[ID: Two sheets of a white worksheet with black writing. The worksheet is title "Self-Care Assessment". There are eight sections to the worksheet and 5-15 statements in each section. There is space at the beginning of each statement to write a number. A key at the top of the worksheet explains what each number means. /end]
Title: Self-Care Assessment
The following worksheet for assessing self-care is not exhaustive, merely suggestive. Feel free to add areas of self-care that are relevant for you and rate yourself on how often and how well you are taking care of yourself these days. When your are finished, look for patterns in your responses. Are you more active in some areas of self-care? Do you tend to ignore others? Are there items on the list that hadn't even occurred to you? Listen to your internal responses and dialogue about self-care, and take note of anything you would like to prioritize moving forward.
In a box: Rate the following areas according to how well you think you are doing....
3 = I do this well (e.g. frequently)
2 = I do this OK (e.g. occasionally)
1 =I barely or rarely do this
0 = I never do this
? =This never occurred to me /box ends
__ Eat regularly (breakfast, lunch, and dinner)
__ Get regular medical care for prevention
__ Get medical care when needed
__ Take time off when sick
__ Wear clothes I like
__ Do some fun physical activity
__ Think positive thoughts about my body
__ Exercise
__ Eat healthily
__ Get massages
__Take Vacations
__ Get enough sleep
__ Do some fun artistic activity
__ (Other) ______________________________
__ Take day trips or mini-vacations
__ Have my own personal psychotherapy
__ Make time away from technology/internet
__ Read something unrelated to work
__ Notice my thoughts, beliefs, attitudes and feelings
__ Engage my intelligence in a new way or area
__ Do something at which I am not expert
__ Make time for self-reflection
__ Write in a journal
__ Attend to minimizing life stress
__ Be curious
__ Say no to extra responsibilities
__ Be okay leaving work at work
__ (Other) _______________________________
__ Spend time with people whose company I enjoy
__ Stay in contact with important people in my life
__ Re-read favourite books, re-view favourite movies
__ Identify and seek out comforting activities/places
__ Express my outrage in social action or discussion
__ Love yourself
__ Allow myself to cry
__ Give myself affirmation/praise
__ Find things that make me laugh
__ (Other) _______________________________
__ Make time for reflection
__ Find a spiritual connection or community
__ Be aware of non-material aspects of life
__ Try at times not to be in charge or the expert
__ Identify what is meaningful to me
__ Seek out reenergizing or nourishing experiences
__ Contribute to causes in which I believe
__ Read or listen to something inspirational
__ Spend time in nature
__ Be open to inspiration
__ Cherish my optimism and hope
__ Be open to knowing
__ Meditate
__ Find time for prayer or praise
__ Have experiences of awe
__ (Other) ________________________________
__ Schedule regular dates with my partner
__ Call, check on, or see my relatives
__ Share a fear, hope, or secret with someone I trust
__ Stay in contact with faraway friends
__ Make time for personal correspondence
__ Allow others to do things for me
__ Make time to be with friends
__ Ask for help when I need it
__ Communicate with my family
__ Enlarge my social circle
__ Spend time with animals
__ (Other) ________________________________
Workplace or Professional Self-Care
__ Take time to chat with coworkers
__ Identify projects/tasks that are exciting
__ Balance my load so that nothing is "way too much"
__ Arrange work space to be comfortable
__ Get regular supervision or consultation
__ Negotiate/advocate for my needs
__ Make quiet time to work
__ Take a break during the day
__ Set limits with my boss/peers
__ Have a peer support group
__ Identify rewarding tasks
__ (Other) _________________________________
__ Strive for balance within my work-life and work day
__ Strie for balance among my family, friends, and relationships
__ Strive for balance between play and rest
__ Strive for balance between work/service and personal time
__ Strive for balance in looking forward and acknowledging the moment
Areas of Self-Care that are Relevant to You
__ (Other) _________________________________
__ (Other) _________________________________
__ (Other) _________________________________
Adapted from the Saakvitne, Pearlman, & Staff of TSI/CAAP (1996). Transforming the Pain: A Workbook of Vicarious Traumatization. Norton. Adapted by Lisa D. Butler, PhD. /end]