My Vision

My Long-term Vision________________________________________________________________

On a scale of 1-10: How motivated am I to reach this goal?____How reachable is this goal?_______

Circle where I am in the change process with this goal:

Pre-contemplative Contemplative Preparation Action Maintenance

In the past what has kept me from reaching this goal? (Check all that apply) (List the 5 sabotages)
[ ] Entitlement [ ] Motivation [ ] Fear [ ] Safety and Protection [ ] Power

What resources do I have that will help me reach this goal?

[ ] Books [ ] People [ ] Journal [ ] Exercise [ ] _________ [ ]_________

Other____________________________________________________________________________

What internal strengths do I already have already that will help me reach this goal?
[ ] Experience [ ] Determination [ ] Self Awareness [ ] Patience [ ] etc.

Other____________________________________________________________________________

What do I need to do to move to the next stage of change?

For contemplation:

What is my current belief?

_______________________________________________________________________________

What would I rather believe?

________________________________________________________________________________

What stops me from believing this?

________________________________________________________________________________

For preparation:
What is my start date?______________________________________________________________
To prepare for this start date, my plan is:

1._______________________________________________________________________________

2._______________________________________________________________________________

3._______________________________________________________________________________

For maintenance:
What will I do to continue to maintain my motivation and take emotional care of myself:
1._______________________________________________________________________________

2._______________________________________________________________________________

Wendy Rawlings