Self Care Assessment

Written By: Heather
Heather Kempton Coquitlam Couples Counsellor

Self Care Assessment

Consider the following 40 statements below, filling in the blanks that follow with the number that best corresponds with your life at this time.

Responses: 1 = Very True 2 = Somewhat True 3 = Rarely True

  1. When people get upset, I try to smooth things out. ____
  2. I am able to listen to others problems without trying to “fix” them and/or take away their pain. ____
  3. My self-worth is determined by how others perceive me. ____
  4. When I am exposed to conflict, I feel it is my fault. ____
  5. I feel guilty when others are disappointed by my actions. ____
  6. When I make a mistake, I tend to be extremely critical of myself: I have difficulty forgiving myself. ____
  7. I usually know how I want other people to treat me. ____
  8. I tell people how I prefer to be treated. ____
  9. My achievements define my self-worth. ____
  10. I feel anxious in most situations involving confrontation. ____
  11. In relationships, it is easier for me to “give” than to “receive”.____
  12. I can be so focused on someone I am helping that I lose sight of my own perceptions, interests and desires. ____
  13. It is hard for me to express sadness. ____
  14. To make mistakes means that I am weak. ____
  15. It is best to not “rock the boat” or “make waves”. ____
  16. It is important to put people at ease. ____
  17. It is best not to need others. ____
  18. If I cannot solve a problem, I feel like a failure. ____
  19. I often feel “used up” at the end of the day. ____
  20. I take work home frequently. ____
  21. I can ask for help but only if the situation is serious. ____
  22. I am willing to sacrifice my needs in order to please others. ____
  23. When faced with uncertainty, I feel that things will get totally out of control. ____
  24. I am uncomfortable when others do not see me as being strong and self-sufficient. ____
  25. In intimate relationships, I am drawn to people who are needy or need me. ____
  26. I have difficulty expressing my differing opinion in the face of an opposing viewpoint. ____
  27. When I say “no”, I feel guilty. ____
  28. When others distance from me, I feel anxious. ____
  29. When listening to someone’s problems, I am more aware of their feelings than I am of my own feelings. ____
  30. I find it difficult to stand up for myself and express my feelings when someone treats me in an insensitive manner. ____
  31. I feel anxious when I am not busy. ____
  32. I believe that expressing resentments is wrong. ____
  33. I am more comfortable giving than receiving. ____
  34. I become anxious when I think I’ve disappointed someone. ____
  35. Work dominates much of my life. ____
  36. I seem to be working harder and accomplishing less. ____
  37. I feel most worthwhile and alive in crisis situations. ____
  38. I have difficulty saying “no” and setting limits. ____
  39. My interests and values reflect what others expect of me rather, than my own interests and values. ____
  40. People rely on me for support. ____


It is important for you to periodically review your self-care, along with your needs and action plans to meet those needs.

If you find that your responded with a 1 (Very True) to more than 15 of these items, it’s definitely time to take a close and careful look at self-care issues.