On this page you will find measures, scales, handouts, and education materials you can use in your practice with clients.
Debating whether to use scales or screening measures with clients, or not?
Some therapists don’t use scales/screenings and some who absolutely do with every client. My suggestion is to ultimately do what works for you – I think it is fine to use a screening measure in one session and then re-administer it a few sessions later with the caveat that it would be good to explain in detail that is what you are doing – “let’s look at where you are today”, and then revisit this a few sessions later and see what has changed – “what has improved, what has stayed the same, what has worsened” and then go in detail in the aspects around what may have worsened while celebrating what has improved.
That being said, other counsellors choose not to use any scales or screening measures, and that is valid too.
Another value of using screening measures is clients who may want to explore a medical route often struggle with what to say when visiting the doctor. As doctor offices are often not very warm, doctors may be overloaded and often is in a rush, patients may feel rushed and aren’t always able to discuss what they are going through (i.e. someone with anxiety or depression who feels rushed, even if the doctor doesn’t mean to do it, isn’t going to be able to express themselves clearly). A screening measure that they can just hand over to the doctor can be beneficial.
You can talk to 20 therapists and probably get a 50/50 split around this topic so essentially it’s up to you whether you choose to use scales and measures, and if you do, how you use them.
Liana Lowenstein FavouriteTherapeutic Activities for Children, Adolescents and Families
CADDRA is the Canadian ADHD Resource Alliance and is full of amazing information about ADHD https://www.caddra.ca/
Depression worksheets: https://depts.washington.edu/hcsats/PDF/TF-%20CBT/pages/emotion_skills.html#
Assessing for Intimate Partner Violence (administered individually) IPV Individual Assessment Questions
Internationally recognized trauma expert Dr. Janina Fisher talks about her NEW best-selling book, Transforming the ‘Living Legacy’ of Trauma: Dr. Janina Fisher-Transforming the Living Legacy of Trauma. (To access the video you will need to enter your email address, which may lead to continued emails from PESI).
A session of autogenic training might take the following format:
First, the trainee is encouraged to settle into a comfortable position—sitting upright, reclined, or lying down. What is most important is that the chosen posture promotes calm relaxation.
The therapist begins by using verbal cues to guide the trainee’s breathing and direct attention to certain parts of the trainee’s body. The verbal cues can encourage sensations of heaviness and warmth, which can then lead to deep relaxation. The therapist might lead the cues, have the trainee repeat them, or have the trainee say them silently, depending on the level of training the individual has received.
Some of the verbal cues that may be learned include:
Once the lesson is finished, the therapist will help the trainee “cancel” the relaxation session. One phrase that is commonly used is “Arms firm—Breathe deeply—Open eyes.” The session concludes, and the trainee is encouraged to practice what has been learned at home, outside of the session. Each session expands on the last lesson until the trainee and therapist feel confident that the process can be conducted independently.
Each lesson focuses on a different sensation in the body, and there are six established lessons (techniques) included in autogenic training:
The goal of each session is for the trainee to feel a sense of calm at its conclusion and to have gained better control over unwanted emotional, physiological, and physical responses to stimuli. Those who practice autogenic training and utilize it regularly may find it an effective treatment for a wide range of physical and mental health issues. —
Hold your left nostril down with your left thumb and inhale through your right nostril. Then close your right nostril with your left index finger, so both are closed, and hold the breath. Release your left nostril only and exhale.
With your right nostril still closed, inhale through your left. Now close your left nostril with your thumb, so both nostrils are closed, and hold the breath. Release your index finger from your right nostril and exhale.
This is one set. Complete a minimum of five sets to harmonize the left and right hemispheres of your brain, calm your nervous system, and create a sense of relaxation and ease.
Where the client is asked to repeat and exaggerate a particular action, feeling, or expression so that he or she becomes more aware of it.
Autogenic training is a relaxation technique that can help lower stress levels and promote a feeling of calm in the mind and body. This method is useful on its own for minor stress reduction and basic relaxation exercises
Start by bringing attention to some sensation in the body – perhaps the breath or another object of attention. Continue gently returning the attention to this object for a few minutes. Next, see if you can locate some anxiety within the body. Just notice how it feels.
If you can’t find any anxiety, generate a scary thought or an image to help conjure it up. We want to get the anxiety going strongly enough to be able to practice feeling it, but not to be overwhelming.
Once you’ve got some anxiety going, just breathe, and feel it. Notice how it feels throughout the body. Greet it like an old friend, “Oh I know you, you’re my old pal fear. You’ve visited me on so many occasions. Welcome back.”
