[NOTE: Until now, all posts in this blog have concerned the use of analogies in psychotherapy. This entry is the first departure from that format. All entries on other topics, like this one, will be titled “Feature:_____________.” These entries will still be concerned with issues and strategies for clinicians. Your feedback about this change is encouraged.]
For a number of years I have been using tracking calendars with some of my clients. In cases in which I think it would be helpful, I describe the process to them and encourage them to try it, and most agree. These are ordinary one-month calendar pages (included in some word-processing software and also available online) that I give to my clients, along with individualized instructions, usually written at the bottom of the calendar. In most cases I ask them to record their mood each day, using a number from 1 to 10, 10 being the best. In addition to this I ask them to record other aspects of their lives, using some letter or symbol we have agreed upon. These may include:
E – days when they have gotten some exercise
S – days when they have had some kind of social contact
A – alcohol use, along with a number for number of drinks
W – a work day on which they did go to work
WX – a scheduled work day when they didn’t go to work
B – a day when they bathed
GJ – completing a gratitude journal
G,FB, D – Gambling, Food Binge, Drugs – incidents of carrying out a compulsive activity
M – any meds taken as prescribed
I also normally ask them to write down a key word if anything particularly important occurs that day – good or bad – the key word being enough to remind them what happened so that they don’t forget to share that in their session.
Sometimes clients have a very hard time choosing one number for their mood on a given day. I tell them to do their best, perhaps looking at it as their average mood for the day – but in some cases have suggested they record one number for the earlier part of the day and another for later.
No client has to track all of these behaviors. It might help to keep the number of items they are tracking quite low, especially at first. Additional items to track might be unusual and/or unique to the client, such as hours on the computer (not at work), incidents of enuresis or encopresis, number of phone calls to a given individual, or number of times they checked to make sure a door was locked.
Research suggests that what we track, we improve. It may be an increase in a given behavior we are after, or it may be a decrease, but whatever we are trying to change, it is more likely to change in the desired direction, if it is tracked. So one of the purposes for this assignment is to facilitate the changes that the client desires.
Another purpose is to “connect the dots” between changes in mood and other factors, such as substance abuse, exercise, and social contact. By keeping the tracking calendar, the client may provide evidence for the theory that exercise and/or social contact improves their mood. In another case, they may see the pattern between drinking days and days immediately following, when their mood worsens.
Yet another purpose is diagnostic. The client may not be able to give the clinician a good picture of their functioning; they may not be able to guess how often they experience a sad mood, or how their personal hygiene routine has changed, or how often they get out socially. If they are willing and able to keep the calendar, that data becomes available. It may change in the process – the client may push themselves a little so that the calendar shows they are making progress – but that’s fine; if the calendar functions more as an impetus to change rather than as tool for assessing a baseline, there’s nothing wrong with that – baselines are useful, but unless we’re doing formal research, they may not be needed.
Some clients will lose their calendars and/or forget to keep them. I have certainly given up on some clients with regard to tracking calendars. But I am fairly tenacious about it and have tried some tactics which have been helpful. I have given the same client a new calendar every week for several weeks in a row, not criticizing, just handing them a new one with the remark that we’ll try again. I have encouraged some clients to keep them in their car so that they wouldn’t get it mixed up with other household items, and so that it would be with them when they came to their next session. In a couple of cases, I had the client fill it out in the first few minutes of their session, once I found out they’d forgotten it, going back over the week in their memory and doing their best to recall. This sends the message that I take this tool seriously and also that any passive-aggressive “forgetting” will not work; they’ll have to do it eventually. In one case the client started to remember to do it at home on her own after a few times of filling it out in the office.
Of course some clients are not entirely honest about the report. This may not really be much of a problem. Whether the client is recording accurately or manufacturing data, the tracking process keeps these various behaviors on their mind and may still lead to improvement, even if less than reported.
Perhaps a more vaguely-defined reason this technique often helps, is that it provides some very specific things for the client to do and sends a message that their issues are not stable aspects of their identity, but rather, aspects of their behavior that are in flux and can be observed. It separates the client from the symptom. It wraps a rational process around what they may see as their own irrationality, and may make it seem more manageable. It may give them hope.
Whatever the purpose, using tracking calendars with a wide variety of clients, to record a wide variety of symptoms and behaviors, has proven useful to me in providing good care.
the analogy bank 