The Integrated Couples Clinical Assessment (ICCA-AU)

A comprehensive questionnaire for couples therapy at Delta Psychology.

Welcome

This questionnaire is part of the assessment for couples therapy in this practice. It is designed to give your psychologist a thorough, reliable understanding of your relationship from your point of view, before or early in the therapy. Your partner will complete the same questionnaire separately. Please complete it on your own, in a private space, without discussing or comparing answers with your partner.

Why so many questions?

The questionnaire draws on the best-validated relationship measures used internationally so that your psychologist has a clear, multidimensional picture of how your relationship is functioning. It takes most people 30–45 minutes . There are no right or wrong answers.

How to answer

Answer each question as honestly as you can, based on how things generally have been over the past few months (unless the question specifies another time frame).
Where scales ask you to rate frequency or agreement, choose the option that fits best even if none is perfect.
"Partner" means the person you are attending therapy with.

Privacy and safety. Your answers are confidential and part of your clinical record. Some sections ask about safety, mental health, substance use and fidelity. These are routine questions we ask every client. If you are in immediate danger, please stop and contact:
• Police / Ambulance: 000
• 1800RESPECT (family violence & sexual assault, 24/7): 1800 737 732
• Lifeline (crisis support, 24/7): 13 11 14
• 13YARN (Aboriginal & Torres Strait Islander crisis line): 13 92 76
• Suicide Call Back Service: 1300 659 467

I have read the above and I am completing this form on my own. I understand my responses will be discussed in therapy and stored in my clinical record. *

Review and submit

Thank you for completing the questionnaire. When you press Submit , your responses, scored subscales, and a clinical interpretation will be sent securely to your psychologist at john@deltapsychology.com .

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