Teaching Clients to Use the Cognitive-Behavioral Thought Record

Charles Holton, LCSW

Many clients complain that the traditional format of the thought record -- define the troubling thought, identify the distortion, state a more rational thought -- doesn’t provide help in actually changing how they are thinking. “I can think of more rational thoughts, I just don’t believe them!” is a typical com me nt.

This format, developed by Christine Padesky, is helpful in providing a step-by-step procedure for developing new beliefs that are more accurate and reality-based. In teaching clients to use it, instruction is also being given in developing a “solution-focus”; that is, the client improves his/her skill at noticing and valuing exceptions to the absolute-thinking characteristic of most core-beliefs. The process values and encourages self-reliance, responsibility for and pleasure in monitoring one’s flow of experience, and acceptance and curiosity about the influence of what we notice on how we feel.

(1) Identify the Core Belief. Deeper than either automatic thoughts, or the internalized rules that govern many of our responses, core beliefs are the primitive, absolute convictions we hold about ourselves or the world. “I am worthless.” “Everybody betrays me .” “No-one could love me .” Clients will typically endorse these state me nts as true, occasionally expressing surprise if the therapist challenges them. The thought record can be effective with more transient ideas, but finding the driving ideas that embody the cognitive distortions will pay dividends.

(2) Rate % Belief. The client assigns a nu me rical value to the influence this idea has on their perceptions and experience: “How much do you believe it?” The act of scaling is empowering in itself, and offers clients both perspective about the impact of the problem on their life, and an implied differentiation between them and the problem -- even if the client scales belief at 100%, the belief is not them.

(3) Evidence the Belief is True. This is usually the easy part. Encourage the client to list every piece of evidence they can think of that verifies the core belief. Inevitably, clients have lots of stories that illustrate it. That’s fine, because the core belief is part of the truth. At this point don’t contradict or challenge any aspect of the client’s conviction in the core belief. Rather, let that energy diffuse itself in the telling. Let this go on as long as it needs to, until it seems to conclude with its own rhythm.

(4) Evidence the Belief is Not 100% True. Or, Evidence Other Things Are Also True. Encourage the client to spend as much ti me (and written space) on this section as the previous one, which may require persistent encourage me nt from the therapist. This does not contradict the core belief but comple me nts it. When have other kinds of events occurred? For example, if “People always hurt me ” is the core belief driving the client’s perceptions, this section could be used to investigate the questions “What other things do people do? When do people not hurt me ? When has it not bothered me much that so me one has been me an?” Again, exploring exceptions to the perceptions driven by the core belief should be detailed and exhaustive.

(5) Re-rate % Belief. Typically there will be a decrease in reported % belief at this point in the exercise, evidence that the core belief is losing so me of its influence on the client. It should be noted that a decrease from 100% to 99% although sounding minimal is enormously significant in that it represents a shift from absolutely not believing in the possibility of any alternative to experiencing the possibility of shifting perspectives. Of course, any shift should be noticed and explored.

(6) New Belief. Where the core belief is absolute and primitive, the new belief usually has the richer, more complex form of adult perspective: “Although many people have hurt and disappointed me (or so me form of core belief), a lot of people have been friendly or helpful, too, at ti me s (or so me form of evidence it’s not 100% true).” The inclusive quality of the new belief differentiates it from the excluding, information-filtering quality of the original core belief.

(7) Any new thoughts or feelings? The purpose of this section is to encourage further processing on the part of the client, and to illustrate that the exercise doesn’t have pat answers or finish a process, but rather opens a door for the client to continue noticing, valuing and learning from their own experience.

Thought Record

Core belief:

Rate % Belief:

Evidence it’s True

Evidence it’s not 100% true (What else is true also?)

Re-rate % Belief

New Belief

Any new thoughts or feelings as a result of the new belief?