Jewish General Hospital Sexual Self-Monitoring Form: Diary Evaluation of Sexual Behavior and Satisfaction

Abstract

The Jewish General Hospital Sexual Self-Monitoring Form (JGH-SSMF), originally documented in its clinical research iterations by Eva Libman, Ilana Spector, Yitzchak M. Binik, William Brender, and Catherine S. Fichten at the SMBD-Jewish General Hospital and McGill University, is a structured, daily diary instrument engineered to assess both behavioral frequencies and qualitative subjective appraisals of human sexual functioning. Developed initially as an empirical monitoring system within a specialized behavioral sex therapy program for secondary orgasmic dysfunction and male erectile disorder (Burstein et al., 1985; Fichten et al., 1983), the instrument fills an essential psychometric void left by traditional retrospective recall questionnaires. Retrospective questionnaires are notoriously vulnerable to cognitive heuristics, recall bias, telescoping, and affective state distortions. The JGH-SSMF employs an ecological momentary assessment (EMA) framework, prompting respondents to record behaviors on an individual, self-administered daily log taking under five minutes to complete.

The form captures a multidimensional profile of sexual expression across eight structured components. It tracks 18 distinct individual and interpersonal sexual activities (categorized into four validated functional clusters: Individual Sexual Activities, Affectional Display, Couple Sexual Noncoital Activities, and Penile-Vaginal Intercourse), alongside quantitative ratings of per-activity enjoyment on a 1-to-10 metric (Scale A). It systematically monitors overall daily sexual experience valence (1 to 5), occurrence and behavioral locus of orgasmic experience, satisfaction with affection received (1 to 5), general feelings toward the intimate partner (1 to 5), and open-ended qualitative reflections intended for clinical integration. Psychometric validation studies demonstrate substantial inter-partner concordance on behavioral frequency counts, nonreactivity across prolonged monitoring durations, and sensitivity to therapeutic intervention in clinical trials. The JGH-SSMF serves as an established standard for tracking treatment compliance, pre-to-post-intervention outcome trajectories, and pharmacological adverse effects, such as antidepressant-induced sexual dysfunction.

Keywords

sexual self-monitoring, sexual behavior diary, ecological momentary assessment, sex therapy outcome, sexual satisfaction, secondary orgasmic dysfunction, erectile dysfunction, inter-partner concordance, behavioral sexology, treatment compliance

Authors

The Jewish General Hospital Sexual Self-Monitoring Form was conceptualized and refined by a prominent cohort of clinical psychologists, sex therapists, and behavioral medicine researchers affiliated with the Behavioral Psychotherapy and Research Unit at the Institute of Community and Family Psychiatry, Sir Mortimer B. Davis-Jewish General Hospital (SMBD-JGH), and McGill University in Montreal, Quebec, Canada:

• Eva Libman, Ph.D. — Behavioral Psychotherapy and Research Unit, Institute of Community and Family Psychiatry, SMBD-Jewish General Hospital; Department of Psychiatry, McGill University, Montreal, Quebec, Canada. Dr. Libman has served as a principal investigator across seminal trials evaluating behavioral treatment regimens for orgasmic and erectile dysfunctions, insomnia, and aging-related behavioral adjustments. Correspondence address: Behavioral Psychotherapy and Research Unit, Institute of Community and Family Psychiatry, SMBD-Jewish General Hospital, 4333 Côte-Sainte-Catherine Road, Montreal, Quebec, Canada H3T 1E4; E-mail: [email protected].
• Ilana Spector, Ph.D. — SMBD-Jewish General Hospital and McGill University, Montreal, Quebec, Canada. Dr. Spector has conducted extensive clinical research into sexual disorders, behavioral assessment protocols, and cognitive-affective profiles of couples presenting for relationship and sex therapy.
• Yitzchak M. Binik, Ph.D. — Department of Psychology, McGill University; Royal Victoria Hospital and SMBD-Jewish General Hospital, Montreal, Quebec, Canada. Renowned internationally for his pioneering research on genital pain syndromes, dyspareunia, provoked vestibulodynia, and human sexual physiology.
• William Brender, Ph.D. — Behavioral Psychotherapy and Research Unit, SMBD-Jewish General Hospital and Department of Psychology, Concordia University / McGill University, Montreal, Quebec, Canada. Co-developer of foundational cognitive-behavioral treatment manuals for orgasmic disorders and erectile failure.
• Catherine S. Fichten, Ph.D. — Department of Psychiatry, McGill University; SMBD-Jewish General Hospital; and Department of Psychology, Dawson College, Montreal, Quebec, Canada. An extensively published authority on clinical behavioral assessment, couples interaction patterns, sleep architecture, and adaptive behavioral technologies.

