A Clinical Worksheet for Couples
You may print this page or complete it on screen. Complete your section separately from your partner, then share.
How to Use This Worksheet
Complete this worksheet separately, then share your responses with one another. Work through each section in sequence. There are no right answers — only honest ones. If a section feels activating, pause, breathe, and return to it when you feel more settled.
This worksheet is a reflective tool, not a substitute for clinical therapy. If you are working with a therapist, bring your completed worksheets to your next session.
Part One: Mapping Your Position in the Vessel
Before we can work with a pattern, we must be able to name it honestly. Read the descriptions below and reflect on which resonates most closely with your usual experience in the relationship — not in your best moments, but under pressure.
Part Two: The State of Your Vessel’s Compartments
A healthy relationship maintains distinct, sealed compartments. Circle the current condition of each below, then use the space provided to note where the most urgent leaks are occurring.
| Compartment | Current Status | Where is the leak? What specific issue is flooding this space? |
|---|---|---|
| The Emotional / Intimate Bond |
SecureStrainedFlooded
|
|
| The Erotic / Libidinal Connection |
SecureStrainedFlooded
|
|
| Co-Parenting Alliance |
SecureStrainedFlooded
|
|
| Domestic & Administrative |
SecureStrainedFlooded
|
|
| Financial Partnership |
SecureStrainedFlooded
|
Part Three: Your Somatic Early-Warning System
Learning to recognise your body’s signals before the pattern becomes entrenched is one of the most valuable capacities you can develop. Answer the following from direct bodily experience — not conceptually.
Part Four: Practising the Relational Handshake
Choose a real, recent disagreement — ideally one that felt unresolved. Use the five-step protocol below to revisit it, this time as Observers rather than Participants. Complete this section individually first, then compare.
| # | Stage | Your reflection on this exchange |
|---|---|---|
| 1 | Decode the Ego State | Looking back, which Ego State was your partner speaking from? Which were you speaking from? What clues — tone, language, body language — tell you this? |
| ↳ | Your response: | |
| 2 | Receive Without Defending | At what point did you stop truly listening and begin preparing your defence? What triggered the shift? |
| ↳ | Your response: | |
| 3 | Mirror the Message | Write what you heard your partner actually saying — the emotional content beneath the words: ‘What I heard you saying was that you feel…’ |
| ↳ | Your response: | |
| 4 | Seek Confirmation | If you had reflected this back, do you think your partner would have felt accurately heard? If not, what do you think you missed? |
| ↳ | Your response: | |
| 5 | Reflective Containment | Was there a moment when taking space — genuinely, not as avoidance — might have changed the outcome? What made that feel impossible or unsafe? |
| ↳ | Your response: |
Part Five: Moving Towards the Adult Position
The most demanding — and most freeing — part of this work is the act of conscious movement away from the familiar position. Answer the following honestly.
A Note for Your Next Session
If you are working with a therapist, bring both completed worksheets to your session. Notice where your responses diverge — these divergences are not problems; they are the material. Notice too what felt impossible to write, or what you wrote and then crossed out. These instincts carry important clinical information.
If you would like to begin working with Ari Sotiriou, please contact: enquiries@online-therapy-clinic.com
All consultations take place via live video in a secure, confidential setting. Sessions are available for individuals and couples across the UK and internationally.
© Ari Sotiriou MA PGDip | UKCP Accredited | For personal therapeutic use only. Not for reproduction.