My Maintenance Self-Care Worksheet
Review the Self-Care Assessment that you just completed, which includes what you are doing now for self-care. On this maintenance selfcare worksheet, list those activities that you engage in regularly (like every day or week) under “current practice” within each domain.
Identify new strategies that you would like to begin to incorporate as part of your ongoing maintenance self-care— pay particular attention
to domains that you have not been addressing in the past. On the last page identify barriers that might interfere with ongoing self-care,
how you will address them, and any negative coping strategies you would like to target for change and how you will change them.
MIND
BODY
Current practice
Current practice
New practice
New practice
EMOTIONS
SPIRIT
Current practice
Current practice
New practice
New practice
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My Maintenance Self-Care Worksheet
WORK
RELATIONSHIPS
Current practice
Current practice
New practice
New practice
OTHER:
.
OTHER:
Current practice
Current practice
New practice
New practice
.
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My Maintenance Self-Care Worksheet
Barriers to maintaining my self-care strategies
How I will address these barriers
and remind myself to practice self-care
Negative coping strategies
I would like to use less or not at all
What I will do instead
(Adapted by Shirley Reiser, LCSW and Lisa D. Butler, PhD from materials provided by Sandra A. Lopez, LCSW, ACSW, University of Houston, Graduate School of
Social Work.)
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