Adapted from Saakvitne, Pearlman, & Staff of TSI/CAAP (1996). Transforming the pain: A workbook on vicarious traumatization. Norton.

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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.

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When you are finished, look for patterns in your responses. Are you more active in some areas of self-care but ignore others? Are there items on the list that make you think, "I would never do that"? Listen to your inner responses, your internal dialogue about self-care and making yourself a priority. Take particular note of anything you would like to include more in your life.

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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

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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 fun physical activity

____ Take time to be sexual - with myself, with a partner

____ Get enough sleep

____ Wear clothes I like

____ Take vacations

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Psychological Self-Care

____ Take day trips or mini-vacations
____ Make time away from telephones, email, and the Internet
____ Make time for self-reflection
____ Notice my inner experience - listen to my thoughts, beliefs, attitudes, feelings
____ Have my own personal psychotherapy
____ Write in a journal
____ Read literature that is unrelated to work
____ Do something at which I am not expert or in charge
____ Attend to minimizing stress in my life
____ Engage my intelligence in a new area, e.g., go to an art show, sports event, theatre

____ Be curious

____ Say no to extra responsibilities sometimes 

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Emotional Self-Care

____ Spend time with others whose company I enjoy

____ Stay in contact with important people in my life

____ Give myself affirmations, praise myself
____ Love myself

____ Re-read favorite books, re-view favorite movies
____ Identify comforting activities, objects, people, places and seek them out

____ Allow myself to cry
____ Find things that make me laugh
____ Express my outrage in social action, letters, donations, marches, protests 

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Spiritual Self-Care

____ Make time for reflection
____ Spend time in nature
____ Find a spiritual connection or community
____ Be open to inspiration
____ Cherish my optimism and hope
____ Be aware of non-material aspects of life
____ Try at times not to be in charge or the expert
____ Be open to not knowing
____ Identify what is meaningful to me and notice its place in my life

____ Meditate
____ Pray
____ Sing
____ Have experiences of awe
____ Contribute to causes in which I believe
____ Read inspirational literature or listen to inspirational talks, music 

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Relationship Self-Care

____ Schedule regular dates with my partner or spouse

____ Schedule regular activities with my children
____ Make time to see friends
____ Call, check on, or see my relatives

____ Spend time with my companion animals
____ Stay in contact with faraway friends
____ Make time to reply to personal emails and letters; send holiday cards

____ Allow others to do things for me
____ Enlarge my social circle
____ Ask for help when I need it
____ Share a fear, hope, or secret with someone I trust
 

Workplace or Professional Self-Care

____ 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 clients and colleagues

____ Balance my caseload so that no one day or part of a day is “too much”

____ Arrange workspace so it is comfortable and comforting
____ Get regular supervision or consultation
____ Negotiate for my needs (benefits, pay raise)

____ Have a peer support group
____ (If relevant) Develop a non-trauma area of professional interest

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Overall Balance

____ Strive for balance within my work-life and work day
____ Strive for balance among work, family, relationships, play, and rest

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(Retrieved 8/6/2010 from http://www.ballarat.edu.au/aasp/student/sds/self_care_assess.shtml and adapted by Lisa D. Butler, Ph.D.)