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2 Treatment Phase2.01 Limited Reparenting Offering careIn the first place, good care meansconnecting with the client’s experience.To this end, it helps to keep the image ofthe client as a small child in mind.On an emotional level, the client isoverwhelmed by old pain from herchildhood. The leading question for thetherapist can then be: “What would I do/say if this were really an upset child?”.The answer is not to come up withsolutions immediately but to firstacknowledge what the client feels and,where possible, make a connectionwith her experiences from the pastthat exacerbate the emotions. Careoften means a soft, warm tone of voice,a slow pace and reassurance, ratherthan suggesting well-meaning solutions.State that it is good that the client nowdares to talk about it and ascertainwhether she has thought about thecrisis plan.2.02 Limited Reparenting Providing directionLimited Reparenting means, amongother things, that you, as a therapist,interfere in a personal and activemanner with the important life choices ofthe client. The only emotion-regulatingmechanisms that clients have are thecoping styles of overcompensation,8 schema therapy step by stepavoidance or surrender. In thesebehavioral reactions, scant attention ispaid to what is felt, what the underlyingneeds are and what the exact problemis. The switch ‘to action’ is immediate.Giving direction often means slowingdown and sympathizing and in themeantime actively thinking about whatcould change in the important areas oflife in the longer term.2.03 Limited Reparenting Empathic ConfrontationLimited reparenting does not onlymean caring and directing, it also meansconfronting in an empathic mannerbehavioral patterns that are not helpfuland that prevent the basic needs of theclient from being fulfilled. An empathicconfrontation can be conducted indifferent ways, but within LimitedReparenting it means at leastconfronting in a personal way.The following step-by-step plan can helpto shape the empathic confrontation:1 the therapist examines for him-/ herself which behaviors interfere incommunication.2 the therapist confronts the clientin a friendly but clear way.3 do this in small steps and contemplatethe emotions this calls up.4 expand this example to a broaderpattern of behavior.5 make a connection with the historicalbackground and the modes that havedeveloped as a result.6 appoint a healthier alternative that ismore in line with the needs of the client.2.04 Limited Reparenting - LimitsettingDrawing a limit also implies that thereare consequences if that boundary is notrespected. These natural consequencesare announced in advance. The next timethe problem behavior occurs, it is againexplained why the boundary is thereand the consequence is put into effect.If necessary, these consequencesincrease in severity up to the point thatthe therapy is interrupted or stoppedaltogether.2.05 Detached Protector - ChairworkThe therapist uses chairwork to explainthe protective function of the detachedprotector. The therapist then tries tobypass the Detached Protector andconnect to the Vulnerable Child.The therapist identifies the DetachedProtector in the session.The therapist asks the patient to moveto another chair and explain, as theDetached Protector, how this copingmode is helpful for the patient.The therapist points out that theDetached Protector is not solvinganything and offers a different, morehealthy approach.The therapist then asks the patient to9 schema therapy step by stepmove back to the original chair next tohim and tries to connect to theVulnerable Child, reassuring andcomforting her.If necessary the therapist asks thepatient to go back for a short while tothe chair of the Detached Protector tohear new arguments.Finally, the therapist asks her to returnto the chair next to him to connect to theVulnerable Child again.2.06 Historical role playThe historical role play consists ofseveral phases:1 identification of behavioral patterns,schemas in which the client getsstuck and preliminary discussionabout a meaningful past situationthat underlies the schemas.2 reenactment of this historicalsituation in which the client playsherself (as a child) and the therapistthe other (father).3 discussion of the role play andidentification of the learnedassumptions about herself and/orthe other.4 reenactment of the historicalsituation in which the client plays theother (father) and the therapist playsthe client as a child. The therapistclearly indicates the father’scircumstances at the time, so thatthe client can play the father of thattime as best as possible.