If the sensation of anxiety starts to fade, do whatever you need to do to bring it back. Keep breathing, and keep practicing just welcoming and feeling the fear. Source: https://www.nicabm.com/mindfulness-how-mindfulness-can-help-your-clients-manage-anxiety-a-short-practice-for-befriending-fear/
Place your feet flat on the floor. Next, gently begin alternating tapping your toes, keeping your heels on the floor. Be sure to tap very slowly (about 1 tap per 2-3 seconds).
Place your hands on your knees as you sit with your feet on the floor. Next, gently begin tapping your legs with each hand, alternating hands. Keep your wrists on your legs as you tap each leg. Be sure to tap very slowly (about 1 tap per 2-3 seconds)
Whether you’re vacuuming, dusting, or washing dishes, it can be your meditation if you immerse yourself completely in the activity.
Washing dishes, for example, can be both satisfying and grounding. Feel the warm water on your hands; let yourself enjoy the experience of making something dirty clean again. Don’t think about finishing or what you’ll do when you’re done. Focus solely on the doing and see if you can find a sense of acceptance and presence in doing it slowly and well.
Step 1: Bring to mind something that has been causing you stress. Chose something that upsets you but is not so overwhelming that you aren’t able to focus
Step 2: Hold a pen or your finger 1-2 feet from your face at eye level. Look directly at the object for 2-3 seconds, then focus on a farther object within your line of vision for 2-3 seconds (if there is nothing, gently turn to the left or right to find something to focus on).
Continue going back and forth between the two objects until you feel calmer.
Start by inhaling through your nose, expanding your stomach, and counting to five. As you breathe in, visualize soothing warm light filling your feet, and then exhale through your lips for a count of five, while visualizing yourself releasing any tension you may have been carrying there.
Repeat this process for your ankles, your shins, your knees, and so on, all the way up to your head. After you finish scanning your entire body, you’ll likely feel lighter, calmer, and more at ease.
Where the client is asked to visualize either an actual event from the past or a hypothetical situation. The therapist then helps the individual to focus on what he or she is thinking, feeling, and doing as they mentally experience this event.
Engaging a “half-smile” is a valuable way to change your mental state and cultivate a serene feeling in the moment. As you smile, imagine your jaw softening and a relaxed feeling spreading across your face, your entire head, and down your shoulders. Notice the subtle changes in the quality of your thoughts and emotions.
Sit comfortably and allow your eyes to close. Take a breath or two to settle in and notice the state of your mind. When you’re ready, inhale and then, for the entire length of your exhalation, make a low- to medium-pitched humming sound in the throat. Notice how the sound waves gently vibrate your tongue, teeth, and sinuses. Imagine the sound is vibrating your entire brain (it really is). Do this practice for six rounds of breath and then, keeping your eyes closed, return to your normal breathing. Notice if anything has changed.
is an acronym for strategies to improve your mental and emotional situation. It stands for:
Imagery: Use your imagination to create a better situation than the one that you’re currently in. Transport yourself to a safe space in which everything will turn out okay. Visualize a soothing situation. Allow yourself to tap into the details of the image; imagine how you would feel different physically if you were present in the scene.
Meaning: Tap into what is most important to you in life. Consider what your values are, and shift your thoughts and actions so they are in line with those values. In addition, find a purpose or reason for what you are going through. What meaning can you find in your experience getting through previous crises?
Prayer: Prayer does not have to have a religious connotation. Reap the benefits of prayer by using mindfulness to focus on your presence in the world. You can use a mantra, a quote or even a song lyric to ground you in the moment when you’re feeling troubled. Connect to something greater and open yourself up to the moment.
Relaxation: Relaxation helps reduce the bodily tension often associated with emotional distress. To shift out of the painful moment, try deep breathing, stretching, or progressive muscle relaxation. Help your body feel more comfortable and calm. When your body is calm, you mind will likely feel calm as well.
One Thing in the Moment: Using mindfulness to deliberately focus on just one thing at a time can be a powerful way to slow down your thoughts. Tune in to the present and focus on your breath in this moment, your sensations in this moment, your thoughts in this moment, etc. Letting go of the past and worries about the future can help you refocus your energy on the task at hand.
Vacation: A vacation does not need to be an actual trip. It can be a brief break from your regular routine. Break out of your typical schedule for an afternoon to do something that you haven’t done in a while. Whether it’s meeting friends, walking outside, or taking a long, hot shower, this mini vacation allows you to escape your thoughts and enjoy.
Encouragement: Be honest with yourself and provide realistic, yet hopeful encouragement in order to get through a difficult time. For example, remind yourself that the emotions you are experiencing are temporary and that you have gotten through times like this in the past. Or, tell yourself, “This too shall pass.” Keep your focus on the positive consequences that lie ahead and direct your thoughts on a healthy track.
