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“ There is a crack in everything. That's where the light gets in. ” - Leonard Cohen

Relationships are right at the heart of human health and wellbeing.  The first four sets of handouts listed below highlight the increased death rates, poorer psychological health and lowered wellbeing in those with worse relationships.  There is a rather confusing plethora of different questionnaires for assessing relationship networks.  I like the large amount of helpful information one can elicit from the "Personal community map" and associated sheets (below).  Sheldon Cohen has argued convincingly that social intimacy, social integration, and social conflict all make independent contributions to our health and wellbeing - we want higher scores for intimacy & integration and (usually) lower scores for conflict.  The community map overall question sheet and the associated brief three question current activities scale help look at all three of these important relationship components.  I use this map to identify both current relationships that can be nourished to increase overall intimacy & integration, and also to clarify when it's important to explore how to add new relationships (& new names onto the map). 

The "Relationship questionnaire" is a further way of assessing these components.  Other examples of quite widely used questionnaires are the "Social adjustment scale", "Significant others scale", and "Relationship table" (see below).  When we look at arguably the two best validated psychotherapies for depression - CBT and IPT - it appears that Interpersonal Psychotherapy focuses on relationships while Cognitive Behavioural Therapy focuses on thoughts and behaviours.  It's not so simple, and there's research suggesting CBT therapists may get better results when they too pay more attention to interpersonal factors.  

Besides these ways of taking an overview of someone's social network, I also regularly assess interpersonal style.  Usually I'll use one of the several versions available of the Inventory of Interpersonal Problems - see the "IIP-48" below.  Often helpful too in understanding interpersonal style are the attachment questionnaires on the Good Knowledge page "Relationships, couples, families & psychosexual" which also lists many other handouts & questionnaires on couples, families, children, abuse, sexuality and related areas.  Further handouts listed below are a couple on "Development & maintenance of distressed states" which can be useful when orientating people to the various parts played by relationships in producing their current state.  There are further information sheets too clarifying the interplay of life events and genetic vulnerability in depression onset, the relevance of abuse, trauma & loss, and the important "Traumatic grief scale".

There are a series of handouts on assertiveness, conflict and authenticity.  There is also one on the costs of excessive self-concealment.  There are also very useful handouts & questionnaires on relationships & wellbeing in the sequence on Self-Determination Theory (SDT) lower down the page on "Wellbeing, time management & self-determination" and in the sequence on coping survey questionnaires & the significant others list on "Depression, CBASP & neuroscience".  Clicking on the tag "Relationships" will link you through to lots of further information and research on relationships also on this website.  Additionally you can go to the "Tag cloud" and search on various other terms like "Bereavement", "Couples", "Family", "Friendship", "Mothers" and so on.    

"Strong relationships increase survival as much as quitting smoking" is a blog post about the extremely important paper "Social Relationships and Mortality Risk: A Meta-analytic Review".  The post is downloadable as a PDF file handout "Relationships & mortality"

Relationship background facts, Powerpoint handout - slides 1-6 illustrate the reduced risk of earlier death for those with better relationship networks and slides 7-12 (although rather dated) illustrate some of the psychological benefits of good relationships both for stress resilience and for wellbeing. 

Relationships are important for our health - I wrote this information leaflet a longish time ago, but it still makes very relevant points. 

Psychological needs & wellbeing 1, Psychological needs & wellbeing 2 (SDT) - I use this handout a lot to introduce discussions on wellbeing and the importance of responding to our key basic psychological needs for Autonomy, Competence & Relatedness.  Try printing them out as a two-slides-to-a-page Powerpoint handout.  For lots more on Self-Determination Theory see the handouts lower down the page at "Wellbeing, time management & self-determination".  

Personal community map - this chart is a helpful way of encouraging people to begin describing their relationships.  It may take an hour or so to fill in properly, but it can then provide a major focus for subsequent therapy.  When handing out this chart, also give the instructions and questions sheets (see below) 

Personal community map instructions - these instructions go with the "Personal community map" (above), explaining how to fill the chart in, and giving background information. 

