Your guide to sleep diaries for CBT
Here’s how sleep diaries can help your clients achieve better rest.
Discover evidence-based therapy activities for teens that improve participation and outcomes.
Every therapy client is unique — but after working with enough people, therapists start to identify certain patterns.
Adriana Jodoin, a licensed clinical psychologist who provides therapy to clients in Massachusetts and New York, says she’s noticed one clear trend when working with teenagers: they can be slow to open up and hesitant to participate in therapy.
“Adult patients are like puppies. They’re excited for the treatment and they’re ready to talk,” Jodoin says. “Teens are more like cats. You have to build up rapport with them and build up trust, and then eventually they’ll warm up to you and talk.”
Building a rapport with a teen client can be easier said than done — but clinically appropriate activities may help. Incorporating art, movement, mindfulness, games, and other activities into sessions may help teens come out of their shells and begin to fully engage with the process. Here are eight therapeutic activities to try with teens in your practice.
Teenagers aren’t just smaller adults. They are at a distinct developmental stage, with their brains and bodies still maturing. Their developing brains are still getting a handle on impulse control, complex decision-making, and risk management. Not only that, teens are still figuring out who they are and who they want to be. They may be experiencing certain intense emotions or challenging situations for the first time.
For all these reasons, teens may not be able to process and articulate their feelings and emotions in the same ways that adults do. They may also struggle to identify and change problematic patterns of thought or behavior. In fact, they may be hesitant to engage in the therapeutic process entirely.
Jodoin says resistance is a common issue with teen clients, often because they’re in therapy at the request of a parent, caretaker, or other adult, rather than out of genuine desire for treatment. Many teenagers also value independence and chafe against authority, so they may think a therapist is trying to tell them what to do and want to rebel against that perceived intrusion.
This combination of factors can make teenagers hesitant to open up in the therapy room, sometimes necessitating approaches that go beyond traditional talk therapy.
Teenage clients may struggle (or even refuse) to engage in pure talk therapy, and there are plenty of reasons for that. Teen clients may be in therapy at the behest of their parents, making them resentful of the time they spend in sessions. They may not fully understand why they’ve acted in certain ways or experienced certain emotions, which can make it difficult to express themselves verbally. They also may be embarrassed or nervous to discuss personal thoughts and experiences with a relative stranger, or may not trust that the provider won’t tell their caregivers about the sessions. (As a first step, it is important to clarify what you will and won’t discuss with caregivers to build trust with your client.)
In these cases, creative approaches can help unlock new forms of communication and self-expression. When conversation isn’t flowing, art, music, or writing can help fill the silence and encourage your client to show new sides of their personality and psyche.
Art therapy can be a great tool for clients of all ages who struggle with verbal expression, offering different mediums through which they can explore, process, and convey emotions. And there’s no need to limit yourself to traditional art forms like drawing and painting, especially when working with adolescents and teenagers. Incorporating digital art and photography — which come naturally to many “digital natives” who grew up with technology — can be a great way to meet a teen client where they are.
There are many ways to incorporate music into a teen’s therapy session. Clients who are musically inclined may prefer to express themselves by singing or playing an instrument — but the possibilities don’t end there. You could encourage your client to find existing song lyrics that convey their feelings, or to write their own lyrics to capture a mood. Or, you could simply listen to music together during sessions to reduce stress and improve mood.
Bonding over shared music tastes is also a great way to strengthen rapport, Jodoin adds. “If I know that they love Taylor Swift, I will go full Swiftie,” she jokes.
Sometimes, it’s easier for young clients to describe their thoughts and emotions in writing than to say them out loud. Expressive writing techniques, such as journaling, can be a great tool for people who fit that description. Encourage your client to write for a short time — maybe 10 or 20 minutes — about whatever is on their mind, focusing less on narrative and story structure than on their feelings and emotions. This process can not only improve mental health and well-being, research suggests, but also help clients gain self-awareness and practice written communication skills.
