The Surprising Power of Surveys

How Measurement and Reflection Can Transform Your Therapy

When you start working with me (or any TEAM-CBT therapist), one of the first things you’ll experience will tell you this is a little different. If you’ve seen therapists before or seen therapy on TV, you likely don’t see “ongoing paperwork” or “written mood surveys” as a standard part of the process.

The “T” In TEAM Is for Testing

The very first letter in TEAM-CBT (created by Dr. David Burns) stands for “testing.” What does testing mean in the context of therapy? Why was I initially tempted to disregard it? And why do I now see it as indispensable? 

What do I mean by testing? 

First things first, it’s not a performance evaluation, and you can’t do well or poorly! After I meet with a potential client and they decide to schedule a session with me, I send them their first form to fill out. It’s the longest and most involved you’ll face in our work. It’s long because it aims to capture and summarize lots of information about you and what’s bothering you. Reviewing your answers together will give us a solid foundation to work from and guide an initial conversation about your background and history that I’ll need to know about you. 

Excerpted from “Brief Mood Survey” Copyright © 1997 by David D. Burns, M.D. Revised 2010, 2011, 2018, 2022.

Here’s where it gets more unusual: Each time we meet, my clients fill out pre- and post-session forms. They answer questions about their levels of sadness, worry, and anger, among other things. At the end, they also answer questions about the session itself. Sometimes, they find this annoying and time-consuming; sometimes, they find it pointless or even insulting. 

A common objection is that it feels a little off, somehow. It just doesn’t seem like the right vibe for therapy. 

Good Reasons to Object to Testing

I’ve been doing this for years, and I’ve heard a lot of good reasons not to use surveys. I even had some objections myself when I first started learning TEAM-CBT. There are probably more good reasons to object than I list here, but these are some of the more common ones. 

They Take Time

Our sessions are typically 52 minutes long. You need about five minutes before and ten minutes after we meet to fill out the forms. But if your brain is like most peoples’ (and like mine, in other parts of my life), you probably think of our session as belonging to a single hour-long block of meeting time. If you do, the five- and ten-minute pockets you’d need might be spoken for already. Your other commitments likely fit more neatly into a single-hour unit. 

Doing the surveys is annoying and gets in the way of other parts of your day. Also, what if our session brought up painful emotions, and your eyes are still puffy from crying? Filling out the post-session form at that moment is the last thing you want to do. 

The Scores Feel Arbitrary

“What if my answers aren’t accurate? How do I know if I feel “somewhat” or “moderately” sad?” I’ve had clients concerned that the scores won’t reflect a real trend; they might just be a transitory record of a rough night’s sleep or a stressful week at work. 

Testing Doesn’t Feel Like Therapy

When your life is already hard, the last thing you want is more work. People don’t usually start seeing a therapist at the first sign they’re not feeling great. By the time we start, my clients are often overwhelmed, exhausted, and discouraged. What probably sounds most appealing (I guess what sounds most appealing to me when I’m in that state) is to be wrapped in something comforting, handed a warm cup of tea, and given a break from the demands of life. 

It’s so appealing to be able to come into a therapist’s office and unload all the things you can’t talk about with anyone else in your life. That’s often a huge part of what we need. Someone giving you more work might seem both counterintuitive and counterproductive. “I’m here because I’m already stressed out and overwhelmed, and you’re saying you want me to take surveys every time we meet?”

Why I Use TEAM-CBT (and Testing) Anyway

When I first started training in TEAM-CBT and tried using the surveys, I heard all these objections. They’re all valid and reasonable, so I stopped. Frankly, they were a bit of a headache for me, too, and I couldn’t see a compelling reason to use them. 

Then I learned more. I got more client experience, spent more time with teachers and mentors, and increasingly understood testing as an indispensable part of my work. 

Testing Sets a Baseline and Help Us See the Change

The most basic reason for using mood surveys is that they provide information about how you’re feeling throughout our work together. When we start, we know where things stand. As time passes, we can see what kind of progress we’re making. The numbers also make that progress more visible, like when you take ‘before,’ ‘after,’ and ‘during’ pictures when you’re painting a room.  

Crucially, we can also see if we’re not making progress and make adjustments. In a traditional therapeutic relationship, the client and therapist might have very different ideas about the goal of therapy and how well things are going. With the mood surveys, we can review the numbers together and make sure we’re both on the same page. 

Testing Tells You This Therapy Is Different

That brings us to a very connected but slightly different point: I hope the surveys convey my confidence that we can genuinely change your feelings. 

Therapy is not remotely a uniform experience – each practitioner is unique in personality, specialty, and level of skill and training. Privacy and confidentiality mean the only windows we have into what’s possible in therapy are limited. We have only our personal experiences and what we see on TV. 

Most of us are unclear about what therapy can accomplish, and it usually doesn’t seem like much. When I start working with a new client, they are inevitably skeptical that we’ll reach their goals. Of course, they’re skeptical—it’s a wild claim! 

So many (very reasonable) criticisms of CBT perceive it as a form of toxic positivity dressed up as therapy. “You think you’re inadequate? What if you tried thinking you’re extremely adequate instead?!” If that’s what was happening in TEAM-CBT, I wouldn’t just be skeptical; I’d run headlong in the opposite direction. 

Anyone who’s ever tried to “just think differently” knows it doesn’t work. It usually makes us feel worse instead of better. So, I fully respect, relate to, and understand the skepticism. And I still feel confident I can show you how to change your feelings.

I’m so confident that I want numbers. I want us both to be able to tell if it’s working. I want to hold myself accountable, and if what we’re doing isn’t working, I want to know that, too. Then, we can figure out what’s getting in our way. 

