BUFieldWorkSelf‐CarePlan(Assessment)
Name:_______________________________Date:____________________Agency:______________________________
Self‐CareAssessment
Thefollowingworksheetforassessingself‐careisnotexhaustive,onlysuggestive.Feelfreetoadd
areasofself‐carethatarerelevantforyouandrateyourselfonhowwellyouaretakingcareof
yourselfthesedays.Takeparticularnoteofanythingyouwouldliketoincludemoreinyourlife.
Ratethefollowingareasaccordingtohowwellyouthinkyouaredoing:
5=Idothiswell(frequently)
4=IdothisOkay(occasionally)
3=Ibarelyorrarelydothis
2=Ineverdothis
1=Thisneveroccurredtome
Physical Self‐Care
Psychological Self‐Care
_____EatRegularly(breakfast,lunch,dinner)
_____EatHealthy
_____Exercise
_____Getregularmedicalcareforprevention
_____Getmedicalcarewhenneeded
_____Taketimeoffwhensick
_____Getmassages
_____Dance,swim,walk,run,playsports,sing,orsome
physicalactivity
_____Taketimetobesexual‐withselforpartner
_____Getenoughsleep
_____WearclothesIlike
_____TakeVacations
_____Other
_____TakeDaytripsormini‐vacations
_____Maketimeawayfromtelephones,emailandinternet
_____Maketimeforself‐reflection
_____Noticemyinnerexperience;thoughts,beliefs,feelings
_____Havemyownpersonalpsychotherapy
_____Writeinajournal
_____Readliteraturethatisunrelatedtowork
_____DosomethingatwhichIamnotanexpertorincharge
_____Taketimetobesexual‐withselforpartner
_____Attendtominimizingstressinmylife
_____Engagemyintelligenceinanewarea;art,show,sports
_____Becurious
_____Saynotoextraresponsibilitiessometimes
_____Other
Emotional Self‐Care
Spiritual Self‐Care
_____SpendtimewithotherswhocompanyIenjoy
_____Stayincontactwithimportantpeopleinmylife
_____Givemyselfaffirmations,praisemyself
_____Lovemyself
_____Re‐readfavoritebooks,re‐viewfavoritemovies
_____Allowmyselftocry
_____Findthingsthatmakemelaugh
_____Expressmyoutrageinsocialaction,letters,donations,
marches
_____Other:
_____Maketimeforreflection
_____Spendtimeinnature
_____Findaspiritualconnectionorcommunity
_____Beopentoinspiration
_____Cherishmyoptimismandhope
_____Beawareofnon‐materialaspectsoflife
_____Tryattimestonotbeinchargeortheexpert
_____Beopentonotknowing
_____Identifywhatismeaningfultomeandnoticeitsplacein
mylife
_____Meditate
_____Pray
_____Sing
_____ContributetocausesinwhichIbelieve
______Readinspirationalliteratureorlistentoinspirational
music
______Other:
RelationshipSelf‐Care
OverallBalance
_____Scheduleregulardateswithmypartnerorspouse
_____Scheduleregularactivitieswithmychildren
_____Maketimetoseefriends
_____Call,checkon,orseemyrelatives
_____Spendtimewithmycompanionanimals
_____Stayincontactwithfarawayfriends
_____Maketimetoreplytopersonalemailsandlettersand
sendcards
_____Allowotherstodothingsforme
_____Enlargemysocialcircle
______AskforhelpwhenIneedit
______Shareafear,hopeorsecretwithsomeoneItrust
______Other:
_____Striveforbalancewithinmywork‐lifeandworkday
_____Striveforbalanceamongwork,family,relationships,play,
andrest
OtherareasofSelf‐CarethatareRelevanttoYou:
(AdaptedfromSaakvitne,Pearlman,&StaffofTSI/CAAP(1996).Transformingthepain:Aworkbookonvicarious
traumatization.Norton)
**BelowisaSelf‐CarePlanthatyouwillbeaskedtocompleteduringyourfieldwork
internship.ThisSelf‐CarePlanwillbeausefultoolforyouduringthisinternshipto
reflectuponyourreactionsandfeelingstoexperiencesinyourlifeparticularlyas
theyrelatetoyourstresslevelandcoping.YourSelf‐CarePlanismeanttobea
resourceforyoutocounterbalanceyourpersonallifewithyourworklifesoyoucan
feelproductiveandhealthy.Throughoutthesemesterasyoutakethecompassion
fatiguescale(Pro‐QOL)bi‐weekly,youmaynoticethatstressfromyourexternal
environmentfluctuatesdependinguponyourexperiencesandtherequirements
placeduponyoufromyourinternship,schoolworkandyourpersonallife.Atthe
BUfieldworkprogramwestronglybelievethattheabilitytodevelopandimplement
aSelf‐Careplanearlyoninyourcareerisnecessarytomaintainprofessional
integrityandpersonalhappiness.AlthoughyouwillreceiveagradeforyourSelf‐
CarePlan,thereisnorightorwrongapproach…onlytheonethatyoufeelwillhelp
youbestaccomplishasuccessfulbalanceinyourlife.
“Thisisaveryimportantpractice.Liveyourdailylifeinawaythatyouneverloseyourself.
Whenyouarecarriedawaywithworries,fears,cravings,anger,anddesire,yourunawayfrom
yourselfandloseyourself.Thepracticeisalwaystogobacktooneself.”ThichNhatHanh
______________________Self‐CarePlanDate:_________________________
Iusethisworksheetasaguidetoremindmyselfoftheimportanceofmaintainingahealthy
personalandprofessionallife.IunderstandthatIhavecurrentstrategiesthatareusefuland
othersthatarenot.Inthisworksheet,Iwillidentifywhatcurrentactivitieshelpmetomaintain
ahealthylifeandwhatnewactivitiesmaybeadditionallyhelpful.Inthisworksheet,Iwillalso
includehowIwilladdresspotentialbarriers,includingnegativecopingstrategiestopositive
self‐careandhowIwilladdressthesebarriers.
IdentifyingRedFlags:
(IwillknowwhenIneedtorevisitmyself‐careplanwhenIfeel……orwhenInotice……orwhen
someonetellsme………orwhenIscore___ontheCFscale)
Areaof
CurrentPractice
Concentration
Mind
Body
Emotions
Spirit
Barrierstomaintainingself‐care
Barriersandnegativecopingstrategies
NewPractice
ActionPlantoChange