Cognitive behaviour for pain worksheet – client information

It’s not always easy to find freely available client worksheets that reflect ‘real life’ situations, and are written for the age and reading level of the people we often see. For example, most of the people I work with are practical ‘hands-on’ people who don’t like reading or writing, and are either very visual ‘show me what to do’, or kinesthetic ‘let me do what I need to do’. So they can find some of the materials available for cognitive behavioural therapy rather unrelated to their own situation.

I thought I’d share with you a client worksheet I recently developed for a man who has always worked in very practical metal fabricating work. Although he is very intelligent and readily learns new concepts, he is not the sort of person to read a book for leisure, and he dislikes writing.

He is happy to carry out ‘missions’ (I never use the word ‘homework’ because it reminds people too much of school!), but strongly prefers them to be action-based, and if there is any recording to be done, that it be ticking boxes rather than writing sentences. Does he sound like any of your clients?!

CBT worksheet for client handout

The worksheet attached (above) has a brief explanation of what CBT is, then three pictures of activities. The ones used in this example were relevant to the person I was working with – and it’s not terribly difficult to replace these examples with ones relevant to the individual you’re working with.

If you’re using something like Microsoft Word, you can go to the clipart section on their website and there are a lot of photographs you can find showing everyday activities. If none of these fit, very inexpensive clipart CD’s are available with literally 1000’s of different photographs of people and activities that you can use.

I used these because although I would love to have taken him to his own workplace and home, in this instance I was only able to see him at the Centre, and photographs are much more able to elicit automatic thoughts (AT’s) than just talking about a situation.

I then ask him to tell me what was going through his mind, and write this down in the speech bubble beside the relevant picture. Sometimes at this point it’s helpful to work through the AT’s so you access the underlying beliefs, attitudes, or rules that are being expressed – because often you’ll elicit an exclamation like ‘Oh no!’ or a swear word, which is ‘shorthand’ for the unstated but highly relevant belief that is being elicited. The next step is to ask about the emotion that occurs as a result of the statement – and then to write that down in the thought bubble.

This then allows you to identify three separate instances when an automatic thought can be identified, as well as recording both the thought and the emotion very briefly and with graphic illustrations rather than a whole lot of writing. Even if, in the end, there is writing, the photographs seem to help reduce the ‘brain fog’ that can get induced by seeing a lot of writing all on one page.

The final part is to work through one example of an AT and its effect, look at the pro’s and con’s, perhaps work through any thinking patterns (I use this word rather than ‘maladaptive’ or ‘errors’ because it’s less demoralising to hear that it’s a pattern than a fault or error), and replace with a more helpful but equally true statement.

See what you think – and let me know how this works for you.

be careful what you say...

Remember, if you’re keen to keep reading these posts, you can subscribe using the RSS feed at the top left of this page. You’re always welcome to make a comment – for or against – about any of these posts. I always respond to comments (YAY! someone’s let me know they’re out there!!) , and respond as soon as I can.


  1. Yay comments! 🙂

    Thanks for checking out the latest post, I would love to talk to high schools or the first years, but I’m not sure the school would be keen on it 😉

    I thought I’d comment this time, just to let you know that I am still reading your posts (I have your feed on Google Reader so I’m not usually over here). Give yourself props, though, for always having such thoughtful and detailed posts – a big challenge to maintain in the midst of the PhD!

  2. Thanks Bryn, I drop by your place too, but not as regularly as I’d like to. That’s mainly because I have yet to really come to grips with Google Reader. One day!!!

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