Identifying clients’ thoughts that underlie their feelings and behavior is key to cognitive behavioral therapy (CBT). Often it goes smoothly. However, sometimes clients struggle to identify their underlying thoughts. When this happens, it can be helpful to use imagery to recreate the situation that is triggering your client.
When clients imagine themselves in the situation, they reexperience their feelings and can more easily access their thoughts. Here is an example:
A client is crying in session over an experience or conversation they had with someone that was upsetting to them. You ask them what they were thinking and they respond, “I don’t know, it was awful.” You can use the following steps to help your client identify their thoughts. Start by saying:
1) “I want to understand your reaction better. I think it would be helpful to imagine yourself back in the situation. Would that be okay? Take a breath and imagine being back in the situation that upset you.”
[PAUSE]
2) “Now, replay the upsetting conversation in your head. Hear the person’s voice and see the expression on their face.”
[PAUSE]
3) “Now notice your feelings [PAUSE]; allow yourself to be aware of your thoughts. Just take your time to notice all your feelings and thoughts.”
After concluding this imagery exercise, ask your client what feelings and thoughts they noticed when they imagined being back in the situation. If they mainly tell you their feelings, pause, summarize their feelings, and then ask about the thoughts that went with those feelings.
The more you pause, and the more detailed the image your client recreates, the more they will reexperience their feelings, and the more they will be able to access their thoughts at the time.
Nina Josefowitz, PhD, is a psychologist and an acclaimed teacher known for her interactive, experiential approach. She has taught cognitive behavioral therapy (CBT) to mental health workers throughout the world, including psychiatrists and psychiatric residents in Ethiopia, psychologists in China, and graduate students in India. She has given workshops on CBT to social workers, nurses, occupational therapists, counselors, psychologists, and students in North America. For more than twenty years, she has taught CBT to graduate students in the department of applied psychology and human development at the Ontario Institute for Studies in Education (OISE) of the University of Toronto. She has published in the areas of trauma, women’s issues, ethics, the therapeutic relationship, and a variety of issues related to CBT. Her most recent interests include adapting CBT to diverse populations and developing experiential teaching methods.
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