THE WORKSHEET FOR EFFECTIVE CHANGE
THE COMPLETE PROCESS TO SUCCEED IN CHANGE




A word document shorter version of this is available to write into, in the piece:  The Five Stages Of Deliberate Change, with an example of a completed worksheet. 

Using the simpler form (above) or this form, I recommend that you highlight and copy the entire webpage and then paste it into your own wordprocessing document.   This is recommended because the space allotted will expand as you continue to type in what is needed.

There is also a form, at the end, for a "Master List Of All The Habits I'd Like To Change In The Next Few Years."   All of them, not just some!    Then you'd prioritize them on which to do in which order and by when. 

(Note that working with a qualified coach or consultant/counselor can dramatically increase the effectiveness.)

Some parts are skippable, but I wanted to have at least one "complete" process.  It is not wise to be stuck on taking shortcuts or shortcutting any process - especially is they are important and impactful.

Yes, this will take extra time compared to not doing it properly (aka using a "short" cut).  But what you want is to be able to complete this successfully - and this is what it takes.  (And you'll save the time it takes to do it over after not having succeeded before.)


IDENTIFY THE PROBLEM

The solution often springs out of a clear definition of the problem.

___ I am aware (at least someone has asserted it and it seems true) that this is SOMETHING THAT IS NOT SERVING ME AND/OR IS HARMING ME.

Comments: _________________________________________________________________

__________________________________________________________________________

DESCRIPTION of what it is:  ____________________________________________________

__________________________________________________________________________


CLEARLY IDENTIFY AND DEFINE THE HARM/DAMAGE

It is not helping me and/or it is harming me in the following way(s):

                             HARM/DAMAGE                                                                               RATING
______________________________________________________    ___
______________________________________________________    ___
______________________________________________________    ___
______________________________________________________    ___

Rate each one on a scale of 1-10, with 10 being horribly harmful. 


THE PAYOFF(S) I am getting from my current behavior:  (Number these for reference below). 
There are primary believed or actual payoffs, plus what are known as secondary benefits, which are simply "side benefits".  These are a result of running what are called "rackets".  What is, and could in the future, holding this behavior in place - describe the process, so you understand it and can therefore find a substitute that will provide the same.

1.  ________________________________________________________
2.  ________________________________________________________
3.  ________________________________________________________

What else I could do that would get the same payoff or be a suitable substitute: 

1.  ________________________________________________________
2.  ________________________________________________________
3.  ________________________________________________________


DESCRIBE THE NEW BEHAVIOR & THE OUTCOME YOU WOULD LIKE TO ACCOMPLISH

My new behavior I wish to accomplish is: ________________________________________
________________________________________________________________________

The outcome(s) I would like to accomplish is: ____________________________________
________________________________________________________________________

__ I am listing my new rules on a "These are the rules" page.


IDENTIFY THE BENEFITS to my life of doing this change:






Rate each one on a scale of 1-10, with 10 being incredibly beneficial.

What I will do to keep these clearly in mind, if needed:

__ Review, remind myself every __ days or week or _____
    __ Visualize the feelings, rewards, etc of doing the new strategy
    __ Review the list of benefits/whys and strongly declare your commitment


WHAT I WANT - My destination is:  (Clearly defined, and attainable.)




AM I WILLING TO PAY THE PRICE? (If you're not, don't bother to start.) 

   ___ Yes, absolutely.


WHAT HAS GOTTEN IN THE WAY OR MIGHT GET IN THE WAY

__ I must first know enough about how things work.  I will "study" to the point where I can proceed with the benefit of Sufficient Knowing.

Temptations, situations that got in the way:

Other: 


Write below each of the "get in the way" items (above) what strategy and handling you will do when those come up.


OVERALL BASE FACILITATORS

__ I understand that willpower and the capability for change are increased if I do certain things that generate more energy and keep my energy up. Doing this will make all of this much easier and much more productive.  (Energy Checklist and The Pre-Set, Super-Committed Schedule For An Always Powerful Day!  Not Optional!)  I also understand that changing that energy and my momentum during the day will help me be less prone to do dysfunctional behaviors.  Therefore, what I choose to do to utilize those very doable methods are: 



COMMITMENT: Based on the above, I commit to the following (with specific dates and actions toward it):

I will do this to full completion of the objective, period, with no outs.  (If I fail, I will re-start and go at it again.  I have decided that ultimate failure on this is not an option.)

    Committed to this ___ day  of ____________, 2____:  _________________________
                                                                                                    Signed
    I will announce this commitment to:  ________________________________________


ACTIONS, Specific, and dates  (can be filled in later):  (Also, if relevant, specify how long you’ll do the action for.)  I hereby make the decisions to do these actions. 




