How to Use Therapy Worksheets in Counselling

Therapy worksheets like the ones found in CTRI’s Counselling Activities Workbook are valuable tools in the counselling room. These informative handouts and reflective exercises can bring focus to a conversation, help the client retain information, and facilitate the integration of new skills.

However, therapy worksheets can also be a barrier to growth and learning if they aren’t used properly. Although the temptation might be to quickly give your client a handout at the end of a session without much explanation, these tools are most useful when introduced in an intentional process.

 These informative handouts and reflective exercises can bring focus to a conversation, help the client retain information, and facilitate the integration of new skills.

Four Steps for Effectively Using Therapy Worksheets with your Clients:

 

1. Listen for Opportunities

Look for indications that a take-home handout may be valuable. This could be when the client needs more time to process things or would benefit from practicing new skills. Or maybe progress seems to be “stuck” and they’ve shown an interest in doing between-session work.

Case Study: Jo and Terry

Jo and Terry were looking for ways to improve their relationship. It was quickly apparent that their communication pattern was a barrier to solving problems, as both talked over the other person and did not listen well.

I asked, “Is this how conversations go at home?” They both said yes, so I followed up by inquiring, “How does this affect your ability to work things out?” They both agreed it was a barrier.

Look for indications that a take-home handout may be valuable.

 

2. Explore

Consider whether an at-home activity would help the client achieve their goals. Introduce the idea of doing some work at home and discuss what they feel will be doable. You may want to note that the goal of therapy is for the client to gain skills and insights they will use at home, so practicing now will help with that.

Think about what type of therapy worksheet your client might be interested in. Not everyone will be motivated to fill in a daily record or take time for a reflective activity.

Case Study: Jo and Terry

Jo and Terry were interested in trying something but were unsure if they could fit it into their busy week. I inquired about what might prevent them from doing some homework, which provided more insights into the challenges they faced in maintaining their relationship, emphasizing external factors such as busy schedules. We discussed the idea of trying the exercise just once that week.

I chose an earlier version of the Active Listening exercise from CTRI’s Counselling Activities Workbook. The purpose of this activity is for partners to practice showing empathy through active listening. The handout outlines the components of active listening and provides instructions for a 2–4-minute conversation, followed by reflective questions. It is best introduced by practicing within a session, and then having the client try it at home.

Also consider contraindications to the proposed activity. For example, if there was a high degree of conflict and contempt in Jo and Terry’s interactions, active empathetic listening might not be the first step as it could spark conflict. Information about how to take a time out in emotionally charged interactions might have been more appropriate in such a case.

Also consider contraindications to the proposed activity… active empathetic listening might not be the first step as it could spark conflict.

 

3. Review and Adapt Therapy Worksheets (If Necessary)

Don’t wait until the last few minutes of the session to show your client the handout. Rather review it with them, explaining the purpose and each step. Ask if they have questions and if they think it’s something they could do. Some activities will need in-session practice, while others such as reflective exercises can be explained and then done at home. Some therapy worksheets may even need to be adapted to your client’s needs.

Case Study: Jo and Terry

For Jo and Terry’s in-session practice, I gave them each a magazine and had them select a picture to talk to their partner about. This was designed to keep the topic as neutral as possible, to practice the skill of active listening before applying it to emotionally tense conversations. We tried it with me coaching them, and I asked each of them the reflection questions at the end of the exercise. They agreed they would like to try it at home, using a neutral topic.

 

4. Follow-Up

Providing the handout is just the beginning of the therapeutic process – it’s essential to follow up on how it went. For a written exercise such as a daily record or thought journal, have the client bring back the completed handout and review it with them in the next session. For other activities, ask for a report. You can then help them identify what worked, what didn’t, and discuss new insights or skills they might have gained.

Case Study: Jo and Terry

Jo and Terry came back the next week and reported that the exercise “did not work.” When I inquired about what part of it hadn’t worked, they admitted they didn’t actually try it. We were then able to explore what prevented them from trying, which turned out to be mutual anxiety about being vulnerable with each other. The remainder of that session was spent working on that tentative emotional connection, and the activity was kept as an option for when they felt more ready. They were open to a bit of humour, so I also suggested some silly hand signals or keywords to lighten things up.

The week after that, they came in smiling because they had spontaneously decided to try the active listening exercise for discussing a problem, and it had gone well! Clearly some emotional safety had to be established first.

Providing the handout is just the beginning of the therapeutic process – it’s essential to follow up on how it went.

Therapy worksheets provide active, experiential learning, and can help clients move from discussion to action. Even when the homework “doesn’t work,” it can be a step toward further understanding and progress.

Regardless of what tools you use, listen closely to the client and ensure that you are collaborating with them and not pushing your own agenda. Be open and flexible to respond to what they need in the moment.

For more tips on using worksheets and handouts, see these CTRI blog posts by Vicki Enns:

• Tools for Collaborative Counselling
• How to Use Counselling Activities to Support Change

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