Personal community map questions - I ask people to answer these questions as they fill in, and after they've filled in, their personal community map (see above).  Their answers help to clarify what they probably need to do to continue building personal relationships that promote health, stress resilience, and wellbeing.

Personal community map activities scale - this set of three quick questions helps monitor week to week relationship involvement.  It links with the personal community map exercise above.  It is downloadable both as a Word doc and as a PDF file.  

Relationship questionnaire & scoring - this is adapted from research showing social support, social integration and social conflict all contribute to self-esteem and health.

Social adjustment scale & instructions - this scale (Weissman et al, 1976) is good.  The SAS is well validated, but I now tend to use the more home-made "Personal community map" (above) in preference as I find the latter leads so naturally to good clinical interventions/personal change work. 

Significant others scale - this scale (Power et al, 1988) has been quite widely used to assess intimacy, practical support and social integration with significant others in one's life. 

Relationship table, sheet 1 & sheet 2 & instructions - this is an interpersonal psychotherapy (IPT) derived way of assessing relationships.

IIP-48 questionnaire & score sheet - I use this questionnaires about characteristic interpersonal style a lot.  To paraphrase Alice Miller and others "The walls we build to protect ourselves, become the prisons in which we live."  This assessment tool highlights and helps track changes in our interpersonal "prison walls."  Spikes further out away from the centre of the score sheet chart highlight aspects of our interpersonal style that are causing us particular problems.  Similarly, scores of "3" or "4" in answer to any of the individual questionnaire items may also benefit from therapeutic attention.

Development & maintenance of distressed states - I use this Powerpoint diagram a lot when discussing with people why they are in a distressed state.  It can be helpful in highlighting the importance of maintaining, precipitating and vulnerability factors - relationships may have a part to play in any of these areas.  I also point out that therapeutic gains can be made working with all three of these general sets of factors - for example, emotional processing work for past experience (both precipitating and vulnerability factors) and more standard cognitive-behavioural approaches for maintaining factors.  For a somewhat more heavily relationship-focussed version of this diagram see "Development & maintenance of relationship difficulties".  

Life events, genetics & depression onset, slides 1 & 2, and slides 3 & 4 - I typically print these slides out (in black & white) to produce two A4 sheets of a 2-slides-to-a-page handout.  They make some very useful points - for example the importance of life events (particularly involving relationships) in the onset of various psychological disorders, and the interaction of life events and genetic vulnerability.

Grief, trauma & abuse - here's a five page information handout I put together on grief, trauma & abuse a number of years ago.  It's dated but still contains much that's informative and accurate.

Traumatic grief inventory & background - after bereavement (and other experiences of loss) people often feel anxious and depressed.  Some people may suffer traumatic grief reactions - similar to posttraumatic stress disorder but characterised more by yearning than fear or avoidance.  This can be an important diagnosis to make as effective treatment may well involve other interventions besides more classic approaches to anxiety and/or depression.  This download includes both the questionnaire and some background information and research abstracts.    

Communication scales - a handout from Carkhuff & Berenson's adaption of the classic Rogerian person-centred triad highlighting key interpersonal qualities in close relationships.

Assertiveness diagram - this slide illustrates the simple, but helpful "Don't be a sledgehammer or a doormat" spectrum model of assertiveness.

There are a series of blog posts on different aspects of interpersonal conflict, several of which are also downloadable as handouts - see, for example, "Conflict: not too much, not too little - some research suggestions", "Conflict: not too much, not too little - and how to make it constructive", "Conflict: not too much, not too little - the importance of assertiveness in close relationships" and "Conflict not too much, not too little - insights from game theory".

Honesty, transparency & confrontation - this interesting 3 page handout describes the emotion-focused therapist Les Greenberg's comments on honesty/authenticity in therapeutic relationships.  His remarks however are also very relevant to other close relationships that are basically supportive but sometimes run into difficulties e.g. couples, families, and friendships. 

Self-concealment scale & related references - this is an interesting questionnaire I use occasionally to highlight the health risks of being to "self-concealing" and "private".  It links in with the overall benefits of intimacy and interpersonal trust.  It links too with the importance of clients feeling they can be really open in the therapeutic relationship.

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