Therapist Cheat Sheet: Dynamic Session Guide
Purpose: To replace generic openers with structured, collaborative interventions that assess progress, refine focus, and enhance the therapeutic alliance.
Section 1: Goal Setting & Recalibration
(Use when sessions feel stagnant, directionless, or when a goal has been achieved/metastasized.)
Objective: To create, update, or reframe therapeutic goals, ensuring they are relevant and motivating.
For New Goals:
"If we could make one meaningful change in your life in the next few months, what would it be? Let's work backwards from that vision."
"Looking at the challenges you've been facing, what would you like to do differently, feel differently, or believe differently as a result of our work?"
"On a scale of 1-10, how important is [current therapy topic] to you right now? What would make it a 10?"
For Recalibrating/Updating Goals:
"I notice our sessions have been circling [topic]. Does this still feel like the most valuable use of our time, or has the core challenge evolved?"
"Let's revisit the treatment plan goals we set. Which of these feels most alive for you right now? Which feels less relevant?"
"It seems like we're a bit stuck. If we were to completely change our approach today, what new direction would feel most energizing to you?"
Section 2: Weekly Progress & Context
(A structured alternative to "How was your week?")
Objective: To gather data on successes, challenges, and specific focus areas from the past week.
Progress & Wins (No matter how small):
"Tell me about a time this week where you managed a difficult thought, feeling, or situation even slightly differently than you would have before."
"What's one thing you did this week that was in alignment with your values or goals?"
"Did you have any 'aha' moments or observations about yourself between our sessions?"
Recent Challenges:
"Where did you feel the most stuck, triggered, or discouraged since we last met?"
"What specific situation would you like to 'unpack' together today?"
"Did any old patterns or unhelpful thoughts resurface this week?"
Specific Area of Focus for This Session:
"Given what you've just shared about your wins and challenges, what feels most important to focus on in our time today?"
"Is there something specific happening in the coming week that you'd like to prepare for?"
"Of all the things we could talk about, what feels like it would have the biggest impact to discuss right now?"
Section 3: Treatment Plan Review
(A formal check-in on the overarching roadmap, best done every 4-8 sessions.)
Objective: To ensure the therapy is on track and aligned with the client's long-term objectives.
"I'd like to take about 10 minutes to formally review our treatment plan. Let's look at the original goals we set."
For each goal:
"On a scale of 0-10, where 0 is no progress and 10 is completely achieved, where would you rate your progress on this goal?"
"What has contributed to that score? What's helped you get this far?"
"What would need to happen to move it just one point higher?"
"Has your understanding of the problem changed since we started? Do these goals still feel accurate?"
Section 4: Meta-Conversation & Feedback
(The most critical section for the therapeutic alliance and efficacy.)
Objective: To openly assess the process of therapy itself and make real-time adjustments.
What's Working / What Can Improve:
"What has been the most helpful or impactful part of our work together so far?"
"Is there anything about our sessions or my approach that hasn't been as helpful as it could be?"
"If you were the therapist, what would you do differently in our sessions to make them more effective for you?"
Assessing Perceived Progress & Frequency:
"On a scale of 1-10, how confident are you feeling in your ability to manage your challenges independently?"
"As you think about your progress, how does our current session frequency feel? Is weekly still feeling essential, or are you starting to feel you could space them out more?"
"A sign of progress is often needing therapy less. I'm curious if you've had any thoughts about what it might look like when you're ready to start tapering down our sessions?"
How to Implement This Cheat Sheet:
Don't Use All at Once: This is a menu, not a checklist. Choose one or two questions from a relevant section to open a session.
Be Transparent: You can say, "Instead of asking how your week was, I'd like to try a slightly more structured way of checking in. Is it okay if I ask you about a specific win or challenge from the past week?"
Let it Flow: Use these questions as a launchpad. The client's answer is what you follow, not the next question on the list.
Schedule Reviews: Proactively schedule the "Treatment Plan Review" (Section 3) and "Meta-Conversation" (Section 4) every few months. It signals that you are proactive about their progress and the value of their time and investment.
This framework empowers the client, makes the process transparent, and ensures that every session is intentionally moving toward their desired outcomes.
I have clients who are nuerodivergent and have difficulty with checking in on their mood/anxiety. How can I check in on this component without the usual scaling questions.
Of course. This is a common and important challenge. Traditional scaling questions ("On a scale of 1-10...") can be difficult for neurodivergent individuals for several reasons: interoception (difficulty sensing internal states), alexithymia (difficulty identifying and describing emotions), or a cognitive style that finds abstract, non-linear scales confusing or meaningless.
