Dr. Smelt and Fred discuss thought sheets for the first half of session four. He begins to see how situations, thoughts, feelings, and more reasonable thoughts link together. Dr. Smelt then remembers that Fred had begun this session with noting a problem at work.

Therefore, she says, “Now that we’ve gone over this first thought sheet, I’m wondering if you’d like to tackle the second agenda item you mentioned at the start of this session?”

“Oh, yes. I suppose we should talk about what happened this morning at work.”

“OK, so what happened, Fred?”

“Remember, I told you my boss said I needed a new attitude a few weeks ago? Well, I’ve been working on that. Like you said, I’m trying to notice my negative thoughts about my coworkers and shift my perspective a little before I talk with them. I think it’s helping me sound a little less biting.”

Dr. Smelt nods and says, “That’s really good work, Fred. I’m surprised you’ve been able to shift something like that so soon.”

Fred replies, “Anyway, the good news is that my boss even said something about it. He dropped by my cubicle this morning and said he’s noticed that I’ve been trying to be more civil with my coworkers. I guess I didn’t realize how bad I’d been.”

“So, how did you feel when he said that?”

“Actually, I felt a lot of things. At first, it felt good to get a compliment. But then I felt a huge wave of shame. How could I be so stupid all this time? How could I be so unaware of my anger? Why did I need to almost go to jail to realize what was going on?”

Dr. Smelt observes, “This calls for another thought sheet. Let’s go over it, OK?”


Dr. Smelt writes:

Situation: My boss complimented me for working on my anger issues.

Feelings & Sensations: Pleased and proud. But then, ashamed. My face was hot. Rapid pulse. Sweaty. Just downright miserable.

Dr. Smelt then asks Fred, “Can you tell me what thoughts you were having as your feelings changed to the negative? Here, write them down.”

Fred writes, after the word “Thoughts”:

Thoughts: I must be incredibly stupid. How can I not even know what I even know what I sound like or how I come off with people? How did I get to this point? What’s wrong with me? I must be a terrible person.

Dr. Smelt remarks, “I can sure see why you felt so bad with thoughts like that. Can you see how your thoughts or perceptions of this event led you to feel the way you did?”

Fred replies, “Oh sure. It’s pretty clear. But I don’t see any other way to look at it, really. You can’t deny that I was, in fact, pretty stupid.”

“Well, ‘stupid’ isn’t the word I would use,” Dr. Smelt answers, “Let’s consider some other possible ways of looking at all of this.”

NOTE: This point in the session represents a critical juncture in Fred’s therapy. If Dr. Smelt can help Fred see that his thinking really tends to contain numerous distortions while helping him to avoid “negative thinking about his negative thinking,” things may go rather well from here. However, Fred is a challenging patient who will slip many times on his quest to manage his anger. Dr. Smelt’s job is far from done.

Photo Credit: Michael Krigsman

In Therapy Session 4: Fred
In Therapy Session 4.75: Fred