Therapeutic games can provide a valuable double whammy for clinicians working with teens and adolescents. Playing games together can improve the client-therapist relationship, while simultaneously (and subtly) chipping away at the client’s hesitation to engage in therapy. When a client is relaxed and enjoying their time, as when playing a game, they are less likely to be hostile or resistant, which makes it easier to forge a bond.
By easing tensions in the room, you are also laying the groundwork for therapeutic progress. Clients often take down their guards while playing games. When they’re in that relaxed state, you may be able to bypass conscious resistance and begin to access their underlying emotions and thought patterns. Once the ice is broken, a young client may be encouraged to open up not only in the moment, but also in the future.
When regular conversation fails, gamify it. Therapists can either buy or create card games that spark conversation through fun prompts, questions, or activities. For example, some clinicians play “Emotions Uno,” a spin on the classic card game in which players have to share certain feelings or memories depending on the cards they draw.
An “emotions Thumball” promotes a similar concept in a slightly more active way. You could toss one around with a client who loves sports, for example.
Many teenagers love playing games on their phones or computers. Bringing an activity that they already enjoy doing in their free time into the therapy room may encourage them to engage. Some video games — like SPARX — are specifically designed to teach players therapeutic skills and concepts, such as emotional regulation and problem-solving. Meanwhile, other games can simply be used as conversation starters, icebreakers, or stress reducers.
Some teenagers are hesitant to share their innermost thoughts and feelings in therapy. If that’s the case for your client, it may help to take the focus off of them for a little while, while still making productive use of your time together.
Rather than pressuring a resistant teen to open up about their own life, you could create a deck of hypothetical role-playing or problem-solving scenarios that they draw and work through at random. This way, the client will still learn crucial therapeutic skills without having to share before they’re ready.
Therapy doesn’t always have to be all about thoughts, feelings, and conversation. Particularly when working with clients who struggle with verbal expression, it’s often a good idea to engage the body as well, either through physical activity or mindfulness techniques.
Plenty of research shows there’s a strong connection between the mind and the body. Activities such as yoga, breathing exercises, and meditation foster this connection and offer a host of benefits. For one, they can reduce physiological and psychological stress, putting teen clients in a relaxed headspace that may be more conducive to productive therapy. Practicing these techniques during sessions can also equip teens with evidence-based coping skills they can use in their day-to-day lives to counter anxiety, stress, and other mental health concerns.
A guided meditation can help clients relax, reduce stress, and center themselves. Visualization techniques may provide helpful structure to meditation time. For example, you could instruct your client to envision the place where they feel happiest or calmest, and guide them through thinking in detail about what it looks, feels, and even smells and tastes like to be there. Or, you could guide your client through a “body scan” meditation, during which they notice and purposely relax each part of their body to release tension.
Helping your client engage all five of their senses can help them feel grounded and centered, countering feelings of anxiety, nervousness, or agitation. One popular technique is the “5-4-3-2-1” method, which instructs participants to notice five things they can see around them, four things they can touch or feel, three things they can hear, two things they can smell, and one thing they can taste.
“Tapping” is another evidence-based grounding technique. Using the fingertips to gently tap various parts of the body has been shown to stimulate the nervous system and provide a sense of calm.
Just like with any client, building a successful therapeutic relationship with a teenager requires patience, creativity, and a true understanding of who your client is as a person — and who they would like to become. It’s a process that can’t be rushed or forced.
Headway gives providers the greatest gift of all: the time and space to focus on building that rapport and understanding, without getting distracted by administrative work and other time-consuming hassles. With other clinical support resources and a free, comprehensive platform that includes built-in marketing support, EHR features, documentation templates, billing support, continuing education resources, and more, Headway takes extraneous tasks off your plate so you can focus on providing great care — to clients of all ages.
Here’s how sleep diaries can help your clients achieve better rest.
These techniques are commonly used to help treat symptoms of obsessive-compulsive disorder.
Many therapists were trained to view them as important clinical tools, but they’re not evidence-based.