Honey, It’s Time for Our Annual Checkup

Should we treat our relationship like we do our health?

Three years ago, my vacation was rudely interrupted by the results of my recent blood work. My cholesterol had shot up over 50 points in the last six months for no apparent reason, and my doctor wanted me to check in with her urgently.¹

This nasty surprise left me frustrated and concerned for the rest of my weekend getaway. Nothing had changed significantly in my exercise or diet, so I couldn’t understand why my health was suddenly an urgent issue.

A couple of weeks later, I found the culprit: the dreaded green smoothie!²

Photo credit: sentidos humanos on Unsplash

I had recently started adding coconut milk to my morning smoothie. To my surprise, that meant I was consuming double the recommended dose of saturated fat by noon every day.³ One tiny change spiked my cholesterol. Who knew?

But here’s the silver lining: I caught this trend early because I had just had my annual physical and bloodwork. This allowed me to fix the problem quickly.

Relationships often work the same way. They usually do not fall apart all at once. More often, small changes quietly compound: less appreciation, more stress spilling over, less connection, more avoided conversations. By the time a couple realizes something is seriously wrong, the pattern may have been building for months or years.

That raises the question: how can we pay attention to our relationship’s vital signs before small changes become serious problems?

An Idea Whose Time Has Come

Two decades ago, researcher and clinician James Cordova began to work on this exact problem. He suspected that, before separation, many couples had either missed or avoided early warning signs until the problems became much harder to address.

His answer was the Marriage Checkup: a structured, prevention-oriented process where couples assess the health of their relationship, receive feedback, identify strengths and concerns, and choose small next steps before problems become crises. Importantly, it was not designed as a one-time fix. Like a physical, it included a follow-up checkup a year later.

Dr. Cordova and his colleagues found that this simple structure produced meaningful benefits; getting this type of relationship checkup has been shown to improve relationship happiness, intimacy, and acceptance;⁴ reduce depression;⁵ and, for women, decrease stress.⁶

While the original research used therapists to deliver the checkup, the formula is not a mystery. So how can you create your own annual relationship checkup?

The DIY Checkup

Here is a simple, four-part version of a relationship checkup that you and your partner can put into practice on a regular basis:⁷

1. Assessment (optional)
   Take a relationship assessment and discuss the results, paying special attention to strengths, teamwork, and shared growth. This is like a doctor checking your vitals and giving you an objective perspective. You can use a tool like the Gottman Sound Relationship House or simply rate your relationship 1-10 in ten key areas.⁸
   

2. What’s Good
   Take 10-15 minutes and write down everything that has gone well in the last year. When you have both finished reflecting, take turns sharing, celebrating, and appreciating each other. When thanking your partner, highlight strengths, values, or admirable traits that contributed, and be sure to fully receive gratitude!
   Examples: We have been parenting well together, we have supported each other through challenges, our sex life has been enjoyable, we have had good routines, we have enjoyed activities together, and we have been flexible.
   

3. What Needs Attention
   Take 5-10 minutes and write down what could be better in the relationship from your perspective. Highlight the top 1-2 areas that could benefit from attention, and take turns sharing them. Listen without judging or fixing.
   Example: I think we are struggling to connect on a daily basis when we both get busy.
   

4. Looking Ahead
   Each partner commits to strengthening one area already going well and taking one small step to improve an area of difficulty (framed as approach goals). Refine these together, write them down, and agree to review quarterly.
   Examples: I will keep coordinating a weekly date night and relationship check-in; I will keep gently asking for and supporting efforts to go to bed together instead of withdrawing.

In The Sun Also Rises, Ernest Hemingway describes going broke “gradually, then suddenly.”⁹ Relationships can decline the same way.

An annual relationship checkup is a way to notice gradual changes before they become sudden ones. It helps couples pause, look at what is working, name what needs attention, and choose one or two small steps before the damage compounds.

In other words, the goal is not to wait until the relationship feels sick. The goal is to build a rhythm of care while it is still healthy.

1. I know, I know, you are breathlessly wondering, was it LDL or HDL cholesterol?? It shall remain a mystery…but really the triglycerides were the real concern.

2. My son would be thrilled to hear this! If you have any wisdom on getting a six-year-old to consume more fiber, I’m all ears.

3. Sorry, coconut milk. I know you are delicious and probably healthy in small doses, but I will never forgive you.

4. Cordova, J., et al. (2014). The marriage checkup: A randomized controlled trial of annual relationship health checkups. Journal of Consulting and Clinical Psychology, 82(4), 592–604.

5. Gray, T. D., Hawrilenko, M., & Cordova, J. V. (2020). Randomized controlled trial of the marriage checkup: Depression outcomes. Journal of Marital and Family Therapy, 46(3), 507–522.

6. Leth‐Nissen, A. B., Fentz, H. N., Trillingsgaard, T. L., & Stadler, G. (2023). Randomized controlled trial of the Marriage Checkup: Stress outcomes. Journal of Marital and Family Therapy, 49(1), 242–259.

7. One important note: Since this is a chance to honestly face challenges as well as opportunities, do not take it on at a time when you are feeling depleted. The success of a checkup comes from viewing the relationship as a system of equal partners. This means strengthening your motivation, increasing awareness of your role in patterns, and deepening acceptance of your partner for who they are instead of trying to change them.

8. My favorite list: friendship, emotional intimacy, fun/play, teamwork, conflict management, appreciation, trust, sex/affection, stress spillover, shared purpose

9. Likely from drinking too much coconut milk. Also, I didn’t actually read The Sun Also Rises and I’m not a huge Hemingway fan. But if you’ve made it this far in the article, you are probably going to forgive me!