Conflict Behavior Questionnaire
(Adapted from Wolfe, Jaffe, Gough, & Wekerle, 1994)
For this section, we want you to think about what you would do if you had a boyfriend or girlfriend and were angry at them. Please circle your choice for each question.
If you were upset or angry at each other, would you...
 Definitely would Probably would Not sure Probably wouldn't Definitely wouldn't
1. give him/her the "silent treatment" or refuse to talk to him/her for a while). 0 1 2 3 4
2. do something to make her/him feel jealous. 0 1 2 3 4
3. destroy something s/he valued. 0 1 2 3 4
4. tell her/him that you were partly at fault. 0 1 2 3 4
5. explain your feelings rather than just accuse him/her of being wrong. 0 1 2 3 4
6. offer a solution that would make you both happy. 0 1 2 3 4
7.  make fun of him/her in front of others. 0 1 2 3 4
8. use "I statements" to tell her/him how upset you are. 0 1 2 3 4
9. blame him/her for all of your problems. 0 1 2 3 4
10. hit, kick  or or throw something at her/him. 0 1 2 3 4
11. threaten to hit, kick, or throw something at him/her. 0 1 2 3 4
12. hit, kick, or punch something else, like a wall or table. 0 1 2 3 4
13. leave the room to cool down. 0 1 2 3 4
14. deliberately try to frighten her/him 0 1 2 3 4
15. bring up other things about him/her that bother you. 0 1 2 3 4
16. threaten to break up or stop loving him/her. 0 1 2 3 4
17. push, shove, or shake her/him. 0 1 2 3 4
18. yell or scream at him/her 0 1 2 3 4

Relationships Skills Questionnaire
These next questions ask how confident you are in YOUR ability to do each of the following. If you have had a girlfriend or boyfriend, complete this questionnaire with them in mind. If you have not had a girl or boy friend, please complete this questionnaire while thinking of another close relationship (i.e., family member, close friend, etc.).
How good are you at....
 Not 
Good
Poor
OK
Good
Very 
Good
1. dealing with important disagreements openly and directly  1 2 3 4 5
2. openly talking about what you want 1 2 3 4 5
3. telling your partner when you feel hurt or upset with him or her 1 2 3 4 5
4. showing respect to your partner when you disagree with his or her opinions  1 2 3 4 5
5. controlling your temper when your partner is angry at you 1 2 3 4 5
6. accepting criticism from your partner without attacking or challenging them 1 2 3 4 5
7. controlling your temper when you are angry or frustrated with your partner 1 2 3 4 5
8. controlling feelings of jealousy 1 2 3 4 5
9. working out "everyday" problems with your partner 1 2 3 4 5
Justification of Violence Questionnaire
In each of the following situations, would you push, grab, shove, slap, or hit your boyfriend or girlfriend? Please circle your choice for each question.
Would you push, grab, shove, slap, or hit your boyfriend or girlfriend if he/she...
Definitely would
Probably would
Not sure
Probably wouldn't
Definitely wouldn't
1. called you nasty names. 0 1 2 3 4
2. wouldn't leave you alone. 0 1 2 3 4
3. yelled at you. 0 1 2 3 4
4. followed you around when you told him/her not to. 0 1 2 3 4
5. ignored you. 0 1 2 3 4
6. flirted with your best friend. 0 1 2 3 4
7. teased you in front of your friends. 0 1 2 3 4
8. hit or pushed you. 0 1 2 3 4
9. broke up with you. 0 1 2 3 4
10. wouldn't shut up. 0 1 2 3 4
Resources and Help Seeking Questionnaire
If your boyfriend/girlfriend were to ever grab, shove, slap, kick, or punch you at sometime in the future, would you (please circle your choice):
If your boyfriend/girlfriend were to ever grab, shove, slap, kick, or punch you, would you...
Definitely would
Probably would
Not sure
Probably wouldn't
Definitely wouldn't
1. Break up? 0 1 2 3 4
2. Talk to a friend about it? 0 1 2 3 4
3. Talk to a family member or pastor? 0 1 2 3 4
4. Talk to a teacher, doctor, or counselor? 0 1 2 3 4
5. Call the police? 0 1 2 3 4
6. Call a dating or domestic violence hotline to ask for advice? 0 1 2 3 4
Dating Violence Test
1. When people abuse their partners, they are trying to control them.     False  True
2. The effects of emotional abuse can be just as serious as physical abuse.  False True
3. Men can be victims of domestic violence.  False True
4. People who beat their partners are always violent. False True
5. People who don't leave abusive partners want to be hit . False True
6. Once a woman decides to leave an abusive relationship, it is usaully
     easy for her to leave. 		 False True
7. Domestic or dating violence is a criminal offense.     False True
8. Jealousy and uncontrolled anger are two common causes of dating violence.  False True
9. Most victims of serious physical abuse are female. False True
10. If you feel scared, threatened, or controlled by what your partner
      says or does, you are in an abusive relationship.   		 False True
11. It is possible for rape to occur within a marriage.  False True
Violence Supportive Attitudes Questionnaire
The next set of questions ask your opinion about violence. Circle a number 1 through six to indicate how much you agree or disagree with each statement.
Strongly Disagree
Disagree
Slightly Disagree
Slightly Agree
Agree
Strongly Agree
1. Except for self defense, there is never a good reason to be violent with another person. 1 2 3 4 5 6
2. Females should be responsible for raising children and doing the housework. 1 2 3 4 5 6
3. A person who abuses someone while using alcohol or drugs is not responsible for their behavior. 1 2 3 4 5 6
4. Jealousy is a good way to show love. 1 2 3 4 5 6
5. Sometimes, people get so angry that they cannot stop themselves from hitting somebody. 1 2 3 4 5 6
6. It would do some people good to be hit by their partners. 1 2 3 4 5 6
7. There are things I can do to help a friend who is in an abusive relationship. 1 2 3 4 5 6
8. Domestic/dating violence is a crime and should be punished, no matter who does it. 1 2 3 4 5 6
9. I can be non-violent in conflict situations. 1 2 3 4 5 6
10. There are some times when I think I might not be able to keep from hitting someone. 1 2 3 4 5 6
11. Pushing is a form of violence. 1 2 3 4 5 6
12. The Englewood community has at least one agency for preventing dating/domestic violence. 1 2 3 4 5 6


Personal Information
A
B
C
D
E
  • What grade are you in?
 7 8 9 10 11
  • Gender?
 Male Female
  • Have you ever had a dating partner?
 Yes No
  • How many girlfriends/ boyfriends have you had?
 0 1 - 3 4 - 7 8 - 12 More than 12
  • Do you currently have a steady boyfriend or girlfriend?
 Yes No
  • How long have you been dating this person?
 Currently not dating Less than 1 month 1 to 3 months 3 to 8 months More than 8 months
  • How often do you and your partner spend time together all alone?
 Currently not dating Rarely, we're usually with others About once a month About once a week Almost daily


Experience with dating violence
 A B
  • Have you ever felt threatened, humiliated, or controlled by a dating partner?
 Yes No
  • If 'yes', has this happened in the last three months?
 Yes No
  • Have you ever been hit, slapped, kicked or otherwise physically hurt by a dating partner?
 Yes No
  • If 'yes', has this happened in the last three months?
 Yes No
  • Have you ever yelled at, humiliated, or threatened your boyfriend or girlfriend in order to get them to do what you want?
 Yes No
  • If 'yes', has this happened in the last three months?
 Yes No
  • Have you ever hit, slapped, kicked or otherwise physically hurt a dating partner?
 Yes No
  • If 'yes', has this happened in the last three months?
 Yes No