The

Psychotherapy File
An Aid to Understanding
Ourselves Better

Published April 2000

V.04.00

Association for Cognitive Analytic Therapy

3rd Floor, South Wing, Division of Academic Psychiatry

St Thomas Hospital, Lambeth Palace Road, London SE1 7EH
[email protected] www.acat.org.uk 0207 928 9292 ext 3769
Association for Cognitive Analytic Therapy, 3rd Floor, South Wing, Division of Academic Psychiatry
St Thomas Hospital, Lambeth Palace Road, London SE1 7EH
Psychotherapy File 04.00
[email protected] www.acat.org.uk 0207 928 9292 ext 3769

The Psychotherapy File

Introduction
Each of our lives is different. The experiences that we have had so far in our lives shape the way we see ourselves and others.
Many people feel that the way they see things is the right way and is familiar. However, sometimes these ways of seeing things
and what we do as a result can be the source of our problems.
In order to make things better it can help to recognise how you see yourself and others. It is also helpful to recognise your
patterns of thinking, feeling and acting. This is the first step in learning to have more control and happiness in your life.
The following questions are designed to help you start thinking about your way of seeing the world and your particular
patterns.
Keeping A Diary Of Moods And Behaviour
Symptoms, bad moods, unwanted thoughts or behaviours that come and go can be better understood and controlled if you
learn to notice when they happen and what starts them off.
If you have a particular symptom or problem of this sort, start keeping a diary. The diary should be focussed on a particular
mood, symptom or behaviour, and should be kept every day if possible. Try to record this sequence:
1. How you were feeling about yourself and others and the world before the problem came on.
2. Any external event, or any thought or image in your mind that was going on when the trouble
started, or what seemed to start it off.
3. Once the trouble started, what were the thoughts, images or feelings you experienced.
By noticing and writing down in this way what you do and think at these times, you will learn to recognise and eventually
have more control over how you act and think at the time. It is often the case that bad feelings like resentment, depression
or physical symptoms are the result of ways of thinking and acting that are unhelpful. Diary keeping in this way gives you the
chance to learn better ways of dealing with things.
It is helpful to keep a daily record for 1-2 weeks, then to discuss what you have recorded with your therapist or counsellor.
Starting To Change
You may get quite depressed when you begin to realise how often you stop your life being happier and more fulfilled. It is
important to remember that its not being stupid or bad, but rather that:
a)

We do these things because this is the way we learned to manage best when we were younger,

b)

We dont have to keep on doing them now we are learning to recognise them,

c)

By changing our behaviour, we can learn to control not only our own behaviour, but we also
change the way other people behave to us,

d)

Although it may seem that others resist the changes we want for ourselves (for example, our parents
or our partners), we often under-estimate them; if we are firm about our right to change, those who
care for us will usually accept the change.

Working With The Psychotherapy File

Look through the descriptions on the following pages and mark how far you think they apply to the way you feel. Some will
be familiar, others will not. If a description feels familiar but is not quite right cross out the words that do not apply and write
in how things are for you in your life. Remember there is no way of doing this badly or of getting it wrong. Discuss what you
have discovered with your therapist. You and he/she can work together to work out what your unhelpful patterns are, get the
descriptions as accurate as possible as the first step towards making helpful changes.

Association for Cognitive Analytic Therapy, 3rd Floor, South Wing, Division of Academic Psychiatry
St Thomas Hospital, Lambeth Palace Road, London SE1 7EH
Psychotherapy File 04.00
[email protected] www.acat.org.uk 0207 928 9292 ext 3769

TRAPS, DILEMMAS and SNAGS

Patterns that do not work but are hard to break.

Sometimes, there are certain ways that we think and act that do not achieve what we want. These can be
hard to change.
Please read through the following patterns and decide how much this applies to you. Then circle the best
response on the right.

A. TRAPS

Traps = ways we think and act that make our problem worse rather than better, like a vicious circle.

Circle best response

1. FEAR OF HURTING OTHERS

I keep my feelings and

my needs to myself because
I worry I will hurt others.
I feel bad for feeling angry.
This reinforces that I should
keep my feelings and needs
inside.

This allows others to

sometimes ignore or abuse
me in different ways.

Sometimes
Applies
Feeling ignored or abused,
I feel and act angry.
Does Not
Apply

Circle best response

2. DEPRESSED THINKING

When I feel hopeless

and worthless, I expect
to do poorly at things.

I feel even more hopeless,

worthless and depressed

Often
Applies

I perform less well, because

I dont bother to try hard and
I already expect to do poorly.
Because I feel hopeless
and worthless, I see my
performance as even worse
than it really is.

