CPT Esteem Worksheet for Others: Processing Interpersonal Intimacy & Connection

This worksheet operationalizes the assessment of relational intimacy through a structured 1-to-10 Likert scale. Clients are prompted to rate their agreement with core statements regarding core loneliness, internal emptiness, and the struggle to experience genuine connection even in loving environments. By requiring a written explanation for each value, the tool moves the client from an emotional “gut feeling” to a cognitive appraisal of the specific evidence they are using to maintain these beliefs.

The focus on describing the “why” behind each rating is a prerequisite for Socratic challenging. It allows the clinician to see the underlying logic of the client’s isolation, such as the belief that trauma has fundamentally changed them in a way that makes connection impossible. This baseline measurement is vital for tracking the softening of rigid interpersonal beliefs as treatment progresses.

How This Worksheet Can Be Used

During sessions:
Clinicians use the worksheet to anchor discussions during the Intimacy/Esteem phase of CPT. Reviewing the ratings collaboratively helps identify cognitive distortions like “all-or-nothing thinking” or “emotional reasoning” regarding the client’s social world.

Between sessions:
Clients complete the ratings as a homework assignment to reflect on their current relational state. This encourages self-observation outside the therapy room and helps the client recognize moments where they may be proactively distancing themselves due to stuck points.

As part of treatment planning:
The worksheet provides a measurable baseline for relational health. It can be used to determine if a client needs more targeted behavioral experiments related to social engagement or if the primary barrier is purely cognitive.

Benefits of the CPT Esteem Worksheet for Others

• Identifies specific stuck points related to global negative views of other people.
• Quantifies subjective feelings of isolation, making progress measurable across treatment.
• Clarifies the distinction between “feeling” lonely and the cognitive “beliefs” that maintain isolation.
• Directly addresses the impact of insensitive or unempathic responses on a client’s ability to trust.
• Provides a structured pathway for rebuilding the human need for intimacy and close connection.
• Targets over-accommodated beliefs that prevent the client from experiencing love or genuine care.

Integrating This Tool into Clinical Work

Integration of this tool is most effective when the clinician validates the reality of the client’s past hurt while gently challenging the overgeneralization to current relationships. When a client rates a belief as a “10” (Strongly Agree), the clinician should use Socratic questioning to find the “evidence for and against” that belief in their current life. It is often helpful to link these ratings back to the client’s initial Impact Statement to see how their view of others has shifted since the trauma occurred. As the client works through the CPT protocol, revisiting this worksheet can provide powerful evidence of cognitive restructuring when previously high agreement ratings begin to decrease, signifying an increased openness to connection.

References

• Resick, P. A., Monson, C. M., & Chard, K. M. (2016). Cognitive Processing Therapy for PTSD: A Comprehensive Manual. Guilford Press.
• American Psychological Association (APA). (2017). Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults.
• Monson, C. M., & Shnaider, P. (2014). Cognitive-Behavioral Conjoint Therapy for PTSD. (Relating to the intimacy and esteem modules of trauma processing).
• Chard, K. M., et al. (2012). Cognitive Processing Therapy: Veteran/Military Version. Department of Veterans Affairs.