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Self Care Assessment Worksheet

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:

Balance
____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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