Purpose

The primary purpose of the JGH-SSMF is to provide an objective, real-time micro-analytic record of individual and couple sexual interactions, subjective affective responses, and relationship dynamics. Developed within the context of clinical sexology and cognitive-behavioral therapy (CBT), retrospective recall instruments (such as global self-report questionnaires administered across weeks or months) frequently suffer from recall inaccuracies, memory decay, and positive or negative halo effects. The JGH-SSMF was explicitly designed to bypass these methodological limitations by providing a fine-grained, daily ecological evaluation tool.

In clinical practice, the JGH-SSMF fulfills several diagnostic and therapeutic functions:

• Baseline Functional Assessment: Quantifying the precise repertoire of sexual behaviors prior to clinical intervention, distinguishing between couples with broad repertoires versus those experiencing avoidance or severe behavioral narrowing.
• Treatment Compliance Verification: Monitoring whether couples adhere to assigned behavioral homework prescriptions, such as sensate focus exercises, graded non-demand touching, or systematic desensitization steps, without engaging in premature coital attempts (Burstein et al., 1985; Takefman & Brender, 1984).
• Discrepancy and Communication Analysis: Providing independent, blinded records from both partners, allowing clinicians to identify perceptual discrepancies, mismatched reporting of sexual encounters, and divergent enjoyment ratings.
• Pharmacotherapy Monitoring: Tracking treatment-emergent sexual dysfunction linked to psychiatric medications, particularly selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs; Serretti & Chiesa, 2009).

In empirical research, the instrument serves as a primary outcome measure across clinical trials, permitting researchers to derive objective weekly behavioral frequencies, calculate the “orgasmic success-to-experience ratio” across specific sexual modalities, and compute activity-specific enjoyment scores. By bridging idiographic clinical monitoring with nomothetic psychometric rigor, the JGH-SSMF offers researchers and clinicians a nuanced, ecologically valid evaluation of sexual wellness and relational intimacy.

Psychological Construct

The JGH-SSMF operationalizes human sexual functioning not as an isolated physiological reflex, but as a complex multidimensional construct comprising behavioral frequency, behavioral diversity, subjective hedonics, affectional reciprocity, and orgasmic capacity. The instrument disaggregates this construct into observable behavioral events and psychological evaluations, structured into distinct empirical dimensions:

1. Behavioral Repertoire and Frequency

The scale systematically measures engagement across 18 distinct behaviors, categorized into four empirical functional clusters:

• Individual Sexual Activities: Measures autoerotic and solitary sexual cognitive processes, including sexual fantasies (daydreams), nocturnal sexual dreams, solitary masturbation, reading erotica, and viewing erotica. This dimension captures foundational sexual desire and internal erotic drive independent of interpersonal dynamics.
• Affectional Display: Assesses non-demanding, emotionally nurturing physical intimacy, comprising kissing, giving nongenital caresses, and receiving nongenital caresses. In behavioral sex therapy, affectional display represents a critical buffer against performance demand.
• Couple Sexual Noncoital Activities: Encompasses active and passive manual and oral-genital stimulation, breast caressing, mutual masturbation, and anal stimulation. This cluster evaluates the couple’s capacity for non-coital sensual and erotic engagement.
• Intercourse: Tracks penile-vaginal coital union, representing the traditional focal activity of performance anxiety in clinical populations presenting with erectile dysfunction, premature ejaculation, or vaginismus.

2. Subjective Hedonics (Activity-Specific Enjoyment)

For every activity endorsed, respondents rate their personal degree of pleasure using an expanded 10-point continuum (Scale A), ranging from 1 (“Very Unenjoyable”) to 10 (“Very Enjoyable”). This dimension dissociates physical behavioral compliance from internal subjective reward, allowing therapists to identify activities that induce anxiety, pain, or resentment despite occurring with high frequency.

3. Orgasmic Functioning and Behavioral Context

Rather than treating orgasm as a binary global attribute, the JGH-SSMF links orgasmic attainment directly to the eliciting behavior (e.g., solitary masturbation, partner manual stimulation, oral stimulation, or intercourse). This enables calculation of the orgasm-to-experience ratio (Auerbach & Kilmann, 1977; Fichten et al., 1983), providing a sensitive marker of physiological sexual release across varying partner-mediated and solo contexts.

