Questionnair CSI | Schema Integrative Report

Couples Schema Inventory

CSI-S (90 schema items) + CSI-M (130 mode items) · Est. 40–60 min per partner

Instructions for Clinician

Part A (CSI-S): Each partner rates 90 statements on a 1–6 scale describing how well each statement describes them in their relationship.

Part B (CSI-M): Each partner rates 130 statements on a 1–4 scale describing how often they apply. Partners complete independently.

*All fields are required to proceed

Completion Method

Psychologist's Name

Couple's Presenting Problem(s)

Psychologist's Clinical Comments (Not Viewable by Clients)

Partner 1

Name

Email

Date of Birth

Gender

Preferred Pronouns

Partner 2

Name

Email

Date of Birth

Gender

Preferred Pronouns