Jeffery Young developed Schema Therapy in the 1990s to work with individuals who were living with character problems, chronic problems, and personality disorders that did not benefit from cognitive therapy (Seligman & Reichenberg, 2010). Schema Therapy combines aspects of Cognitive Behavioral Therapy, Gestalt, object relations, and constructivist theories within its methods and techniques (Seligman & Reichenberg, 2010).
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Counselors who utilize Schema Therapy work with their clients to explore early maladaptive schemas that they developed during childhood and gain insight into how they impact their present self-defeating emotional patterns (Seligman & Reichenberg, 2010). Early maladaptive schemas often develop after traumatic events.
There are five maladaptive patterns that a client maladaptive pattern can fall into, which the Counselor will help them identify and understand (Seligman & Reichenberg, 2010). The five patterns include:
- Disconnection and rejection
- Impaired autonomy and performance
- Impaired limits
- Other directedness
- Overvigilance and inhibition
There are three responses that clients can have to their internal schemas; overcompensating, avoidance, and accepting them as truth (Seligman & Reichenberg, 2010). Each of these responses can contribute to challenges in various areas of the client’s life, including their relationships and ability to cope with normative life distress (Seligman & Reichenberg, 2010). Counselors who use Schema Therapy aim to help their clients learn to meet their needs in healthier and more appropriate ways than they may be doing presently after modifying their maladaptive schemas (Seligman & Reichenberg, 2010). Keep reading to learn 10 Schema Therapy Exercises & Activities you can do with your clients.
Mental Health Concerns That Can Benefit from Schema Therapy
Since its creation, Schema Therapy has been used with individuals who are living with personality disorders (Seligman & Reichenberg, 2010). This includes borderline personality disorder, avoidant personality disorder, narcissistic personality disorder, and histrionic personality disorder.
Schema Therapy has supportive evidence showing that it can be used to treat individuals living with eating disorders, agoraphobia, PTSD, and chronic depression (Taylor, Bee & Haddock, 2017). With that being said, there is not enough supportive research to make Schema Therapy fall into the category of an evidenced-based approach in the treatment of these mental health disorders (Taylor, Bee & Haddock, 2017).
While there is some flexibility in the length of time clients receive Schema Therapy, Schema Therapy is more likely to be used as a long-term therapeutic approach (Seligman & Reichenberg, 2010).
Schema Therapy Activities
Schema Therapy exercises can be used in counseling sessions to provide psychoeducation and to explore our clients’ personal experiences with schemas. This can include identifying schemas, challenging current schemas, finding new coping skills for their maladaptive schemas, and improving our client’s interpersonal relationships. Overall, Schema Therapy exercises can help improve our client’s quality of life.
Examples of Schema Therapy activities include the following:
- For Counselors who have just begun using Schema Therapy, you will likely find yourself focusing on exploring different maladaptive schemas that your client is living with. For many, using a worksheet like the Maladaptive Schemas Worksheet offered by TherapyByPro, can be a useful tool. This worksheet lists common schemas including failure, shame, and isolation, to name a few. Clients are asked to write down their personal example of the schema, and then rate the level of belief that they currently have of it. This worksheet can help clients gain a better insight into their schemas and help clinicians develop a roadmap for future sessions.
- The Schema Inventory Worksheet available at TherapyByPro can also be a useful Schema Therapy Activity. This worksheet provides a list of common maladaptive schemas, and healthier thought patterns that could be used to replace the unhealthy ones. This can help increase a client’s awareness of their maladaptive schemas, and give them a concrete example of how to correct the schema.
- Letter writing is a common exercise in many therapeutic approaches, including Schema Therapy. Letter-writing exercises can provide clients with an opportunity to verbalize their experiences, thoughts, and emotions in a healthy manner. TherapyByPro offers a Letter-Writing Template that can help guide clients as they develop their letters. This can be done in session, or used as a homework assignment. Allow time for your client to share their letter with you in session, and process their experience writing and sharing their letter. Allow them to choose what they would like to do with the letter. While some clients may choose to hold onto it, others may choose to shred or even burn their letters. Ensure that you have adequate time to provide the support needed before ending your session.
