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" that 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.

copyright 1996: Dennis Portnoy, from OVEREXTENDED AND UNDERNOURISHED: A SELF-CARE GUIDE FOR PEOPLE IN HELPING ROLES. All rights reserved. Individuals may print this material for personal use only. Written permission is required for any other reproduction.