The Surveys Remind Us Both that You’re the Expert When it Comes to Your Emotions

Early in my practice, I remember commiserating with clients about the frustrations of trying to take the surveys. We wished together that I had some high-tech scanner to wave at them and give us both a readout of their feelings. I didn’t know at the time how counter-productive this would be!

The truth is that emotions are not concrete, static things that someone can read on your face or that some instrument can assess in their type or intensity. That includes these surveys! You cannot respond incorrectly, and no one else can tell you that you have gotten it wrong. No therapist anywhere can read a facial expression and ‘know’ how you’re feeling. 

Therapists sometimes conclude that our general expertise in emotions can give us specific expertise in an individual’s emotions. We tend to pay close attention to nonverbals, but we aren’t mind-readers and are often wrong. More importantly, a therapist getting it wrong while believing we’re incapable of being wrong creates a terrible therapist-client relationship. 

Testing Develops Your Skills and Self-Knowledge

The book How Emotions Are Made is absolutely worth reading and might blow your mind, as it did mine. One key takeaway: assessing and describing your emotional state affects the emotions you assess.

You are the expert in your emotional state. Describing that state is a skill and a useful one, at that.

On its own, this skill isn’t enough to transform depression into joy, but it is a step toward more agency.

If you’ve ever been told you were overreacting or too emotional, you might be extra wary of rating your emotions. That kind of doubt makes the surveys more challenging at first. Over time, you’ll develop greater confidence in your self-understanding and more words to understand and communicate your experiences. 

Collecting words to better communicate our feelings is a skill most of us never knew we could practice, and a high-tech scanner would only reinforce the idea that we don’t know ourselves. 

Testing Helps Us Get to the Point

The surveys don’t give us access to “ultimate truth,” but they quickly convey information that would otherwise take too much time. We could start each session by talking about how sad and anxious you are conversationally, but that could easily take up all 52 minutes. Surveys, by contrast, summarize and communicate lots of information quickly. Instead of spending our entire session talking about those feelings, I can quickly see which are the most intense and zero in on those. 

That also means we avoid spending five minutes of our brief session running through “I’m fine, how are you?” because we can quickly figure out what’s bothering you and use our time more meaningfully. 

Finally, if your survey responses suddenly change, we’ll discuss it, and you’ll have a chance to share your thoughts. Your poor night’s sleep, the argument with your partner, the looming work deadline–I want to know about these, even if they’re not what we’re working on that week. I won’t assume that therapy is the cause of a huge change unless you say it is. 

Testing Acknowledges that I, a Therapist for Perfectionists, Am Not Perfect

One of the biggest reasons I will never give up Testing is that I need your feedback. The therapeutic relationship is the absolute, number one, most important factor in our success. If I make mistakes and don’t know it, the rupture in trust will undermine our best work. 

Here’s a worst-case scenario I want to avoid: we start working together, get off to a decent start, begin to make some progress, then boom: I say something awkward and lose your trust. I don’t know it, though, so I sail on blithely, continuing to grow that kernel of hurt you feel or doubt you have. We’ve stopped making progress, but maybe neither of us notices. For a while, you keep trying because it’s annoying to change therapists, but eventually, you get fed up and stop working with someone who isn’t helping you.

That would be fine, even ideal, if it were true that we were never going to reach your goals no matter what. But if knowing my errors early on would have made the difference, I’d be sad to miss the chance to improve our relationship.  

Excerpted from “Evaluatoin of Therapy Session” Copyright © 2001 by David D. Burns, M.D. Revised 2004, 2020.

Not only does the trust in our relationship mean the difference between reaching your goals and stalling out, but the work we do to repair our relationship is likely to be some of the most important we do. That process will bring us closer together and serve as a sandbox for navigating hurt, disappointment, or anger in your ‘real life’ relationships. 

I’m not perfect. I will say things that don’t land quite right or make a choice that doesn’t make sense to you and fail to explain it. When those things happen, or any of the myriad things that could piss you off about me, I want to know. 

Testing Has Real Downsides, and It’s Essential for Great Therapy

Testing is time-consuming. It can feel annoying and irrelevant (I’m just having a bad morning! This doesn’t mean there’s a trend, Cheryl!) or incomplete (“Okay, yes, I put ‘4-Extremely’ but I need to explain…) or uncomfortable (“I kind of thought we didn’t get very far in this session.”). Testing means setting aside time before and after every session. 

Testing feels weird because it’s not the norm for therapy. It might seem intrusive because being honest about so many questions at once is vulnerable. It’s also an additional task that can evoke pre-existing feelings of guilt, overwhelm, or shame about getting things done. 

You might object to testing as a part of therapy for many solid, understandable reasons. If that’s the case for you, and you’re up for working on it, we can address those things first in our work together. If not, though, I fully understand! I support your choice to work with someone who doesn’t use surveys, and you would be in excellent company.

If you’d like to start therapy but want to find someone who doesn’t use surveys or homework, get in touch! Starting therapy is a huge move and sometimes an intimidating process. I know a lot of therapists in Georgia, and I might be able to help you narrow your search.

Cheryl Delaney, MS, LPC

I’m Cheryl Delaney, a Georgia-based therapist who helps perfectionists keep high standards while experiencing more joy and connection.

I’m a recovering perfectionist myself, and I love showing other people the way out. I’m a TEAM-CBT therapist passionate about making therapy as effective as possible, always keeping compassion and empathy at the center. You can read more about me and my approach (TEAM-CBT) or schedule a free consultation to ask questions about how therapy might work for you.