Stepfamily Foundation Research Questionnaire

IMPORTANT

I have previously received counseling from a Certified Stepfamily Foundation counselor or coach.   

Yes No

 

TELL US ABOUT YOU

Here is a list of challenges typically faced by people who live in stepfamily situations.
This should be filled out by each partner separately. After completing the questionaire, you will be contacted by Dr.Jeannette Lofas0

Name:

Date:

Phone Home:

Phone Office:

Cell Phone:

Address:

E-mail address:

Your Occupation

Your Partner's Occupation

Income

 

Your age:

 

Your Partner's age:

Sex: M F

Years of Schooling:

Number of years with your partner:

Dating Living Together Married

1st Marriage 2nd Marriage 3rd Marriage

I am a female who is in my first marriage and married to a man with children.

I am a male who is in my first marriage and married to a woman with children.

Position in the family (You may be more than one)

  • Father

  • Father Who Visits his children

  • Father Whose Children Live w/ Him

  • Stepfather

  • Mother

  • Mother Who Visits her children

  • Dating

  • Engaged

  • Mother Whose Children Live with Her

  • Stepmother

  • M/F Partners with Mutual Child(ren)

  • Grandmother

  • Grandfather

  • Step Grandmother

  • Step Grandfather


Instructions:

Using a scale of 1-5 check a number next to each statement as it applies.

1: strongly true
2: true
3: neutral
4 not true
5: strongly not true


General Questions



1. Overall this is a happy partnership.

1 2 3 4 5

2. We love each other, but our differences over the children are making our relationship difficult.

1 2 3 4 5

3. My expectation was that re-coupling would not be this difficult.

1 2 3 4 5

4. I know a stepfamily just doesn’t always work like a biological family.

1 2 3 4 5

5. I do not know how a stepfamily works.

1 2 3 4 5

6. Knowing who comes first --- the partner or the kids --- is difficult for us.

1 2 3 4 5

7. I am not clear as to what my position and role is in this stepfamily.

1 2 3 4 5

8. The prior spouse is a problem.

1 2 3 4 5

9. We cannot agree on discipline and expected behaviors of the children.

1 2 3 4 5

10. The child(ren)'s visitation causes upsets between us.

1 2 3 4 5

11. Guilt seems to run the biological parent's relationship withhis/her child(ren).

1 2 3 4 5

12. There is so much blaming of each other in the stepfamily.

1 2 3 4 5

13. I feel like an outsider and left out when my partner's kids visit.

1 2 3 4 5

14. My partner's child is misbehaving.

1 2 3 4 5

15. My child misbehaves when my partner is there.

1 2 3 4 5

16. We disagree over money.

1 2 3 4 5

17. Money… we disagree, especially regarding the children.

1 2 3 4 5

18. The ex "badmouths."

1 2 3 4 5

19. As a step mother, and his partner, I feel he does not discipline his children appropriately.

1 2 3 4 5

20. As a step father, and her partner, I feel she does not discipline her children appropriately.

1 2 3 4 5

21. As a step mother, I feel my ideas about rules and the children are not important to my partner.

1 2 3 4 5

22. As a step father, I feel my ideas about rules and the children are not important to my partner.

1 2 3 4 5

23. As a biological father, who’s children visit, I am concerned that they will not want to visit me.

1 2 3 4 5

24. As a biological father, whose children visit, I have difficulties  with rules and discipline.

1 2 3 4 5

25. Our major issue of dispute is the children.

1 2 3 4 5

26. Our major issue of dispute is the ex spouse.

1 2 3 4 5

27. I dislike my stepchild(ren).

1 2 3 4 5

28. I have trouble with my children when they visit.

1 2 3 4 5

29. I lose time at my work due to conflicts over the children.

1 2 3 4 5

30. This family has a negative impact on my work.

1 2 3 4 5

31. I spend more time on the phone regarding concerns with my family.

1 2 3 4 5

32. I use sick days or personal days more than I did before.

1 2 3 4 5

32. The increased demands for time and for my family have impaired my productivity and focus.

1 2 3 4 5

33. I delayed marriage in order to focus on my career.

1 2 3 4 5

34. I never actively or consciously decided to delay marriage but the right man/woman just did not appear.

1 2 3 4 5