Self-Care Workshop - Self Assessment Worksheet 2

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Self-Care Workshop - Self Assessment Worksheet 2


Self assessment worksheet for the Self-Care Workshop 2018


Self assessment worksheet for the Self-Care Workshop 2018.Includes a scale of ?,0-3 and is separated into physical, psychological, emotional, spiritual, relationship, professional, and overall balance in terms of self-care.

Adapted from Saakvitne, Pearlman, & Staff of TSI/CAAP (1996). Transforming the Pain: A Workbook on Vicarious Traumatization. Norton. Adapted by Lisa D. Butler, PhD.


Lisa D. Butler



Text Item Type Metadata


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 you 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.
Rate the following areas according to how well you think you are doing...
3 = I do this well (e.g., frequently) 0 = I never do this
2 = I do this OK (e.g., occasionally) ? = This never occurred to me 1 = I barely or rarely do this
Physical Self-Care
____ 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
Psychological Self-Care
____ 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, feelings ____ Engage my intelligence in a new way or area ____ Do something at which I am not expert
Emotional Self-Care
____ Spend time with people whose company I enjoy ____ Stay in contact with important people in my life ____ Re-read favorite books, re-view favorite movies ____ Identify and seek out comforting activities/places ____ Express my outrage in social action or discussion
____ Exercise
____ Eat healthily
____ Get massages
____ Take vacations
____ Get enough sleep
____ Do some fun artistic activity ____ (Other) __________________
____ 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) ___________________
____ Love myself
____ Allow myself to cry
____ Give myself affirmation/praise ____ Find things that make me laugh ____ (Other) ___________________

Spiritual Self-Care
____ 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
Relationship Self-Care
____ 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
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
Overall Balance
____ 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) ___________________
____ 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) ___________________
____ 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
____ Strive 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 Saakvitne, Pearlman, & Staff of TSI/CAAP (1996). Transforming the Pain: A Workbook on Vicarious Traumatization. Norton. Adapted by Lisa D. Butler, PhD.





Lisa D. Butler, “Self-Care Workshop - Self Assessment Worksheet 2,” Womanist Working Collective Archive, accessed July 4, 2022,

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