IMPROVE the Moment can be quite valuable when dealing with overwhelming emotions or unexpected situations. There are many strategies involved with this skill, so find the strategy that works best for you. The goal is to learn to deal with difficult emotions more effectively. Take note of how have you generally dealt with crises in the past, and see if these strategies work better. It’s important to let go of old habits if they are not beneficial. Instead, establish new coping strategies that are more likely to lead to positive and healthy results.
1) Begin by grounding yourself, noticing the points of contact between your body and the chair or floor. Then, inhale deeply into your lower abdomen. On your exhale, you might opt to squeeze your arms across your chest in an embrace, and linger for a full exhale. Take several deep breaths in this way.
Then, while taking care to allow each word to hold its full meaning, silently affirm to yourself:
May I be happy;
May I be safe;
May I be at ease;
May I be peaceful.
As you feel the full weight and warmth of each word’s meaning, focus your attention on cultivating feelings of love and kindness towards yourself. Repeat this cycle of phrases several times.
2) Then, while continuing to hold these intentions of loving-kindness, call to mind someone you love dearly, and affirm:
May they be happy;
May they be safe;
May they be at ease;
May they be peaceful.
Allow yourself to fully experience the love that you feel for this person. You might repeat this cycle of phrases several times, calling to mind close loved ones.
3) Next, call to mind someone you are acquainted with, and have neutral feelings towards, and repeat this practice above. It may be difficult to summon feelings of loving-kindness towards them; give yourself the time you need for these loving feelings to arise towards this person, and for the words to feel true to their meaning.
4) Expand this loving-kindness practice by calling to mind others you have further degrees of separation from, such as: animals, those who have passed on, and people you have never met before. If it feels appropriate to you, you might call to mind and hold in loving presence those around the world who are sick with COVID-19, those who have lost loved ones to it, and those who are feeling lonely and isolated right now as a result of the pandemic. Finally, call to mind someone who you are in conflict with or have a challenging relationship with, and extend your sentiments of loving-kindness towards them, as part of your practice.
5) Complete this loving-kindness practice by returning to yourself with compassion, repeating:
May I be happy;
May I be safe;
May I be at ease;
May I be peaceful.
Following this, you might spend several moments in warm silence, basking in the feeling of loving-kindness you have generated, before returning your attention to the world around you. Towards whom, or in what direction has your heart grown?
Instead of eating quickly with one eye on your food and the other on your iPhone, turn mealtime into meditation. It doesn’t take long to eat, so why not put everything aside and take this time for you? Your texts, emails, and social media pages will still be there when you’re done.
Breathe deeply and try to identify the different nuances of scent in each item on your plate. When you’re eating, take deep breaths between each bite, and think about your meal like a foodie, appreciating the different flavors and textures.
If you find your thoughts wandering to things you’ve done or have to do, bring your attention to the feeling of the fork in your hand. Then breathe deeply, take a bite, and focus on savoring the food in front of you.
The goal with the My Life Story – A Narrative Exercise is to begin creating emotional distance from your past so that you can become reflective in order to gain perspective on your life as a whole. This is a storytelling outline that helps you organize life events and gain self-compassion, without going too deeply into the memories.
You can gently stimulate the vagus nerve with yoga postures that open across your chest and throat. Try this gentle seated heart opening practice by bringing your hands to your shoulders. Inhale as you expand across the front of your chest, open your elbows wide, and lift your chin. Exhale as you contract your elbows in front of your heart and tuck your chin. Take several deep breaths in this moving meditation. Focusing on your inhalation in this breath pattern can be stimulating and uplifting. Allow yourself to expand into the open heart.
Where the client dramatizes relevant aspects of his or her existence. This may involve taking on the role of a character in his or her life or of a part of the self. The empty chair technique is a classic example of role-playing.
Self-compassion and the practice of “loving kindness” ask you to engage in the act of friendliness toward yourself and others.
Take a moment to reflect on a challenge you are facing in your life. Now, imagine someone else facing a similar challenge. Can you evoke a sense of compassion or kindness toward this other person? Notice how this feeling of compassion feels in your body. Wish them well. See if you can you extend that same quality of loving kindness toward yourself? Wish yourself well.
Imagine that you are a star or a firefly or a light bulb. What do you do? You shine. Feel every inch of your skin glowing outward, as you shine in every direction—as far out as you wish. How does that feel? Most people experience this as spacious and calm.
Everyone has something or someone that makes them happy inside—perhaps a friend, a child, a flower, a piece of music. Stand with your eyes closed, and spend a moment thinking about whatever it is that makes you smile inside. What happens in your body? Most people experience a softening and warmth in their chest, and a freeing up in their entire body.
Can you use your image while you are in a conflict to keep your body stabilized
in the feeling of compassion? That would alter your relationship to your opponent. Can you stay anchored in this feeling even when thinking about difficulties in your life?