(Optional) Some treat or reward for myself starting this:__________________________

(Definitely) The reward for completing this will be:  _______________________________
                 Be generous here, but don't give it to yourself unless you complete what is necessary
                    to do to get the desired result.
Rewards along the way at each milestone will be:




SET IN PLACE THAT WHICH WILL SUPPORT ME ALONG THE WAY

My plan to do that which follows to keep me on the path:





Who will support me and what resources I will use.



The affirmations and declarations to excite me and support me


WHAT WILL KEEP ME ON THE PATH?

__ Read the benefits and payoffs, above, at least daily.
__ Daily, at least, repeat related affirmations (to make this "larger" in your mind and to wire it
     into neuronal pathways, which in turn make things easier because it is easier to follow a
     grooved pathway in the brain).
__ Partner, support team in the process (being accountable, and sharing this sheet with the
    other person)
__ Rewards (for even small things)
__ Celebrate, how:  _______________________________________________________
__ My monitoring sheet 
__ Interacting with a role model, finding models to emulate
__ If I fail, I simply re-start, and continue adding new weight to my neuronal pathway.
__ Write in your Improvement Journal what you notice and what to do to make things work.
__ Specifically writing down what you will do and when (in studies, this had huge results
       compared to those with just an intention)
       __ Specifically writing down each step and when it will occur in the sequence of what you do
            in life (this set up "cue-ing", so that the precedubg action/event "triggers" this action)
__ Having a system and a process, written down, that is clear and inclusive


HOW I SEE MYSELF IN THE FUTURE:  (Visualization, which motivates, plus giving me a chemical boost, feel, smell, taste.)




Such as:  I am proud of myself for quitting smoking.  I see myself as smoke-free and very healthy and alive.  I am so grateful for having done this.   I see myself smiling with satisfaction as my supporters are applauding my success.  I am confident about all of this.  I am a better person for having done this - and persisted.  I am forever grateful.  And I am so very proud of myself for following through!


WHAT COULD PULL ME OFF THE PATH AND MY ACTIONS TO HANDLE

Cue, situation, circumstances, people, stimulus      Action I will take to keep on the path

________________________________________     ________________________________
________________________________________     ________________________________
________________________________________     ________________________________
________________________________________     ________________________________


JOURNAL OF OBSERVATIONS

Since change involves doing new things you don't quite know how to do (such as discipline yourself), observing the failures and acknowledging even the small successes is an important tool, so you can adjust.  Keep this worksheet available to look at or put it into the journal.  If it is a paper journal, it's best if it is hardbound.  (The Improvements Journal is an example of a possible format/concept.


REASSESSMENT DATE tickled on calendar for initially revisiting and reassessing: 

             ____/____/____


ASSESSMENT:   (If doing by hand, use the back of the page for additional inputs.)

How it is going/succeeding:


How  the actions/strategies should be revised: 

FINAL SIGN OFF

____ I have built this into my life and it is something I will do always as part of my life.

    Signed off this ____ day of _____________, ____ 

    _________________________


    _____________________________________________________________________


MASTER LIST OF ALL THE HABITS/BEHAVIORS I'D LIKE TO CHANGE
IN THE NEXT FEW YEARS


See a filled-in example included in The Five Stages Of Deliberate Change.

List all the items you can think of, stop for a second, then add a few more.  Keep this list in your About Me notebook for reference, and add to it over time.  Rate the level of harm from 1—10, with 10 being very, very harmful and 1 being minor – these ratings will serve as a prioritization basis for the list on what to address to have the most benefits to your life.  One would then use the change form to address each in the order you choose.  It is interesting to note how many of these will have a high harm level, but are pushed out of our awareness on a daily basis.  The IMP column rates importance, prioity to do this, and the impact of it.  A = Very high impact, B = Large impact, C = Some impact, D = Little impact.  On the key ones you choose to commit to, place a tentatve date to start.  Don't start a new one until you've largely mastered the current one.

IMP                   ITEM                                                         COMMENTS           HARM     DATE START
                                                                                                                                            Level of

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The Sections In This Worksheet
(To navigate and/or to get an overview)  The bolded items are crucial.

Identify the problem
Clearly identify/define the
  harm/damage
The payoffs one is getting
  from the current behavior
  What else could be done
    to get those same
    benefits?
Describe the new behavior
  and the desired outcome
Identify the benefits
What I want
Am I willing to pay the
  price?
My commitment
Actions I will take
  Including rewards
Get support - people,
  resources, systems
What will keep me on
  the path?
How I see myself in the
  future
What could pull me off
  the path and my 
  actions to handle
  those
How could I strengthen and energize myself to facilitate this?
Journal observations
Reassessment date
Assessment
Final sign off
Copy and paste the list below into a word document for easier use.