What Worksheet to Send for Each Presenting Concern: A Therapist's Guide

The hardest part of between-session work isn't finding a worksheet. It's picking the worksheet — the one that matches what the client is actually struggling with this week, at the level of activation they can tolerate, without asking them to do homework they'll quietly skip.

This is the internal cheat sheet we use. For each of the 15 presenting concerns that show up most in general practice, it gives you a first-line worksheet, a step-up option when the first one lands, and the clinical reason to choose one over the other. Every worksheet linked here is ready to send from the client resources library.

A rule that makes all of this easier: match the worksheet to the client's nervous-system state, not to the diagnosis. A dysregulated client needs a regulation tool, even if their chart says GAD. A regulated client can do cognitive work, even if their chart says PTSD. Everything below assumes you make that call first.

1. Panic attacks

Send first: Panic Attack Survival Plan

Panic is a retrieval problem, not an insight problem. Mid-attack the client cannot access a coping strategy they learned last Tuesday, so the plan has to be one page, in their own words, and on their phone. Have them fill it in with you in session rather than as homework — the act of writing "what I will tell myself" while calm is what makes it retrievable while activated.

Step up: 5-4-3-2-1 grounding as the in-the-moment companion, and the anxiety worksheet collection once panic frequency drops and you can move to interoceptive work.

2. Generalized worry and rumination

Send first: Worry Tree

The Worry Tree does one job well: it forces the hypothetical/practical distinction. Clients who spin for hours usually can't tell the difference between a worry that has an action and a worry that doesn't, and the branching format teaches it faster than any explanation.

Step up: Worry Time once they can sort worries but still can't put them down. Stimulus-control for rumination is behavioral, not cognitive — scheduling the worry is the intervention.

3. Depression and low activation

Send first: Behavioral Activation Planner

For low activation, start with behavior and let mood follow. The most common failure here is over-ambitious scheduling: help the client pick activities they'd rate 2/10 in difficulty, not 6/10. One completed small thing beats three planned big ones.

Step up: Values Compass when activity scheduling works but feels hollow — that's the signal to attach behavior to values rather than to mood repair. The depression worksheets page has the full sequence.

4. Suicidality and crisis planning

Send first: Safety Plan Worksheet (Stanley-Brown)

This is the one item on the list that is never homework. Build it collaboratively in session, in the client's language, with means-restriction discussed explicitly. Then make sure they leave with a copy they can actually reach — phone photo, not a folded paper in a bag.

Step up: Distress Tolerance Worksheet for the skills layer that sits underneath the plan.

5. Emotion dysregulation

Send first: Emotional Regulation Worksheet

Naming and rating emotions is unglamorous and it is where regulation starts. Before skills training, most clients need a week or two of simply noticing intensity on a scale — you'll get better data for skills selection, and they'll get the first experience of an emotion having a shape.

Step up: the DBT worksheets library for skills-by-module sequencing once labeling is reliable.

6. Anger

Send first: The Anger Iceberg

Anger work fails when it starts with control strategies. The iceberg reframes anger as a surface signal, which lowers defensiveness enough for the client to look underneath it — usually at hurt, fear, or shame. Send it after a session where anger came up, not before.

Step up: the anger management worksheets collection for trigger tracking and time-out planning.

7. Boundaries and people-pleasing

Send first: Boundary Builder

People-pleasing clients can usually describe the boundary they want and not the sentence they'd say. This worksheet is scripting practice — insist on actual wording, because "I'll be clearer with my mom" is not a boundary.

Step up: Communication Skills Worksheet, and the codependency worksheets page when the pattern is relational rather than situational.

8. Trauma and triggers

Send first: Trigger Map

Mapping people, places, and sensory cues gives you both a shared map before any processing work begins. Keep it descriptive — this is not the place for narrative detail, and a between-session worksheet should never invite the client into the story alone.

Step up: the window of tolerance worksheet for state tracking, then the trauma worksheets library once stabilization holds.

9. Dissociation

Send first: Dissociation-Specific Grounding

Standard grounding often fails for dissociation because it asks for interoception the client can't reach. Orienting to the room — external, visual, present-tense — works better. Practice it in session at low activation first so it's rehearsed before it's needed.

10. Shame and self-worth

Send first: Shame Resilience Map

Shame needs a container before it needs challenging. Mapping triggers, physical cues, and the "shame script" makes it observable, which is usually the first relief the client has felt in the topic.

Step up: Self-Compassion Break and the self-esteem worksheets collection.

11. Insomnia

Send first: CBT-I Sleep Diary

Two weeks of diary data before you change anything. Sleep interventions built on self-report memory almost always target the wrong variable — the diary tells you whether you're dealing with onset, maintenance, or scheduling.

Step up: Sleep Hygiene Worksheet, plus the sleep worksheets page for stimulus control.

12. Addiction and relapse risk

Send first: Urge Surfing

Urge surfing teaches the one fact that changes behavior: urges peak and fall. Send it early, and ask for a rating of urge intensity at the start, peak, and end so the client sees the curve in their own handwriting.

Step up: Relapse Prevention Worksheet and the recovery worksheets collection once early abstinence is stable.

13. OCD

Send first: Sitting with the Urge (ERP)

ERP homework only works when the exposure is specific, graded, and agreed on in session. The failure mode is a worksheet that becomes a reassurance ritual — watch for clients who complete it perfectly and feel worse.

Step up: the cognitive distortions worksheet for the appraisal layer, once compulsions are reducing.

14. ADHD and executive function

Send first: ADHD Weekly Planner & Habit Tracker

Structure beats insight here. Keep the planner short enough that filling it in is not itself an executive-function task — if it takes more than three minutes, it won't happen twice.

Step up: Procrastination Worksheet and the ADHD worksheets library.

15. Couples conflict

Send first: Conflict Resolution Worksheet

Send one copy per partner and have them complete it separately. The value is in the difference between the two accounts, which becomes the agenda for the next session.

Step up: the couples worksheets collection for repair attempts and communication structure.

How to make sending it actually happen

The gap in between-session work is rarely selection — it's the send. Three things close it:

1. Send before the client leaves the room. Assigning from memory after the session is where homework goes to die.
2. Say the "why" out loud. One sentence — "this is so you can see the urge rise and fall" — roughly doubles the odds it gets done.
3. Open it first thing next session. A worksheet you never look at teaches the client it was optional.

In TherapistAssist you can generate a personalized version of any of these, edit it, and send it to the client's portal in under two minutes — or open the matching in-session tool and work through it together on screen. Browse the full worksheet library to see everything available by concern and modality.