- Chair work is a common Schema Therapy exercise used in sessions. With this exercise, your client will move between two, or possibly more, chairs that represent different parts of themselves that contribute to their maladaptive schemas. The chairs being used should be arranged to face each other so that as your client moves, they can visualize talking to themselves. This exercise can help clients understand how the different parts of themselves interact together.
- We mentioned above that there are three possible coping skills for early maladaptive schemas; overcompensating, avoidance, and accepting them as truth. Clients who find themselves overcompensating may benefit from the use of TherapyByPro’s Overcompensating Pro and Con Worksheet to explore the gains and losses of this coping response. Clients are asked how often they use this response and to list the pros and cons of doing so. This can help clients recognize where they can make changes to their behavior, and begin to see the impact that their behaviors have on their relationships with others. Worksheets are also available for clients who cope with the use of avoidance and those who accept their schemas as truth.
- Guided imagery is a technique that can be used at various points during Schema Therapy. It can be used in the beginning to explore past experiences, and also to focus on the future. When we use guided imagery for current and future concerns, we can work with our clients to replace their negative emotions and automatic thoughts with positive, or more realistic, ones.
- Providing psychoeducation during therapy sessions is often the first step toward making clinical gains. A follow-up to psychoeducation is exploring and processing situations outside of your therapy sessions where your client is able to apply the knowledge or skills that you have introduced to them. TherapyByPro offers a Schema Diary Card that can be used to track and organize your client’s experiences so that you can talk about them in your sessions. Encourage your client to complete their diary card outside of the session and bring it to the following appointment to explore and discuss.
- Being able to confront your client in a compassionate manner is an essential skill when providing Schema Therapy. Confrontation can be used to point out maladaptive schemas, behaviors, and thoughts as they arise during sessions. Being able to do this in a supportive manner allows you to continue progressing towards the client’s goals, without damaging the therapeutic relationship. Compassionate confrontation can be vital for clients who have a history of trauma, abuse, and neglect.
- Role-playing exercises can be used as a behavioral intervention during Schema Therapy. Role-playing can be used to gain a better understanding of how your client views their environment and interacts with others. By exploring your client’s interpersonal relationship patterns, you can point out any unhealthy or maladaptive patterns. This work supports the goal of improving your client’s interpersonal relationships.
- Schema coping modes are an important topic to include in your clinical work. TherapyByPro offers an Exploring Schema coping modes Worksheet that can be used to explore and process a client’s use of a particular coping mode. With this sheet, clients will be asked to identify what triggered the coping mode, and the benefits of this coping mode, and ask them to identify any needs that are not being met by this coping mode. This worksheet can be used during a counseling session, or completed outside of session and reviewed in session.
Final Thoughts on Choosing Activities for Schema Therapy
Thank you for reading our resource on 10 Schema Therapy Exercises & Activities for your clients. Every client that we work with has walked their own path in life and have a history rich with unique experiences. With that being said, it is understandable that clients respond differently to different therapeutic approaches. While behavioral and cognitive behavioral approaches work well for many clients, you will likely meet an individual at some point during your career who is not reaching their goals with these forms of treatment, and that’s okay.
The work that we do with our clients should be tailored to their unique needs and experiences. For clients who are living with a personality disorder, Schema Therapy can be an effective therapeutic approach to improving their quality of life. Schema Therapy activities and exercises can be an effective tool for counselors looking to enhance their client’s experience in counseling.
If you are interested in learning more about Schema Therapy and how it can be applied to your clinical work, Continuing Education Courses and training can be a great opportunity for you. As with all clinical approaches and interventions, it is important to ensure your competency before using new strategies with your clients.
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- Seligman, L. & Reichenberg, L.W. (2010). Theories of counseling and psychotherapy: Systems, strategies, and skills (3rd Edition, pp 285-287). Pearson Education, Inc.
- Taylor, C. D. J., Bee, P., & Haddock, G. (2017). Does schema therapy change schemas and symptoms? A systematic review across mental health disorders. Psychology and psychotherapy, 90(3), 456–479. https://doi.org/10.1111/papt.12112