TERM is an acronym that stands for Temperature, Energetic exercise, Regulate breathing and Muscle relaxation.
TEMPERATURE At times when we are upset our body temperature can rise. An effective way to counter the rise in body temperature is to splash cold water on your face. Holding an ice cube in your hand or allowing the air conditioner to blow cold air on your face are other alternatives to lowering your body temperature. By lowering the body temperature, it will allow you to ‘cool down’ both physically and emotionally.
ENERGETIC PHYSICAL ACTIVITY When emotions get intense, exercise at the intensity level to match your emotions. You can run to the end of the block, do jumping jacks or swim a few laps in the pool. Increasing the oxygen flow to the muscles helps to relax the body and decreases stress levels.
REGULATE BREATHING Breathing can help us reduce emotional pain. Breathing is one of the easiest and simplest ways to regulate our emotions. Counting your breathes, breathing I to a count of four, exhaling to a count of four. Focusing on measured breaths, after doing this for a few minutes you will begin to feel the tightness in your muscles relax as the fight or flight response leaves you.
MUSCLE RELAXATION This method of muscle relation requires focusing on a set of muscles, such as your legs. Tighten the muscles in your legs and hold them for five seconds, then let the muscles relax. When you tighten muscles, then allow them to relax the muscle will become more relaxed then before having tighten the muscles. Relaxed muscles require less oxygen thereby allowing your breathing and heart rate to lower.
A dialectical behavior therapy (DBT) skill called IMPROVE the Moment can help you manage difficult emotions during stressful situations. By reducing the intensity of emotion, you can feel more in-control when life throws you a curveball. Here’s how it works…
How does Tapping Work?
The basic technique requires you to focus on the negative emotion at hand: a fear or anxiety, a bad memory, an unresolved problem, or anything that’s bothering you. While maintaining your mental focus on this issue, use your fingertips to tap 5-7 times each on 9 of the body’s meridian points. Tapping on these meridian points – while concentrating on accepting and resolving the negative emotion – will access your body’s energy, restoring it to a balanced state.
This technique is also known as “re-authoring” or “re-storying,” as clients explore their experiences to find alterations to their story or make a whole new one. The same events can tell a hundred different stories since we all interpret experiences differently and find different senses of meaning (Dulwich Centre).
Close your eyes. Feel your back against your chair and your feet pressed firmly on the ground, then gently bring yourself into the present moment. Now start breathing through your nostrils and counting as you go, thinking “and” for every inhale, and the number for each exhale—inhale “and,” exhale “one”; inhale “and,” exhale “two.”
Feel your belly rise with each inhalation, and let the breaths slow as you count yourself into a greater sense of relaxation. After you reach 100, open your eyes, move your fingers and toes, and bow your head in gratitude for the mental space you created.
The suggestions below are grouped into things that take about 30 seconds, things that you can do in about 3 minutes, and things that might take 30 minutes or longer.
The 30 second ones are quick fix ‘emergency’ actions you can do if you suddenly feel panicky, scared or unable to cope.
Take a few slow deep breaths. Breathe in, count to 3, breathe out, count to
Close your eyes, hold one hand in the other, squeeze gently and repeat ‘I can get through this’.
Sit on a chair and focus on the sensation of the chair pressing onto your back and bottom.
Take a few sips of cold water, focusing on the cooling feeling as you swallow it.
3 minute tasks
Phone a loved one or friend for a quick chat. Leave a message if they don’t answer.
Do a household task, like a quick bit of washing up, cleaning the bathroom mirror or making a bed. Feel the satisfaction of having done something!
Listen to a favourite piece of music, something soothing or uplifting depending how you feel.
30 minutes or longer tasks
Pamper yourself with a luxurious bath, and maybe have scented candles and soothing music.
Do ‘proper sort-out’ of a cluttered kitchen cupboard, drawer, wardrobe or bookcase.
Make a hot drink in a mug and sip it slowly, feeling the warmth of the mug in both hands.
Enjoy a TV or radio program, either a recording of an old favourite or something new.
Draw a tree with several large leaves on it. On each leaf, write down a personal strength, person that supports you, or a healthy way to cope with stress.
Though you can practice this any time you’re walking, you may want to find a peaceful place to stroll, away from crowds, chaos, or noise pollution. If it’s safe to walk barefoot, this will give you a sense of being more connected to the earth.
Stand with your spine straight, with your shoulders and arms relaxed, and take a few inhalations and exhalations to breathe in calming energy and breathe out tension.
Now begin slowly moving forward and sync your breathing with your steps—right foot, inhale; left foot, exhale. Use all of your senses to fully experience where you are—the warm feeling of sun on your face, the soft sound of wind rustling leaves on trees. The goal is not to arrive at a destination; it’s simply to be present in the experience of walking.