A contact and boundary plan
This worksheet helps you write down a choice about your own contact. It does not tell you to leave, stay, block someone or wait a particular number of days. You can leave questions blank and change your plan.
1. Name the situation
A period of space, limited contact and one planned conversation are different choices. Shared responsibilities may require a practical channel.
What am I deciding about?
What contact is necessary, if any?
2. Make the boundary usable
Focus on what you will do. Another person may disagree; a boundary is not a way to control their response.
Which channel and topics fit this situation?
What will I say or do if the conversation moves outside that purpose?
3. Choose the next action
A short, specific plan can be easier to follow than a rule for the rest of your life. Necessary contact is not a failure or a reset of progress.
My next action, and when I will take it:
Who or what could support me? When might I review this plan?
Attachment Shift · September 8, 2026 · Free for personal use. Keep completed copies somewhere suitable for your privacy. This blank worksheet does not collect or submit answers.