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You are here: Home >> Resources >> Handouts >> Self Care Assessment Worksheet

September, 2004

Rate the following areas in frequency

5 = Frequently
4 = Occasionally
3 = Rarely
2 = Never
1 = It never occurred to me

Physical Self-Care

____ Eat regularly (e.g. breakfast, lunch, and dinner)
____ Eat healthily
____ Exercise
____ Get regular medical care for prevention
____ Get medical care when needed
____ Take time off when sick
____ Get massages
____ Dance, swim, walk, run, play sports, sing, or do some other physical activity that is fun
____ Take time to be sexual -- with yourself, with a partner
____ Get enough sleep
____ Wear clothes you like
____ Take vacations
____ Take day trips or mini-vacations
____ Make time away from telephones
____ Other:

Psychological Self-Care

____ Make time for self-reflection
____ Have your own personal psychotherapy
____ Write in a journal
____ Read literature that is unrelated to work
____ Do something at which you are not expert or in charge
____ Decrease stress in your life
____ Notice your inner experience -- listen to your thoughts, judgments, beliefs, attitudes, and feelings
____ Let others know different aspects of you
____ Engage your intelligence in a new area (e.g. go to an art museum, history exhibit, sports event, auction, theater performance)
____ Practice receiving from others
____ Be curious
____ Say no to extra responsibilities sometimes
____ Other:

Emotional Self-Care

____ Spend time with others whose company you enjoy
____ Stay in contact with important people in your life
____ Give yourself affirmations, praise yourself
____ Love yourself
____ Reread favorite books, re-view favorite movies
____ Identify comforting activities, objects, people, relationships, places and seek them out
____ Allow yourself to cry
____ Find things that make you laugh
____ Express your outrage in social action, letters, donations, marches, protests
____ Play with children
____ Other:

Spiritual Self-Care

____ Make time for reflection
____ Spend time with nature
____ Find a spiritual connection or community
____ Be open to inspiration
____ Cherish your optimism and hope
____ Be aware of nonmaterial aspects of life
____ Try at times not to be in charge or the expert
____ Be open to not knowing
____ Identify what is meaningful to you and notice its place in your life
____ Meditate
____ Pray
____ Sing
____ Spend time with children
____ Have experiences of awe
____ Contribute to causes in which you believe
____ Read inspirational literature (talks, music, etc.)
____ Other:

Workplace or Professional Self-Care

____ Take a break during the workday (e.g. lunch)
____ Take time to chat with co-workers
____ Make quiet times to complete tasks
____ Identify projects or tasks that are exciting and rewarding
____ Set limits with clients and colleagues
____ Balance your caseload so no one day or part of a day is "too much"
____ Arrange your work space so it is comfortable and comforting
____ Get regular supervision or consultation
____ Negotiate for your needs (benefits, pay raise)
____ Have a peer support group
____ Develop a non-trauma area of professional interest
____ Other:


____ Strive for balance within your work-life and workday
____ Strive for balance among work, family, relationships, play, and rest

Other Areas of Self-Care that are Relevant to You


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