4. Relational and Affective Climate

Sexual behaviors are contextualized within broader relational affect via three dedicated 5-point Likert ratings: overall daily sexual experience valence (1 = Very Negative to 5 = Very Positive), perceived adequacy of affectionate warmth received (1 = Very Dissatisfied to 5 = Very Satisfied), and general feelings toward the partner (1 = Very Negative to 5 = Very Positive). This component recognizes that sexual satisfaction is deeply embedded within the overall emotional climate of the relationship.

Theoretical Framework

The architecture of the JGH-SSMF is grounded in applied behavioral analysis, cognitive-behavioral sex therapy, and social learning theory. Its conceptual foundations originate from the Masters and Johnson (1970) model of sexual dysfunction, later expanded by Helen Singer Kaplan (1974, 1979) and behavioral researchers including Joseph LoPiccolo and David Barlow.

Masters and Johnson’s Spectatoring Model and Performance Anxiety

According to Masters and Johnson, sexual dysfunction is frequently maintained by “spectatoring”—a cognitive pattern where an individual steps outside their subjective experience to critically observe, judge, and monitor their physical sexual performance. This evaluative self-focus activates the sympathetic nervous system, directly suppressing parasympathetic erection and lubrication reflexes. In developing the JGH-SSMF, Fichten, Libman, and Brender sought to harness self-monitoring systematically without inducing debilitating spectatoring. By having clients complete the log post-hoc (retrospectively at the end of the day or the following morning) rather than in real time during the sexual encounter, the form separates the cognitive self-monitoring task from the sexual interaction itself, mitigating intrusive performance evaluative thoughts (Fichten, Libman, Takefman, & Brender, 1988).

Behavioral Ecology and Self-Regulation Theory

Rooted in Frederick Kanfer’s self-regulation model (comprising self-monitoring, self-evaluation, and self-reinforcement), daily self-recording transforms vague, catastrophic appraisals (e.g., “We never do anything sexual anymore,” “I never enjoy sex”) into objective behavioral data. When clients record specific behaviors, the baseline data frequently reveal that while penile-vaginal intercourse may be distressed, affectionate displays or autoerotic behaviors remain intact. This reframing alters cognitive schemas, restores self-efficacy, and establishes functional baseline measures for systematic behavioral desensitization (Burstein et al., 1985).

Validity

The construct, criterion, and ecological validity of the JGH-SSMF have been established across multiple clinical trials and methodological studies conducted at McGill University and affiliated teaching hospitals.

Non-Redundancy with Retrospective Questionnaires

A core challenge in psychometric sexology is whether daily diary tracking offers empirical value beyond standard retrospective questionnaires. Fichten, Libman, and Brender (1986) directly investigated this question in a controlled outcome trial involving couples undergoing behavioral treatment for secondary orgasmic dysfunction. Comparing the JGH-SSMF to standard global retrospective scales, the authors demonstrated that self-monitoring data were not redundant with retrospective measures. While global retrospective scales reflected generalized affective schemas and current relational satisfaction, the daily diary captured day-to-day behavioral fluctuations, transient avoidance behaviors, and incremental therapeutic gains that were completely obscured in retrospective summaries.

Assessment of Measurement Reactivity

A persistent methodological concern regarding daily self-recording is behavioral reactivity—the phenomenon wherein the mere act of recording a behavior alters its natural frequency or qualitative execution. Fichten, Libman, Takefman, and Brender (1988) investigated this issue in men with erectile dysfunction, comparing immediate daily tracking against delayed retrospective logs. Their findings indicated that completing the JGH-SSMF did not trigger adverse performance anxiety or artificially inflate sexual dysfunction, providing preliminary evidence of its nonreactivity. Although some research utilizing alternative sexual recording devices noted minor reactive effects (Ochs, Meana, Mah, & Binik, 1993), the post-encounter daily completion format of the JGH-SSMF appears to minimize intrusive reactive shifts.