Often
Applies
Sometimes
Applies
Does Not
Apply

Association for Cognitive Analytic Therapy, 3rd Floor, South Wing, Division of Academic Psychiatry
St Thomas Hospital, Lambeth Palace Road, London SE1 7EH
Psychotherapy File 04.00
[email protected] www.acat.org.uk 0207 928 9292 ext 3769

TRAPS CONTINUED

3. TRYING TO PLEASE (2 examples)

(a)
When I feel uncertain
about myself I worry about
upsetting others
This confirms my feelings
of uncertainty about myself
and I worry even more.

Circle best response

I do what I think others want

and I try hard to please them

Often
Applies
Sometimes
Applies

Others take advantage of

me and then I feel angry,
depressed or guilty

Does Not
Apply

(b)
Often
Applies
When I feel uncertain about
myself, I feel overwhelmed
and anxious about upsetting
others.
This confirms my uncertainty
about myself even more

I hide away, put things off

and let others down.
Sometimes
Applies
Others become angry with me.
Does Not
Apply

4. AVOIDANCE

Circle best response

I feel anxious and not very

confident about certain
situations e.g. crowds,
parties, open spaces.

When I go into these

situations
I feel more anxious.

Often
Applies
Sometimes
Applies

My life becomes more limited

and I feel more anxious
and less confident.

Avoiding these situations

makes me feel better so I
stop trying to face them

Does Not
Apply

Association for Cognitive Analytic Therapy, 3rd Floor, South Wing, Division of Academic Psychiatry
St Thomas Hospital, Lambeth Palace Road, London SE1 7EH
Psychotherapy File 04.00
[email protected] www.acat.org.uk 0207 928 9292 ext 3769

TRAPS CONTINUED

5. SOCIAL ISOLATION

Circle best response

I dont feel confident and I

worry that others will find
me boring or stupid.
This convinces me that I am
boring and stupid and so
I feel even less confident.

I avoid looking at people and

dont respond when they are
friendly to me

Often
Applies
Sometimes
Applies

Then people see

me as unfriendly
Does Not
Apply

3. LOW SELF ESTEEM (2 examples)

(a)
I feel worthless and that I
cant get what I want because
I will be punished, rejected
or abandoned.
This confirms my feelings
that everything is hopeless
and that I am worthless.

Circle best response

I feel that
all is hopeless

Often
Applies
Sometimes
Applies

Then I give up trying

to do anything
Does Not
Apply

(b)
I feel worthless and that I
cant get what I want because
things always turn bad or go
wrong for me.
This confirms my feelings
that everything is hopeless
and that I am worthless.

Often
Applies
I feel that
all is hopeless
Sometimes
Applies
Then I give up trying
to do anything
Does Not
Apply

Association for Cognitive Analytic Therapy, 3rd Floor, South Wing, Division of Academic Psychiatry
St Thomas Hospital, Lambeth Palace Road, London SE1 7EH
Psychotherapy File 04.00
[email protected] www.acat.org.uk 0207 928 9292 ext 3769

B. DILEMMAS

Often we act in a way that is unhelpful and we are unhappy because the only other way we can imagine
seems as bad or even worse. We often do not realise that we see things like this and that these are false
choices. They are false because sometimes we assume that if I do x, then y will follow and this may not
necessarily be the case. They are also false when we assume these are our only possible choices. These false
choices can be described as either/or or if/then dilemmas.
Do you act as if any of the following false choices rule your life? Recognising them is the first step to
changing.
Please read through the following dilemmas and rate how much they apply to you by circling the best
response.

Choices about myself; l act as if..or

1.

Often
Applies
either l keep feelings bottled
up

OR I risk being rejected, hurting

others, or making a mess

Sometimes
Applies
Does Not
Apply

2.

Often
Applies

either l spoil myself and am greedy

OR I deny myself things, punish

myself and feel miserable

Sometimes
Applies
Does Not
Apply

3a.

Often
Applies
If l try to be perfect

then l feel depressed and angry

Sometimes
Applies
Does Not
Apply

Association for Cognitive Analytic Therapy, 3rd Floor, South Wing, Division of Academic Psychiatry
St Thomas Hospital, Lambeth Palace Road, London SE1 7EH
Psychotherapy File 04.00
[email protected] www.acat.org.uk 0207 928 9292 ext 3769

DILEMMAS CONTINUED
3b.

Often
Applies
If I dont try to be perfect

then l feel guilty,

angry and dissatisfied.

Sometimes
Applies
Does Not
Apply

4.

Often
Applies
If l must

then l wont.
When faced with a task, l must
either submit unhappily or resist
it passively. Other peoples wishes
or even my own can feel too
demanding, so l put things off and
avoid them.

5.

