How to use a cognitive restructuring worksheet with clients

How you use a cognitive restructuring worksheet with your clients ultimately depends on the clients’ needs and preferences, and your therapeutic style. Some therapists incorporate CBT principles in a regimented way, while others take a more organic approach. If you’re familiar enough with the framework, you can easily incorporate the principle in and out of session, and with or without worksheets.

Build on previous principles

Cognitive restructuring is the next step after completing thought records and identifying cognitive distortions. You can easily find cognitive restructuring worksheets and other resources online, but Tague says it’s sometimes more of a CBT principle rather than a dedicated exercise. It may make sense to simply expand an existing worksheet.

“If you already have a thought log that records how a thought makes you feel, this might just be an added column,” says Tague.

If your client is motivated to work between sessions, you can give the worksheet as homework and process it together at a future appointment. For the sake of Socratic questioning, it’s also effective to simply have your client pay attention to their thoughts between sessions and work on the worksheet together, says Mike Arevalo, PsyD, a private practice therapist and Headway’s clinical product lead.

Engage in Socratic questioning

After you identify the triggering event and record the automatic thought and cognitive distortion, you can help your client challenge their distorted thought by questioning its validity. Then, you can engage in Socratic questioning, says Reagan.

Ask questions that help the client realize the thought may not actually be true, such as “What evidence do you have to support that thought?” or “How do you know it’s true?” Then, you can help your client realize on their own why their thoughts may not be accurate, supportive, or helpful before taking the step to form new ones. 

Generate alternative thoughts 

Finally, once your client realizes they don’t have evidence to support their distorted thought, you can help them form a new, more balanced way of thinking. This is where the actual restructuring or reframing comes in.

“I usually ask ‘How can you think about this differently?’” says Anita Owusu, a Toronto-based private practice therapist. For example, if the distorted thought is “I’m a bad employee,” and your client can’t produce evidence to prove the thought is true, you could reframe it as “I’m a hard-working employee who’s also human and sometimes makes mistakes.” 

No matter what your client’s been struggling with, the framework of cognitive restructuring can help them hone in on their faulty thoughts and core beliefs so they can find more balance and less distress in their day-to-day life.