Self Care Assessment

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Terri L. Gerber, LICSW

1. Are you journaling?  How often? 

2. When you journal, do you ever use techniques such as cross-writing, letter-writing, or gratitude journaling?

3. Are you refraining from dieting and instead focusing on healthy eating (3 meals, 2 snacks, healthy choices)? Answer yes if this is your focus, even if you have "off days".

4. How many cups of coffee do you drink each day?  How many glasses of alcoholic beverages do you drink each day?  Do you smoke?  If so, how many cigarettes each day?

5. Do you work more than 40 hours each week? Briefly summarize your work schedule.

6. Do you have one or two fun or relaxing activities to look forward to each day? Each week?  What do they involve?

7. Are you getting any alone time? How much do you ideally need? How much do you get?

8. Is prayer, meditation or reflection time part of each day? Each week? How and when do you create this?

9.  Is exercise a part of your life?  How often?  In what form?

10.  Are you making time for friendship?  What do you do to either maintain friendships or create new connections?

 11.  How many hours of sleep do you get each night?

 12.  Do you take breaks during the day?  If no, what are the obstacles?

 13.  Are you getting out into the sun or fresh air for at least 15 minutes each day?  How and when do you do this?

 14.  Do you have ritual in your day or week?  Ritual is a practice that helps us get perspective.  A practice that helps us rise above the daily routine to remember the bigger picture.  What are your rituals?

 15.  When it has been a hard day and you are feeling hurt, angry, or emotional pain of some kind, how do you soothe yourself?

 16.  What does your self-talk sound like?  Are you critical?  Negative?  Full of fear?  Are you   compassionate with yourself?

 17.  How much TV do you watch?  How much news do you watch?  Are you making conscious choices?  Are you defending your soul from some of the cultural messages  (i.e., keeping a critical eye open?)