Sometimes
Applies
Does Not
Apply

Often
Applies
If l must not

then l will.
Sometimes, the only proof of my
existence is my resistance. Rules feel
too restricting, so l break rules and
do things that are harmful to me.

6.

Sometimes
Applies
Does Not
Apply

Often
Applies

If others are not expecting me to do

things for them or look after them,

then l feel anxious,

lonely and
out of control.

Sometimes
Applies
Does Not
Apply

Association for Cognitive Analytic Therapy, 3rd Floor, South Wing, Division of Academic Psychiatry
St Thomas Hospital, Lambeth Palace Road, London SE1 7EH
Psychotherapy File 04.00
[email protected] www.acat.org.uk 0207 928 9292 ext 3769

DILEMMAS CONTINUED
7.

Often
Applies
either I get what I want and feel
childish and guilty

OR l dont get what l want and feel

frustrated, angry and depressed.

Sometimes
Applies
Does Not
Apply

8.

Often
Applies

either I keep things (feelings, plans)

in perfect order

OR I fear things will turn into a

terrible mess.

Sometimes
Applies
Does Not
Apply

Choices about how we relate to others; l behave with others as if

1.

Often
Applies

either l am involved with someone

and likely to get hurt

OR l dont get involved and stay in

charge but remain lonely.

Sometimes
Applies
Does Not
Apply

2.

Often
Applies
either l stick up for myself and
nobody likes me

OR l give in and get put on by

others and feel cross and hurt.

Sometimes
Applies
Does Not
Apply

Association for Cognitive Analytic Therapy, 3rd Floor, South Wing, Division of Academic Psychiatry
St Thomas Hospital, Lambeth Palace Road, London SE1 7EH
Psychotherapy File 04.00
[email protected] www.acat.org.uk 0207 928 9292 ext 3769

DILEMMAS CONTINUED
3.

Often
Applies
either l am a brute

OR a martyr (secretly blaming the

other person).

Sometimes
Applies
Does Not
Apply

4(a). With Others...

either l am safely wrapped up in bliss

OR I am fighting.

Often
Applies
Sometimes
Applies
Does Not
Apply

4(b). When fighting,

Often
Applies

either l am a bully

OR a victim.

Sometimes
Applies
Does Not
Apply

5.

Often
Applies
either l look down on people

OR l feel they look down on me.

Sometimes
Applies
Does Not
Apply

Association for Cognitive Analytic Therapy, 3rd Floor, South Wing, Division of Academic Psychiatry
St Thomas Hospital, Lambeth Palace Road, London SE1 7EH
Psychotherapy File 04.00
[email protected] www.acat.org.uk 0207 928 9292 ext 3769

DILEMMAS CONTINUED
6(a).

Often
Applies

either l am made happy by the

admiration of those l admire

OR l feel vulnerable.

Sometimes
Applies
Does Not
Apply

6(b). If l feel vulnerable

Often
Applies

either l put others down

OR l put myself down.

Sometimes
Applies
Does Not
Apply

7.

Often
Applies

either l am involved with others and

feel taken over or smothered

OR l stay safe and uninvolved

but feel lonely and isolated.

Sometimes
Applies
Does Not
Apply

8. When l am involved with someone l care about,

either l have to give in

OR they have to give in.

Often
Applies
Sometimes
Applies
Does Not
Apply

Association for Cognitive Analytic Therapy, 3rd Floor, South Wing, Division of Academic Psychiatry
St Thomas Hospital, Lambeth Palace Road, London SE1 7EH
Psychotherapy File 04.00
[email protected] www.acat.org.uk 0207 928 9292 ext 3769

DILEMMAS CONTINUED
9. When l am involved with someone l depend on,

either l have to give in

OR they have to give in.

Often
Applies
Sometimes
Applies
Does Not
Apply

10(a). As a woman,
either I have to do what others want

OR I stand up for my rights and get

rejected.

Often
Applies
Sometimes
Applies
Does Not
Apply

10(b). As a man,

Often
Applies

either l cant have any feelings

OR I am an emotional mess.

Sometimes
Applies
Does Not
Apply

11.

Often
Applies
either l look down on people

OR l feel they look down on me.

Sometimes
Applies
Does Not
Apply

Association for Cognitive Analytic Therapy, 3rd Floor, South Wing, Division of Academic Psychiatry
St Thomas Hospital, Lambeth Palace Road, London SE1 7EH
Psychotherapy File 04.00
[email protected] www.acat.org.uk 0207 928 9292 ext 3769

C. SNAGS

A Snag is a pattern that stops us from getting on with our lives. A Snag is what is happening when we say,
I want a better life but or I want to change but.
Often getting on with our lives and changing brings new consequences. Sometimes, the worry about these
consequences can snag us. For example, it may feel strange to behave differently from how you, and
others who know you, expect you to behave. A snag may come from others not wanting us to change or
not coping with us changing. Sometimes snags come from us feeling guilty if things go well for us or from
feeling we do not deserve to be happy. As a result, we feel that we have to spoil our pleasure or success.
Remember
We have these patterns because this is the way we learned to manage when we were younger.
By changing these patterns, we can also change the way other people behave towards us.
Please read each snag and then circle the response that best describes how well this applies to you.

