Schema Therapy was developed in the 1990s by Jeffery Young as a therapeutic approach specifically designed for individuals struggling with character problems, chronic issues, and personality disorders that were not effectively addressed by cognitive therapy alone (Seligman & Reichenberg, 2010). Drawing from various psychological theories such as Cognitive Behavioral Therapy, Gestalt, object relations, and constructivism, Schema Therapy integrates multiple perspectives to inform its methods and techniques (Seligman & Reichenberg, 2010). Keep reading to learn 10 Schema Therapy activities and exercises you can do with your clients in therapy.

View all of our Schema Therapy Worksheets

Counselors employing Schema Therapy collaborate with their clients to delve into the early maladaptive schemas they developed during childhood and gain a comprehensive understanding of how these schemas influence their current self-defeating emotional patterns (Seligman & Reichenberg, 2010). Early maladaptive schemas frequently arise following traumatic experiences.

Within Schema Therapy, there are five distinct maladaptive patterns that clients may exhibit, and it is the counselor’s role to assist them in recognizing and comprehending these patterns (Seligman & Reichenberg, 2010). These five patterns include:

1. Disconnection and rejection
2. Impaired autonomy and performance
3. Impaired limits
4. Other directedness
5. Overvigilance and inhibition

Clients can respond to their internal schemas in three distinct ways: overcompensating, avoidance, or accepting them as absolute truth (Seligman & Reichenberg, 2010). Each of these responses can present challenges in various aspects of the client’s life, including relationships and their ability to effectively cope with everyday distress (Seligman & Reichenberg, 2010). Counselors practicing Schema Therapy strive to assist their clients in learning healthier and more adaptive ways of meeting their needs, by modifying their maladaptive schemas (Seligman & Reichenberg, 2010). Continue reading to explore 10 engaging exercises and activities for Schema Therapy that can be implemented with your clients.

Why Schema Therapy?

Schema Therapy is a comprehensive and integrative therapeutic approach that may be chosen for several compelling reasons:

1. Effective for Complex Issues: Schema Therapy is highly effective for individuals with complex and longstanding emotional and psychological issues, including personality disorders, chronic depression, and chronic anxiety.
2. Evidence-Based: Schema Therapy has a growing body of research supporting its effectiveness in treating a variety of mental health conditions, including Borderline Personality Disorder (BPD) and other personality disorders.
3. Holistic Approach: Schema Therapy is holistic, addressing not only thoughts and behaviors but also deep-seated emotional patterns and early life experiences (schemas) that contribute to ongoing difficulties.
4. Attachment-Focused: Schema Therapy incorporates attachment theory, recognizing the impact of early attachment experiences on an individual’s emotional well-being and relationships.
5. Emotion-Focused: This approach is emotion-focused, helping individuals identify, understand, and regulate their emotions. It facilitates emotional healing and the development of healthier emotional responses.
6. Reparenting: Schema Therapy includes a “reparenting” component, which helps individuals heal emotional wounds from childhood by providing them with the emotional support and validation they may not have received earlier in life.
7. Customized Treatment: Schema Therapy can be tailored to the specific schemas and modes (emotional states) experienced by each individual, ensuring that therapy is personalized and comprehensive.
8. Relational Healing: Schema Therapy can be adapted for couples or family therapy, promoting relational healing and improved communication among family members.
9. Positive Therapeutic Relationship: Schema Therapy emphasizes the importance of the therapeutic relationship in providing a secure and corrective emotional experience for clients.
10. Long-Term Benefits: Many individuals who complete Schema Therapy report lasting improvements in their emotional well-being, relationships, and overall quality of life.
11. Transdiagnostic Application: While initially developed for personality disorders, Schema Therapy has been adapted to address a broader range of mental health concerns, making it suitable for clients with diverse issues.
12. Positive Change and Resilience: Schema Therapy helps individuals break free from self-defeating patterns and develop healthier coping strategies, promoting positive change and resilience.
13. Self-Awareness and Self-Compassion: Through exploration of early life experiences and schemas, Schema Therapy fosters self-awareness and self-compassion, helping individuals develop a more positive self-concept.
14. Enhanced Relationships: By addressing deep-seated emotional patterns and schemas, Schema Therapy can improve an individual’s ability to form and maintain healthier relationships.

While Schema Therapy offers numerous benefits, it is important to consider individual preferences and needs when selecting a therapy approach. Schema Therapy may be particularly well-suited for those with complex and deeply rooted emotional issues who seek a comprehensive and integrative approach to healing and personal growth. Keep reading to learn Schema Therapy 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
• Histrionic personality disorder

Schema Therapy has supportive evidence showing that it can be used to treat individuals living with:

• Eating disorders
• Agoraphobia
• PTSD
• Chronic depression

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:

1. 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 TherapyPatron.com, 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.
2. 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.
3. 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.
4. 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. TherapyPatron.com 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.
5. 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. TherapyPatron.com 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.
6. 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.
7. Schema coping modes are an important topic to include in your clinical work. TherapyPatron.com 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.
   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.
8. 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 TherapyPatron.com’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.
9. Worksheets are also available for clients who cope with the use of avoidance and those who accept their schemas as truth.
10. The Schema Inventory Worksheet available at TherapyPatron.com 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.

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.

Our work with clients should always be customized to address their individual needs and experiences. When working with clients who have a personality disorder, Schema Therapy can offer a valuable therapeutic approach to enhance their quality of life. Incorporating Schema Therapy activities and exercises can be particularly beneficial for counselors seeking to enrich their clients’ counseling experience.

To gain further knowledge about Schema Therapy and its application in clinical work, participating in Continuing Education Courses and training programs can be highly valuable. As with any clinical approach or intervention, it is crucial to ensure your competence before implementing new strategies with your clients.

TherapyPatron.com helps mental health professionals better serve their clients. Our (editable, fillable, printable PDF) therapy worksheets can help you streamline your practice, effectively deliver different types of therapy, and support your clients be the best version of themselves.

View all of our Schema Therapy Worksheets

Resources:

• 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
• Seligman, L. & Reichenberg, L.W. (2010). Theories of counseling and psychotherapy: Systems,  strategies, and skills (3rd Edition, pp 285-287). Pearson Education, Inc.

Author: Kayla VanGuilder, MA, LCMHC

Kayla is a Mental Health Counselor who earned her degree from Niagara University in Lewiston, New York. She has provided psychotherapy in a residential treatment program and an outpatient addiction treatment facility in New York as well as an inpatient addiction rehab in Ontario, Canada. She has experience working with individuals living with a variety of mental health concerns including depression, anxiety, bipolar disorder, borderline personality disorder, and trauma.