How to use a cognitive triangle worksheet with clients

Whether you leverage a simple illustration, or something more interactive, there are many ways to use the CBT triangle in your therapy.

Incorporate it into an assessment 

If CBT is your primary treatment modality, consider introducing the CBT triangle during your initial assessment or the very first session.

Mike Arevalo, PsyD, a private practice therapist and Headway’s clinical product lead, says he uses the CBT triangle to introduce his theoretical orientation to clients, which may help them determine whether he’s the right fit or demystify the process of therapy when clients are nervous. “I always explain it at the very beginning to help people understand what techniques I’ll be using in therapy,” he says. 

Offer psychoeducation 

Once you start doing therapy work with a new client, the cognitive triangle can provide a helpful framework. Amanda Reagan, a private practice therapist and Headway’s clinical quality lead, uses the cognitive triangle as a foundation for client treatment plans and for setting goals with clients.

“It allows folks to see how those arrows are moving in the same direction, which is an important tie-in when we’re defining goals,” she says. 

Tague typically introduces the cognitive triangle as a way to develop a shared language before moving forward with treatment For example, it’s common for people to confuse thoughts and feelings, which can be a barrier to treatment. The illustration can help clients understand the difference between these two before you introduce the thought record and cognitive distortions and restructuring.

“It’s a great way to start separating out thoughts, emotions, and behaviors with clients,” she says, and it introduces clients to an avenue into challenging and reframing the thoughts that negatively impact their emotions and behaviors, which will come later in treatment.

Make it interactive 

It’s easy to find illustrations of the cognitive triangle, but it may be helpful to create an interactive experience in session.

Anita Owusu, a Toronto-based private practice therapist, explains the triangle and asks adult clients to draw it out. Or, she puts pieces of paper on the ground labeled “thoughts,” “feelings,” and “behaviors” and then has the client walk around the triangle as they talk about an experience. She also sometimes has clients draw two triangles, one representing a current situation and one representing how they can change it to be less distressing.

“It’s a good way to get people more engaged,” she says.