Here are alternative methods to check in on mood and anxiety, organized by approach.
Neurodivergent-Affirming Mood & Anxiety Check-In Cheat Sheet
Guiding Principle: Move from the abstract to the concrete. Use metaphors, externalization, and somatic (body-based) cues instead of asking for a direct label or number.
1. Metaphor & Imagery-Based Check-Ins
(Uses concrete images to represent abstract feelings.)
The Weather Report:
"If your inner weather this week was a forecast, what would it be? (e.g., sunny, cloudy, a tornado, constant drizzle, a hurricane that passed, etc.)"
Follow-up: "What was the 'temperature'? Was there any 'precipitation' like sudden showers of tears or frustration?"
The Volume Knob or Background Noise:
"If your anxiety had a volume knob, where would it have been set most of this week? (Muted, 2, 5, 8, or a distorted 11?)"
"Was it like static in the background, or a loud, clear alarm siren?"
The Character or Creature:
"If the anxiety (or low mood) was a character or creature hanging around this week, what was it like? Was it a persistent mosquito, a heavy blanket, a critical gargoyle on your shoulder, a snarling guard dog?"
2. Somatic & Sensory-Based Check-Ins
(Bypasses the emotional label and goes straight to the body's signals.)
Body Scanning for Data:
"Let's do a quick body scan. Don't tell me how you feel, tell me what you notice."
"Where are you holding tension? (Jaw, shoulders, hands?)"
"What's your energy level like in your body? (Buzzing, heavy, sluggish, jittery?)"
"Did you have any somatic complaints this week? (Headaches, stomach aches, muscle tension?)"
"Did you feel more or less sensitive to light, sound, or touch this week?"
The Battery Meter:
"On a scale of 0% to 100%, how charged is your social battery? How charged is your general life-tasks battery?" (This separates domains and uses a concrete, tech-oriented metaphor).
3. Pattern & Behavior-Based Check-Ins
(Infers internal state from observable actions and routines.)
Routine & Self-Care as a Barometer:
"How was your rhythm this week? Were you able to stick to your basic routines? (Sleep, eating, hygiene?)"
"What did you do to regulate your nervous system? (Stimming, time alone, special interests, etc.) Was it enough?"
"Did you find yourself seeking out or avoiding certain types of stimulation (people, noise, tasks) more than usual?"
The "What Happened To My..." List:
"This week, what happened to my...
...appetite?
...sleep?
...patience?
...interest in my favorite things?"
The changes in these areas are concrete data points that reveal the underlying mood/anxiety.
4. Externalization & Narrative Check-Ins
(Separates the person from the problem, making it easier to discuss.)
Naming the Visitor:
"Did 'The Critic' or 'The Overwhelm Monster' show up this week? What did it say or do? How did you respond to it?"
"How much of your mental space was taken up by anxiety this week? 10%? 50%? 90%?" (This is different from a scale of intensity; it's a measure of real estate).
The Dashboard Warning Lights:
"If your body and mind had a car's dashboard, which warning lights were on this week? (e.g., 'Check Engine,' 'Low Fuel,' 'Tire Pressure,' 'Overheating')?"
5. Choice & Ranking Check-Ins
(Offers concrete options instead of an open-ended question.)
"Which One?" Scenarios:
"Which best describes your anxiety this week:
A) A constant, low hum.
B) Sudden, sharp spikes.
C) A fog that made it hard to think.
D) Mostly quiet."
"Which word feels more right for your mood: Heavy or Agitated? Slow or Restless?"
Comparing to a Baseline:
"Think about a 'typical' week for you. Was this week more regulated or more dysregulated than that baseline?"
"Compared to our last session, is the emotional 'stuff' bigger, smaller, or about the same?"
How to Implement These:
Co-Create the Tool: In session, ask the client which of these methods makes sense to them. Let them choose or even help you invent a new metaphor that fits their brain.
Be Consistent: Once you find a method that works for a client, use it consistently at the start of sessions. The predictability itself is regulating.
Normalize the Difficulty: Explicitly state, "It's common for people to have a hard time knowing what they're feeling inside. That's why we're using these different tools—to try and find a backdoor into that information."
Focus on the Data, Not the Label: The goal isn't necessarily to get them to say "I was anxious." The goal is to get the concrete data: "My shoulders were tight all week, I couldn't sit still, and I snapped at my partner twice." You can then work with that data directly.