### Self-Care Assessment Worksheet
This assessment tool provides an overview of effective strategies to maintain self-care. After completing the full assessment, choose one item from each area that you will actively work to improve.
Using the scale below, rate the following areas in terms of frequency:
- **5 = Frequently**
- **4 = Occasionally**
- **3 = Rarely**
- **2 = Never**
- **1 = It never occurred to me**
Date:
#### Physical Self-Care
| Activity | Rating |
| ----------------------------------------------------------------------------------------- | ------ |
| Eat regularly (e.g. breakfast, lunch, and dinner) | ___ |
| Eat healthy | ___ |
| Exercise | ___ |
| Get regular medical care for prevention | ___ |
| Get medical care when needed | ___ |
| Take time off when needed | ___ |
| 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
| Activity | Rating |
|----------|--------|
| 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 | ___ |
| Let others know different aspects of you | ___ |
| Notice your inner experience—listen to your thoughts, judgments, beliefs, attitudes, and feelings | ___ |
| 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
| Activity | Rating |
|----------|--------|
| Spend time with others whose company you enjoy | ___ |
| Stay in contact with important people in your life | ___ |
| Give yourself affirmations, praise yourself | ___ |
| Love yourself | ___ |
| Re-read 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 and donations, marches, protests | ___ |
| Play with children | ___ |
| Other | ___ |
#### Spiritual Self-Care
| Activity | Rating |
|----------|--------|
| 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
| Activity | Rating |
|----------|--------|
| Take a break during the workday (e.g. lunch) | ___ |
| Take time to chat with co-workers | ___ |
| Make quiet time to complete tasks | ___ |
| Identify projects or tasks that are exciting and rewarding | ___ |
| Set limits with your clients and colleagues | ___ |
| Balance your caseload so that 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
| Activity | Rating |
|----------|--------|
| Strive for balance within your work-life and workday | ___ |
| Strive for balance among work, family, relationships, play, and rest | ___ |
**Source:** Transforming the Pain: A Workbook on Vicarious Traumatization. Saakvitne, Pearlman & Staff of TSI/CAAP (Norton, 1996)
### Looking forward
Now that you discovered your weak points, list here the 3 most important ones you could work on:
1.
2.
3.
#### Goal setting
What are your 2 goals for next month to improve these points?
For example:
- "write in a journal" -> your goal can be to write in a journal 5 min a day right upon waking up. to make it easy put a journal and pen next to your bed
- "exercise" -> your goal can be to run once a week. set in your calendar "running", every monday morning. on sunday night always put your running clothes and shoes next to your bed
You goals:
-