1.

Often
Applies

For fear of the response of others l must sabotage success as;

a) it deprives others,
b) others may envy me, or
c) there are not enough good things to go around.

2. I must sabotage good things as if I do not deserve them.

Sometimes
Applies
Does Not
Apply

Often
Applies
Sometimes
Applies
Does Not
Apply

Association for Cognitive Analytic Therapy, 3rd Floor, South Wing, Division of Academic Psychiatry
St Thomas Hospital, Lambeth Palace Road, London SE1 7EH
Psychotherapy File 04.00
[email protected] www.acat.org.uk 0207 928 9292 ext 3769

D. DIFFICULT AND UNSTABLE STATES OF MIND

Some people find that their state of mind can feel very different and difficult at times. These changes in
our state of mind can make it difficult to keep control over our behaviour and experience. Please indicate
if any of the following apply to you.

1.

Often
Applies

How l feel about myself and others can change dramatically.

I can switch from one state of mind to a completely different one.

Sometimes
Applies
Does Not
Apply

2.

Often
Applies

Some states are accompanied by intense,

extreme and uncontrollable feelings.

Sometimes
Applies
Does Not
Apply

3.

Often
Applies

Other states are accompanied by an emotional blankness,

feeling unreal, or feeling muddled.

Sometimes
Applies
Does Not
Apply

4.

Often
Applies

Some states are accompanied by feeling intensely guilty

or angry with myself, wanting to hurt myself.

Sometimes
Applies
Does Not
Apply

Association for Cognitive Analytic Therapy, 3rd Floor, South Wing, Division of Academic Psychiatry
St Thomas Hospital, Lambeth Palace Road, London SE1 7EH
Psychotherapy File 04.00
[email protected] www.acat.org.uk 0207 928 9292 ext 3769

DIFFICULT AND UNSTABLE STATES OF MIND CONTINUED

5.

Often
Applies

Some states are accompanied by feeling

that others cant be trusted, are going to let me down, or hurt me.

Sometimes
Applies
Does Not
Apply

6.

Often
Applies

Some states are accompanied by being feeling

unreasonably angry or hurtful to others.

Sometimes
Applies
Does Not
Apply

7.

Often
Applies

Sometimes, the only way to cope with some confusing feelings

is to blank them off and feel emotionally distant from others.

Sometimes
Applies
Does Not
Apply

Association for Cognitive Analytic Therapy, 3rd Floor, South Wing, Division of Academic Psychiatry
St Thomas Hospital, Lambeth Palace Road, London SE1 7EH
Psychotherapy File 04.00
[email protected] www.acat.org.uk 0207 928 9292 ext 3769

E. DIFFERENT STATES

Everybody experiences changes in how they feel about themselves and the world. For some people, these
changes are extreme, sometimes sudden and confusing. In such cases, there are often a number of states
that re-occur. Learning to recognise them and shifts between them can be helpful.
Below are descriptions of such states. Please tick those that you experience. You can delete or add words to the
descriptions. At the end of the list, you can add any descriptions that are not listed but apply to you.

Tick.
1. Zombie. Cut off from my feelings and from others.
2. Feeling bad but soldiering on, coping.
3. Out of control rage.
4. Extra special. Looking down on others.
5. In control of myself, of life, of other people.
6. Cheated by life, by others. Untrusting.
7. Provoking, teasing, seducing, winding others up.
8. Clinging, fearing abandonment.
9. Frantically active. Too busy to think or feel.
10. Agitated, confused, anxious.
11. Feeling perfectly cared for, blissfully close to another.
12. Misunderstood, rejected, abandoned.
13. Scornful and hating of myself.
14. Vulnerable, needy, helpless, waiting for rescue.
15. Envious, wanting to harm others and put them down.
16. Protective, respecting of myself and of others.
17. Hurting myself, hurting others.
18. Angrily giving in to the demands of others.
19. Hurt and humiliated by others.
20. Secure in myself. Able to be close to others.
21. Intensely critical of myself and of others.
22. Frightened of others.
23.
24.
25.

Association for Cognitive Analytic Therapy, 3rd Floor, South Wing, Division of Academic Psychiatry
St Thomas Hospital, Lambeth Palace Road, London SE1 7EH
Psychotherapy File 04.00
[email protected] www.acat.org.uk 0207 928 9292 ext 3769