Adult Attachment Interview Questionnaire
A questionnaire for reflecting on attachment history, caregiving experiences, and current relationship patterns. Please answer honestly and provide as much detail as you can.
Participant Information
Name
*
First Name
Middle Name
Last Name
Age Range
*
Please Select
18-24
25-34
35-44
45-54
55-64
65+
Prefer not to say
Preferred Contact Method
*
Email
Phone
Text Message
No Contact Preference
Interview Background
Current relationship status / close-relationship context
*
Please Select
Single
In a relationship
Married
Separated
Divorced
Widowed
Casually dating
In a committed relationship
Other
Participation context (study, clinic, class, or other)
*
Brief background notes relevant to attachment history
Attachment Experience Questions
How comfortable were you seeking comfort or support from your caregiver as a child?
*
Not at all comfortable
1
2
3
4
Very comfortable
5
1 is Not at all comfortable, 5 is Very comfortable
Which statement best describes your early relationship with your primary caregiver?
*
Very close and supportive
Somewhat close and supportive
Mixed or inconsistent
Somewhat distant or difficult
Very distant or difficult
Current Reflection
Current patterns in close relationships
*
Overall difficulty reflecting on these experiences
*
Very easy
Somewhat easy
Neither easy nor difficult
Somewhat difficult
Very difficult
Submit
Should be Empty: