I feel like I’m constantly behind. No matter how much I plan, I can’t bring myself to start things, and then I just hate myself for it.

Session Goal:

Establish rapport and explore Sarah’s presenting problems using the CBT framework.

Milestones:

Symptom exploration and psychoeducation (CBT triangle)

Tips for Therapist:

Focus on validating Sarah’s experience, then guide her in identifying thoughts, emotions, and behaviors related to her procrastination and low self-worth. Introduce the CBT triangle if appropriate.

I spent the whole weekend in bed. I had so much to do, but I just scrolled on my phone. I feel gross.

Session Goal:

Introduce behavioral activation and begin activity planning.

Milestones:

Behavioral activation and identifying avoidance patterns

Tips for Therapist:

Collaborate on small, manageable activity goals. Explore how inaction reinforces negative thoughts and mood. Emphasize action → mood link.

I kept thinking, 'I’m lazy and useless.' I even cancelled plans because I didn’t want anyone to see me like that.

Session Goal:

Teach Sarah to identify and reframe negative automatic thoughts.

Milestones:

Cognitive restructuring (Socratic questioning, thought log)

Tips for Therapist:

Use a thought record or Socratic questions. Help Sarah examine evidence for/against self-critical thoughts. Focus on building more balanced thinking.

Sometimes I just wonder if it’s even worth trying. I don’t want to die, but I’m so tired.

Session Goal:

Conduct risk assessment and collaboratively develop a safety plan.

Milestones:

CBT-informed suicide assessment and hope-building

Tips for Therapist:

Assess for safety, validate ambivalence, and create a safety plan. Reinforce hope, protective factors, and collaborative problem-solving.

I’ve been ignoring texts. I feel like a burden and that people are just being nice out of pity.

Session Goal:

Explore and challenge Sarah’s core beliefs about self-worth and relationships.

Milestones:

Schema awareness and interpersonal cognition work

Tips for Therapist:

Highlight patterns of avoidance and cognitive distortions in relationships. Begin gentle schema work if appropriate (e.g., 'I am unworthy').

I still have rough days, but I catch myself now. I know when I’m spiraling.

Session Goal:

Review progress and co-develop a relapse prevention plan.

Milestones:

Relapse prevention and summary of learned skills

Tips for Therapist:

Reinforce autonomy, recap key CBT strategies Sarah used, and co-create a personalized plan for setbacks.