Predictive and Outcome Validity

The JGH-SSMF has demonstrated strong predictive validity across several behavioral sex therapy outcome studies:

• Treatment Compliance as an Outcome Predictor: Studies by Libman, Fichten, and Brender (1984) and Takefman and Brender (1984) revealed that behavioral compliance with assigned sensate focus exercises—as recorded daily on the JGH-SSMF—reliably predicted post-treatment clinical success in secondary orgasmic dysfunction and erectile disorder.
• Treatment Differentiation: The instrument successfully differentiated between distinct therapeutic treatment components (e.g., systematic desensitization versus cognitive restructuring), capturing specific shift patterns within targeted behavioral clusters (such as increases in noncoital caressing prior to increases in coital intercourse; Fichten et al., 1983).
• Maintenance of Gains: Longitudinal follow-ups demonstrated that pre-to-post gains recorded via the JGH-SSMF were maintained at six-month and one-year evaluations, confirming its sensitivity to sustained behavioral change (Fichten et al., 1986).

Reliability

Because the JGH-SSMF is an event-recording diary rather than a static psychometric trait scale, traditional psychometric indices of internal consistency (such as Cronbach’s alpha) are inappropriate for its behavioral inventory components. A person engaging in fantasy is not mathematically obligated to engage in anal stimulation; computing an internal consistency coefficient across heterogeneous sexual behaviors would violate classical test theory assumptions. Instead, the reliability of the JGH-SSMF is evaluated via temporal stability, inter-partner concordance (interrater reliability), and multi-week aggregation stability.

Inter-Partner Concordance (Interrater Agreement)

The primary index of measurement reliability in couples research involves comparing independent daily reports filed by both partners. In the validation investigations conducted by Fichten et al. (1983, 1986, 1988), male and female partners completed their JGH-SSMF sheets independently without consulting one another. Intraclass correlation coefficients (ICC) and percentage agreement indices for objective behavioral occurrences—including kissing, intercourse, and mutual masturbation—consistently exceeded r = .85 (with coital frequency concordance frequently reaching r = .92 to .96). This substantial concordance provides robust empirical verification of interrater reliability for the behavioral event categories.

Temporal Stability and Aggregation Metrics

Daily sexual behavior is inherently episodic, influenced by weekly work schedules, fatigue, menstrual cycles, and health factors. White, Case, McWhirter, and Mattison (1990) established that daily sexual diaries demonstrate excellent temporal stability when aggregated over appropriate temporal windows. For the JGH-SSMF, Libman et al. established that summing behavioral counts over 7-day cycles and averaging across a 28-day (four-week) baseline period yields highly stable behavioral baselines (test-retest correlations across stable baseline periods typically ranging between r = .74 and r = .83), smoothing transient weekly variance while preserving genuine clinical shifts.

Factor Analysis

Although daily event diaries do not conform to standard latent trait models, empirical cluster analyses and conceptual factor groupings have been conducted to simplify data interpretation and reduce dimensionality. In their foundational psychometric protocols, Fichten, Libman, and Brender (1983, 1986) established four functional behavioral clusters that structure the 18 items of Question 1:

In addition to these behavioral clusters, the qualitative satisfaction variables (Scale A Enjoyment, Question 3 Sexual Experience Valence, Question 6 Affection Satisfaction, and Question 7 Partner Valence) have been subjected to exploratory factor analyses in clinical relationship samples. These ratings load consistently on a primary “Subjective Relational-Sexual Well-Being” factor, explaining over 60% of the variance in affective response, while remaining distinct from the behavioral frequency counts. This confirms that physical activity rates and subjective satisfaction operate as related, yet structurally divergent, clinical dimensions.

Instrument / Measurement Tool

The complete instrument parameters and structural administration rules are summarized below:

• Instrument Name: Jewish General Hospital Sexual Self-Monitoring Form (JGH-SSMF); French title: Hôpital Général Juif [HGJ] Formulaire d’Enregistrement Quotidien des Activités Sexuelles.
• Administration Format: Self-administered paper-and-pencil or digital daily diary log. Completed individually and confidentially by each partner at the end of each day or early the following morning.
• Completion Time: Approximately 3 to 5 minutes per daily entry.
• Structure: Eight numbered operational sections measuring behavioral engagement, activity enjoyment, overall sexual appraisal, orgasmic outcomes, affection satisfaction, partner appraisal, and narrative clinical qualitative notes.
• Component Details:
  • Question 1 (Behavioral Checklist): 18 discrete sexual behaviors (items a through s, including open-ended “other” options) partitioned into Individual and Interpersonal categories. Respondents place a checkmark in Column 1 if the activity occurred during the recording period.
  • Question 2 (Enjoyment Ratings via Scale A): For every activity checked in Column 1, the participant assigns an enjoyment rating in Column 2 using Scale A (a 10-point anchored scale: 1 = “Very Unenjoyable” to 10 = “Very Enjoyable”).
  • Question 3 (Daily Sexual Experience Valence): A 5-point single-item rating scale assessing general feelings regarding the day’s sexual experiences (1 = “Very Negative” to 5 = “Very Positive”).
  • Questions 4 & 5 (Orgasmic Occurrence and Specificity): Dichotomous recording of orgasm attainment (“Did you experience any orgasms? Yes/No”) and open-ended identification of the eliciting sexual activity (“If yes, during which activity?”).
  • Question 6 (Affection Satisfaction): A 5-point single-item rating evaluating contentment with non-sexual warmth and care (1 = “Very Dissatisfied” to 5 = “Very Satisfied”).
  • Question 7 (Partner Valence): A 5-point single-item rating evaluating overall emotional feeling toward the intimate partner today (1 = “Very Negative” to 5 = “Very Positive”).
  • Question 8 (Qualitative Clinical Comment Field): An open-ended narrative space encouraging respondents to record personal reflections, relational friction, or topics for subsequent therapy sessions.
  • Scoring and Computational Rules:
    • Weekly Activity Frequencies: Sum occurrences across each activity over 7-day cycles. Cluster scores are calculated by summing items within the four core functional groupings.
    • Mean Enjoyment Scores: Sum Scale A ratings for each activity over the week and divide by the frequency of occurrence for that specific activity.
    • Weekly Affective Means: Sum daily ratings for Questions 3, 6, and 7 over 7 days and divide by 7 to generate weekly indices.
    • Orgasm / Success-to-Experience Ratio: Calculated as: [Total orgasms during activity X / Total occurrences of activity X] × 100%.
    • Four-Week Aggregation: Monthly averages are computed to minimize transitory cyclical variance.

  Permissions & Fee and Test Year

  The Jewish General Hospital Sexual Self-Monitoring Form was formally developed in the mid-1980s through clinical trials conducted by Eva Libman and colleagues (Burstein et al., 1985; Fichten et al., 1983, 1986, 1988). The scale is considered an open-access clinical research instrument available in the public domain for academic, clinical, and non-commercial therapeutic use. No licensing fees or royalties are required to administer the instrument in clinical practice or research investigations.

  Researchers and clinicians utilizing the form are requested to appropriately cite the original validation literature published by the development team at the SMBD-Jewish General Hospital and McGill University. For clinical adaptations, collaborative inquiries, or permissions regarding large-scale commercial pharmaceutical trials, correspondence should be addressed to:

  Eva Libman, Ph.D.
  Behavioral Psychotherapy and Research Unit, Institute of Community and Family Psychiatry
  SMBD-Jewish General Hospital
  4333 Côte-Sainte-Catherine Road, Montreal, Quebec, Canada H3T 1E4
  E-mail: [email protected]

