Worksheet
This worksheet guides therapists in noticing and tracking their own nervous system activation throughout the workday to support presence and clinical effectiveness. Use the prompts to identify shifts, explore what regulates or dysregulates you, and build habits of self-awareness for long-term resilience.


Check in with your body and mind before, during, and after sessions using the worksheet prompts. Notice the signs and patterns of your nervous system activation—whether you’re regulated, shut down, or highly activated—and reflect on what triggers shifts and what restores balance. Use this tool to plan small regulation practices and track your progress over time.
This worksheet is designed for therapists, counselors, and mental health professionals who want to enhance self-awareness and prevent burnout. It’s ideal for use in solo practice, group settings, or during supervision as part of a comprehensive therapist self-care plan.
Related Topics
References
Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. W. W. Norton & Company.
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