Therapy Values Clarification Form
Reflect on your personal values, identify areas of alignment and conflict, and set your next-step priorities.
What are your top 3–5 personal values?
*
How important is each value to you?
*
Rows
Importance (1 = Least, 5 = Most)
Value 1
1
Value 2
2
Value 3
3
Value 4
4
Value 5
5
How closely do you feel you are currently living according to each value?
*
Rows
Current Alignment (1 = Not at all, 5 = Fully)
Value 1
6
Value 2
7
Value 3
8
Value 4
9
Value 5
10
Are there any values that currently feel in conflict with each other or with your actions?
Briefly describe any situations where you feel challenged to live by your values.
Which values would you most like to focus on strengthening or prioritizing next?
*
What is one concrete step you can take in the next week to better align with your chosen value(s)?
*
How confident do you feel about making this change?
Not confident
1
2
3
4
Very confident
5
1 is Not confident, 5 is Very confident
What support or resources might help you follow through?
Would you like to share any additional reflections or intentions?
Submit
Should be Empty: