Set limits on diaries & records

Set clear limits on diary-keeping and other journals. By asking for the minimum amount of information necessary, you increase the chances of obtaining reliable data.

Journals and other records kept by the client are a useful adjunct to most therapeutic approaches and an integral part of some, such as Cognitive Behavioural Therapy. Daily or hourly data points can be invaluable in establishing patterns and tracking progress.

Diary sheets may be handed out automatically at the beginning of therapy, in the expectation that clients will keep reliable records which can be used as the basis for therapy. Presenting clients who are already struggling to cope with another responsibility may not be the wisest move.

Anyone who has attempted to keep a daily journal (or blog regularly!) will know the difficulty of maintaining their resolve over the long term: the first week or two are reasonably easy, but week three or four is where most resolutions fail. Therapeutic records are no exception.

Before requiring a regular commitment from a client over & above their attendance at your appointments, it is worth considering:

  • whether the data you are considering are necessary
  • how much detail is required for the analysis
  • how many data points are required

Rather than automatically requiring a diary or other recording outwith the session, ask yourself (and your client) whether the same information could be generated within the session. Clients who have struggled to carve the time for your appointment out of their schedule will appreciate you keeping your requests for extra time to a minimum.

Diary sheets are often standard forms copied from a book and require more information than may be necessary for your analysis, as well as more information than clients can comfortably record at the time. Look back over some old notes to see how often every column is completed reliably (if at all) on standard record forms. The less you require, the easier it will be to provide.

A client suffering migraine headaches drew a smiley face on each migraine-free day in her pocket diary. Flicking through the diary showed a clear increase in the number of smilies.

Most important is to consider whether the record keeping is part of the permanent change that your client wishes to make or is limited to their time in therapy. If the intention is that your client will keep a record indefinitely (e.g. a daily reflective journal), as much time should be devoted in session to establishing this habit as would be devoted to any other change in thinking or behaviour.

If the data is required for a specific part of therapy only, you should agree with the client that they will keep the record for only as long as necessary to collect the required data. If intended to track progress, a record kept for a couple of weeks at the start of therapy and reinstated near the end and again at followup may be more reliable than a supposedly continual record (which will probably lapse after three weeks or so).