A Relationship Autopsy Questionnaire for a Recent Breakup

This questionnaire provides a structured way for a client to reflect on a past relationship and.

After a breakup, a client’s account of the relationship can be disorganized and emotionally charged. They may fixate on the final conflict, assign total blame, or struggle to articulate what actually happened over the months or years. This narrative confusion prevents them from seeing their own role and the dynamics that contributed to the outcome.

This directive provides the necessary structure to turn hindsight into foresight. It moves the client beyond the raw emotion of the ending to a more complete and useful assessment of the entire relationship. They will arrive at the next session with a new perspective on their own contributions and a clearer idea of what a healthy connection looks like for them.


A Relationship Autopsy Questionnaire for a Recent Breakup

Answer the following questions about the relationship that has ended. Use a separate notebook or document. Write in as much detail as you can. There is no need to show this to anyone.

What were you looking for in a partner when this relationship began? What specific qualities initially attracted you to this person? What was going on in your own life, work, social life, personal state, at that time? Looking back, what were the first signs of the problems that would later become major issues? What was your response to them then?

Describe a recurring conflict. What was the subject? How did it typically start? What did each of you do? How did it usually end? How were disagreements handled by each of you? How were important decisions made? What topics, if any, were avoided? Describe a specific moment when you felt closest to this person. Describe a specific moment when you felt the most disconnected. What did you do to maintain the connection? What did they do?

What was the turning point when you knew the relationship was in serious trouble? What was the final event or conversation that led to the breakup? What reasons were given for the end of the relationship? What reasons do you believe were left unsaid? What was your immediate emotional and practical response to the separation?

What actions did you take that strengthened the relationship? What actions did you take that weakened the relationship? What did you want from the relationship that you did not get? What did your partner seem to want from you that they did not get? If you could change one of your own recurring behaviors in the relationship, which one would it be? What pattern, if any, from this relationship is familiar from your past?

Generated with Rapport7 — rapport7.com

Print it. Hand it over. See what changes.

Every directive in the library is printable — branded with your clinic name and logo, ready to go home with the client at the end of the session.

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