!! 2=Often 3=Neutral 4=Rarely 5=EXTREMELY rarely!

	1	2	3	4	5

1 is Worst, 5 is Best

INEQUITABLE DISTRIBUTION OF HOUSEHOLD CHORES - How much does this extinguish your love for your spouse? 1=VERY MUCH! 2=Some 3=Neutral 4=Very little 5=NONE at all

	1	2	3	4	5

1 is Worst, 5 is Best

GETTING TOO COMFORTABLE AND GIVING UP-Has your spouse gotten lax and won't put any effort into the family, the marriage, themselves or life? Are they a slug that just sits there and won't interact?
How often does your spouse do this extinguisher? 1=EVERY DAY!! 2=Often 3=Neutral 4=Rarely 5=EXTREMELY rarely!

	1	2	3	4	5

1 is Worst, 5 is Best

GETTING TOO COMFORTABLE AND GIVING UP - How much does this extinguish your love for your spouse? 1=VERY MUCH! 2=Some 3=Neutral 4=Very little 5=NONE at all

	1	2	3	4	5

1 is Worst, 5 is Best

IRRITATING HABITS (DISCOURTEOUS)–Does your spouse chew her food with her mouth open? Leave stuff all over the counters? Make piles all over the house? Interrupt you?
How often does your spouse do this extinguisher? 1=EVERY DAY!! 2=Often 3=Neutral 4=Rarely 5=EXTREMELY rarely!

	1	2	3	4	5

1 is Worst, 5 is Best

IRRITATING HABITS - How much does this extinguish your love for your spouse? 1=VERY MUCH! 2=Some 3=Neutral 4=Very little 5=NONE at all

	1	2	3	4	5

1 is Worst, 5 is Best

INDEPENDENT BEHAVIOR–Does your spouse ignore your thoughts and interests, and just do what they want to do? Do they have their own set of friends and do their own activities that EXCLUDE YOU?
How often does your spouse do this extinguisher? 1=EVERY DAY!! 2=Often 3=Neutral 4=Rarely 5=EXTREMELY rarely!

	1	2	3	4	5

1 is Worst, 5 is Best

INDEPENDENT BEHAVIOR - How much does this extinguish your love for your spouse? 1=VERY MUCH! 2=Some 3=Neutral 4=Very little 5=NONE at all

	1	2	3	4	5

1 is Worst, 5 is Best

NOT SHARING ACTIVITIES OR FREE TIME TOGETHER (NO RECREATION)-Does your spouse sit at home like a lump and ignore you? Does your spouse ignore your need to occasionally see another living being? Does your spouse refuse have any couple friends or do anything with you that you both enjoy?
How often does your spouse do this extinguisher? 1=EVERY DAY!! 2=Often 3=Neutral 4=Rarely 5=EXTREMELY rarely!

	1	2	3	4	5

1 is Worst, 5 is Best

NO FREE TIME TOGETHER - How much does this extinguish your love for your spouse? 1=VERY MUCH! 2=Some 3=Neutral 4=Very little 5=NONE at all

	1	2	3	4	5

1 is Worst, 5 is Best

THE SILENT TREATMENT OR NOT LISTENING ACTIVELY–Does your spouse give you the cold shoulder for DAYS ON END? Do you talk to them and they ignore you? Do they let you talk but you can tell they are just planning what they are going to say and not really listening at all?
How often does your spouse do this extinguisher? 1=EVERY DAY!! 2=Often 3=Neutral 4=Rarely 5=EXTREMELY rarely!

	1	2	3	4	5

1 is Worst, 5 is Best

THE SILENT TREATMENT - How much does this extinguish your love for your spouse? 1=VERY MUCH! 2=Some 3=Neutral 4=Very little 5=NONE at all

	1	2	3	4	5

1 is Worst, 5 is Best

NOT BEING A SAFE HAVEN–Can you be your True Self with your spouse and know that you are safe and loved and accepted? When you come to your spouse for support or comfort during a time of vulnerability do they add to the hurt?
How often does your spouse do this extinguisher? 1=EVERY DAY!! 2=Often 3=Neutral 4=Rarely 5=EXTREMELY rarely!

	1	2	3	4	5

1 is Worst, 5 is Best

NOT BEING A SAFE HAVEN - How much does this extinguish your love for your spouse? 1=VERY MUCH! 2=Some 3=Neutral 4=Very little 5=NONE at all

	1	2	3	4	5

1 is Worst, 5 is Best

ANGRY EXPLOSIONS-Does your spouse ramp up a disagreement until there is yelling and an explosion? Do they try to 'hurt you back' or punish you for hurting them? Does your spouse rage at you?
How often does your spouse do this extinguisher? 1=EVERY DAY!! 2=Often 3=Neutral 4=Rarely 5=EXTREMELY rarely!

	1	2	3	4	5

1 is Worst, 5 is Best

ANGRY EXPLOSIONS - How much does this extinguish your love for your spouse? 1=VERY MUCH! 2=Some 3=Neutral 4=Very little 5=NONE at all

	1	2	3	4	5

1 is Worst, 5 is Best

ATTACK DOG (VERBAL/EMOTIONAL ABUSE)–Does your spouse "go for the jugular" in a particularly cruel way? Do they use words to just lay you to waste? Do they emotionally DESTROY you just for disagreeing with them?
How often does your spouse do this extinguisher? 1=EVERY DAY!! 2=Often 3=Neutral 4=Rarely 5=EXTREMELY rarely!

	1	2	3	4	5

1 is Worst, 5 is Best

ATTACK DOG (VERBAL/EMOTIONAL ABUSE) - How much does this extinguish your love for your spouse? 1=VERY MUCH! 2=Some 3=Neutral 4=Very little 5=NONE at all

	1	2	3	4	5

1 is Worst, 5 is Best

PASSIVE WARMONGER (PASSIVE-AGGRESSIVE)–Does your spouse always say they "forgot" to the the things they agreed to do? Do they say nasty things about you and then say "It was just a joke!"
How often does your spouse do this extinguisher? 1=EVERY DAY!! 2=Often 3=Neutral 4=Rarely 5=EXTREMELY rarely!

	1	2	3	4	5

1 is Worst, 5 is Best

PASSIVE WARMONGER - How much does this extinguish your love for your spouse? 1=VERY MUCH! 2=Some 3=Neutral 4=Very little 5=NONE at all

	1	2	3	4	5

1 is Worst, 5 is Best

PHYSICAL ABUSE–Physical abuse isn't always "hitting you." Has your spouse ever THREATENED a pet? Punched the wall right near your head? Grabbed you? Pushed you? Kept you awake all night arguing? Thrown something at you? Attacked you with a knife or knitting needles or scissors? Stood in the way so you couldn't leave?
How often does your spouse do this extinguisher? 1=EVERY DAY!! 2=Often 3=Neutral 4=Rarely 5=EXTREMELY rarely!

	1	2	3	4	5

1 is Worst, 5 is Best

How much does this extinguish your love for your spouse? 1=VERY MUCH! 2=Some 3=Neutral 4=Very little 5=NONE at all

	1	2	3	4	5

1 is Worst, 5 is Best

Love Extinguishers Questionnaire

Emotional Neglect

Spiritual Neglect

Physical Neglect

Financial Neglect

Family Neglect

Social Neglect

Security Neglect