Assertive Communication Worksheet

How to use it

1. Describe the situation using as much or as little detail as you want.
2. Choose your goal, feeling words, request, and boundary; there can be more than one workable message.
3. Pick a delivery option and a backup plan that fit the context.
4. You may revise, pass, or seek support before using the message.

Reflection prompts

• Which part of the message matters most to you?
• What would tell you to pause, change approach, or seek help?

Facilitator guidance

Treat passive, direct, indirect, and delayed responses as contextual strategies rather than moral categories. Help the participant distinguish a request from a limit and consider whether the recipient and setting are safe enough for direct communication.

Adaptations & accessibility

• Complete one section at a time or use sentence strips.
• Allow drawing, dictation, role-play, or AAC-supported composition.
• Use a fictional example before discussing a personal situation.

Review considerations

Licensed-clinician review required before use; enhanced safeguarding review is required when the activity may involve coercion, abuse, or meaningful power imbalance.