Sometimes in cognitive behavioral therapy (CBT), teens not only have trouble identifying what they’re thinking and feeling in situations, but they can also have trouble identifying the most upsetting situation among several situations. In order to make each CBT session effective, it’s essential that you and your teen clients focus on the most troublesome situation. To do this, first, eliminate one problem after another, and ask teens to rate the level of relief they feel:
Therapist: So, last week you felt stressed for several days and you’re not sure why. What kinds of things are you thinking about that are stressing you out?
Rita: Well, my piano recital, and then I’m arguing a lot with my best friend. And then I tried to call my dad again and I couldn’t reach him.
Therapist: So, your piano recital, your relationship with your best friend, and you can’t reach your dad. Okay. Which of these situations stress you the most—piano recital, your best friend, or reaching your dad?
Rita: I know this sounds lame, but I’m stressed about them all.
Therapist: Okay. Let’s write down these three things. Let’s say I waved a magic wand and the piano recital was over and you did great. Now how do you feel?
Rita: About the same.
Therapist: How about if you were able to reach your dad and everything was fine with you two. How do you feel now?
Rita: That would lower my stress some, but I’d still feel pretty stressed I think.
Therapist: So, how would you feel if you and your best friend were getting along?
Rita: That would be a huge relief.
Therapist: So, it sounds like your relationship with your friend is the most stressful thing going on for you now.
Rita: Yes. I guess I’m more stressed about that than I realized.
Michael A. Tompkins, PhD, ABPP, is codirector of the San Francisco Bay Area Center for Cognitive Therapy; assistant clinical professor at the University of California at Berkeley; and author or coauthor of numerous books, including Anxiety and Avoidance.