How can clients be taught to deal with automatic thoughts? - Chapter 15

This chapter discusses ways in which clients can respond to automatic thoughts.

Clients not only have automatic thoughts during sessions, but also when they are at home. Clients experience two kinds of automatic thoughts outside of session: ones they have already identified and evaluated in session, and novel cognitions.

For the first group of thoughts clients should know what to do because it was discussed in session and sometimes even written down. The notes made in therapy may contain adaptive responses to dysfunctional thinking, behavioral assignments or a combination of both. Reading these notes at home might help clients cope with their automatic thoughts. For clients that dislike writing and reading there are audio-recorded therapy notes.

To respond to novel automatic thoughts between sessions, the therapist will teach clients to use Socratic questions on themselves or to use a worksheet such as a thought record. But there are other ways to respond to automatic thoughts. Clients can engage in problem solving, use distraction or relaxation techniques, or label and accept their thoughts and emotions without evaluation.

What is a thought record?

The thought record is a working sheet that prompts clients to evaluate their automatic thoughts when they feel distressed. The thought record exists of five columns where clients need to: describe the situation, write down their automatic thoughts that accompanied the situation, write down their emotions, think of adaptive responses and summarize the outcome (‘How much do they now believe the automatic thought?’). Clients should also write down how much they believe in the responses they think are adaptive. An alternative for the Thought record is the ‘Testing your thoughts’ worksheet. This is a simplified version of the thought record.

Most clients, at some point, find that completing a particular worksheet did not provide much relief. If the therapist emphasizes its general usefulness and “stuck points” as an opportunity for learning, you help clients avoid automatic thoughts critical of themselves, the therapy, the worksheet, or you.