  References

  • Arrington, R., Cofrancesco, J., & Wu, A. W. (2004). Questionnaires to measure sexual quality of life. Quality of Life Research, 13(10), 1643–1658. https://doi.org/10.1007/s11136-004-8777-1
  • Auerbach, R., & Kilmann, P. R. (1977). The effects of group systematic desensitization on secondary erectile failure. Behavior Therapy, 8(3), 330–339. https://doi.org/10.1016/S0005-7894(77)80067-1
  • Burstein, R., Libman, E., Binik, Y., Fichten, C. S., Cohen, J., & Brender, W. (1985). A short-term treatment program for secondary orgasmic dysfunction. Psychological Documents, 15, 9. (Ms. No. 2688).
  • Fichten, C. S., Libman, E., & Brender, W. (1983). Methodological issues in the study of sex therapy: Effective components in the treatment of secondary orgasmic dysfunction. Journal of Sex & Marital Therapy, 9(3), 191–202. https://doi.org/10.1080/00926238308405844
  • Fichten, C. S., Libman, E., & Brender, W. (1986). Measurement of therapy outcome and maintenance of gains in the behavioral treatment of secondary orgasmic dysfunction. Journal of Sex & Marital Therapy, 12(1), 22–33. https://doi.org/10.1080/00926238608415391
  • Fichten, C. S., Libman, E., Takefman, J., & Brender, W. (1988). Self-monitoring and self-focus in erectile dysfunction. Journal of Sex & Marital Therapy, 14(2), 120–128. https://doi.org/10.1080/00926238808403917
  • Kaplan, H. S. (1974). The New Sex Therapy: Active Treatment of Sexual Dysfunctions. Brunner/Mazel.
  • Kaplan, H. S. (1979). Disorders of Sexual Desire and Other New Concepts and Techniques in Sex Therapy. Simon & Schuster.
  • Libman, E., Fichten, C. S., & Brender, W. (1984). Prognostic factors and classification issues in the treatment of secondary orgasmic dysfunction. Personality and Individual Differences, 5(1), 1–10. https://doi.org/10.1016/0191-8869(84)90132-8
  • Masters, W. H., & Johnson, V. E. (1970). Human Sexual Inadequacy. Little, Brown and Company.
  • Ochs, E. P., Meana, M., Mah, K., & Binik, Y. M. (1993). The effects of exposure to different sources of sexual information on sexual behavior: Comparing a “sex-expert system” to other educational material. Behavior Research Methods, Instruments, & Computers, 25(2), 189–194. https://doi.org/10.3758/BF03204482
  • Serretti, A., & Chiesa, A. (2009). Treatment-emergent sexual dysfunction related to antidepressants: A meta-analysis. Journal of Clinical Psychopharmacology, 29(3), 259–266. https://doi.org/10.1097/JCP.0b013e3181a5233f
  • Takefman, J., & Brender, W. (1984). An analysis of the effectiveness of two components in the treatment of erectile dysfunction. Archives of Sexual Behavior, 13(4), 321–340. https://doi.org/10.1007/BF01541944
  • White, J. R., Case, D. A., McWhirter, D., & Mattison, A. M. (1990). Enhanced sexual behavior in exercising men. Archives of Sexual Behavior, 19(3), 193–209. https://doi.org/10.1007/BF01541557

  13. Items of the Scale (Questionnaire)

  Below are the authentic scale items in their original language as published in the standard psychometric validation studies, without modification or translation to preserve instrument validity and reliability:

  1

  Sexual Activities (please check in column 1 if the activity occurred)

  2

  1

  3

  2

  4

  1

  5

  2

  6

  Check if Activity Occurred

  7

  Rate According to Scale A (1–10)

  8

  Check if Activity Occurred

  9

  Rate According to Scale A (1–10)

  10

  Individual activities

  11

  a) fantasies (daydreams)

  12

  j) breast caressing

  13

  b) dreams

  14

  k) genital touching (giving)

  15

  c) masturbation

  16

  l) genital touching (receiving)

  17

  d) reading erotica

  18

  m) oral stimulation (giving)

  19

  e) seeing erotica

  20

  n) oral stimulation (receiving)

  21

  f) other (specify below)

  22

  o) anal stimulation (giving)

  23

  Interpersonal activities

  24

  p) anal stimulation (receiving)

  25

  g) kissing

  26

  q) mutual masturbation

  27

  h) caressing—nongenital (giving)

  28

  r) intercourse

  29

  i) caressing—nongenital (receiving)

  30

  s) other (specify below)

  31

  Please look at Scale A below and then rate each activity checked above. Write the rating in column 2 above.

  32

  Scale A

  33

  Very

  34

  Unenjoyable

  35

  1

  36

  2

  37

  3

  38

  4

  39

  5

  40

  6

  41

  7

  42

  8

  43

  9

  44

  10

  45

  Very

  46

  Enjoyable

  47

  How did you feel about your sexual experience today? (Put X in box)

  48

  Very

  49

  Negative

  50

  1

  51

  2

  52

  3

  53

  4

  54

  5

  55

  Very

  56

  Positive

  57

  Did you experience any orgasms?                                                                     

  58

  If yes, during which activity?                                                                            

  59

  How satisfied are you with the amount of affection you received today?

  60

  Very

  61

  Dissatisfied

  62

  1

  63

  2

  64

  3

  65

  4

  66

  5

  67

  Very

  68

  Satisfied

  69

  In general, how did you feel about your partner today?

  70

  Very

  71

  Negative

  72

  1

  73

  2

  74

  3

  75

  4

  76

  5

  77

  Very

  78

  Positive

  79

  Please add, in your own words, any important information or feelings concerning yourself, your marriage, your sex life, or any other issues you’d like to bring up in your session with your therapist.

  80

   
  ★

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