How to use a thought record worksheet with clients

How you use a thought record with your clients ultimately depends on the clients’ needs and preferences, as well as 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 of thought logs, you can easily incorporate the principle in and out of session, and with or without worksheets.

Start with psychoeducation 

Mike Arevalo, PsyD, a private practice therapist and Headway’s clinical product lead, starts with psychoeducation, which includes both an overview of what automatic thoughts are and how they impact our mood and ensuing actions. 

“People often notice the negative consequences of their thoughts first, and I want them to understand how their thoughts drive their emotions and behavior,” he says.

The next step is utilizing their thought record to track this process and build awareness in their thoughts and actions. Introducing clients to the process of identifying the thought, and getting curious about the feeling and behavior that followed, is a necessary step in introducing this as a practice in their own lives.

Assign homework 

Tague typically encourages clients to keep thought records outside of therapy sessions, whether in a journal or in a notes app on their phone. Thought log worksheets can be structured differently, but many include columns for an inciting event, thought, physical and emotional feeling, and consequence or action. No matter the medium you use, Arevalo encourages having clients take note every time they experience a high emotion or engage in a certain behavior. 

“The goal is to bring more awareness to a client’s automatic thoughts, and to build a cadence that helps them check in with themselves outside of therapy,” Tague says. 

Work on it together in session 

If a client opts to take notes outside of therapy, you can invite them to talk about what they’ve written during the session. You may need to help your client understand the link between their thoughts and feelings.

“Folks tend to conflate their thoughts and feelings, saying ‘I feel like’ and then stating a thought,’” says Tague. “We want to start with the thought so people can identify how their thoughts impact them.” 

Walking through a thought log also allows for clients to build awareness of familiar patterns of thinking that lead to certain feelings and ensuing actions, creating space to make shifts in further CBT treatment.

Help them practice in real time

You can also use thought records on the spot — you don’t need a client to write it down to benefit from the framework. This could be as simple as talking it out organically.

“Maybe as we’re kicking off a session, someone shares something that was recently distressing, and we go through the impact of their thoughts in the moment,” says Amanda Reagan, a private practice therapist and Headway’s clinical quality lead. “Then we can start to think about the adaptive or alternative thought that can diffuse the situation.”

Anita Owusu, a Toronto-based private practice therapist, makes thought logging more engaging by writing out headlines on paper and going through each column in real time.

“I’ll explain what each portion is and have them share what happened and how they thought, felt, and behaved,” she says. After that, she often has clients interview her about a model thought record scenario practice asking the same questions. “The goal is to help them integrate this practice into their routines,” she says.