5 Discussion of the role play. Thetherapist first asks the client questionsin the role of father and checks whetherthe father really thinks what the clientinitially concluded. Then test thecredibility of the assumptions again.Then discuss how the client wouldwant to respond in the historicalsituation, but with today’s knowledge.Emphasize that the desired behavior inthe past was not yet possible, but thatshe can try it out now.6 reenactment of the historicalsituation in which the therapistplays the other (father) and theclient stands up for her needs.7 discuss this experience and give a lotof affirmation for what the client hastried. Together formulate the otherperspective (father cannot bereasoned with) and an alternativeconclusion about herself (I can givemy opinion). This builds healthyschemas.2.07 Bully & Attack-EmpathicconfrontationThe therapist uses the same stepswhen doing an empathic confrontation.The Bully & Attack mode, like any otherform of overcompensating coping mode,has an escalating effect, easily triggeringthe therapist to start to talk faster orto argue. The therapist has to deescalate by looking away from time totime, giving small summaries with10 schema therapy step by stepexplicit understanding of the patient’sfeelings, trying to keep a clam tone ofvoice.2.08 Punitive Parent - ImageryrescriptingWith rescripting, there are differentvariations in the use of imagination.For example, the therapist can first startwith a safe place or directly engage withthe upsetting feeling that the clientalready has or directly evoke a pictureof a recent situation that caused a badfeeling or directly go to a meaningfulimage from the past.In the most comprehensive variant,the steps are:1 explanation of aim and method2 safe place3 recent trigger situation4 emotional bridge to the past5 visualization of the originalmeaningful event6 rewrite that event7 back to the safe place8 post-discussion.2.09 Bullying Peers - ImageryrescriptingSometimes the antagonists in thehistorical situation are not a parent butpeers. In these situations, the therapistmust decide if he addresses the bullyingchildren, and/or the teacher who mightbe involved in the situation.2.10 Punitive Parent - ChairworkSending away a Punitive Parent modeusing the multi-chair technique hasseveral steps:1 Identifying and naming the PunitiveParent mode.2 Place the client in another chair andask her, from this punitive experience,to indicate what is wrong with theclient. Let her say it to little Sandra(empty chair).3 Interrupt these punishing messagesafter a few sentences and ask theclient to sit next to you. Indicate thatthe punishing side stays behind onthat other chair.4 Explore the emotions of the VulnerableChild and, if possible, identify thehistorical roots of the Punitive Parent.5 The therapist addresses thePunitive Parent with the strengthnecessary to win.6 Regularly check the client’s feelingsand after a few attempts to silencethe Punisher, put the Punisher’schair out of the door if necessary.7 Comfort the Vulnerable Child.8 Round off with a cognitive frameworkin which the Healthy Adult willunderstand more about whathappened.2.11 Punitive Parent - CognitivetechniqueWhen challenging the (messages of)the Punitive Parent, it is also important11 schema therapy step by stepto submit arguments that show thatthe Punitive Parent is not right.Cognitive techniques offer anopportunity to explicitly highlightthese arguments, such as a moredimensional evaluation in this scene.There are several variations on thistechnique and for a description of thisreference is made to literature fromcognitive behavioral therapy.2.12 Vulnerable Child - Circle DiaryFormClients have a tendency to have extremereactions at an emotional, but also at acognitive level, under the influence oftheir modes and schemes. They drawconclusions that are incorrect orpremature, without examining whatalternative explanations there might befor a difficult situation. In this fragment,together with the client, we go over herfirst automatic reactions and thoughtsafter a friend cancelled an appointment bymaking a cognitive circle. We look at theinfluence of the dysfunctional thoughts onher feelings and behavior and what thereal need was. This creates a morenuanced view of the whole situation.2.13 Vulnerable Child - Audio flashcardRecording an audio flashcard as atherapist has several advantages.On the one hand, it provides a tool forthe client to remember and furtherinternalize the factual arguments

against parent mode. On the otherhand, a recording with the voice of thetherapist who says nice things is alsoa transitional object, which helps tofurther internalize the therapist.2.14 Vulnerable Child - Set homeworkThe therapist gives homeworkassignments at the end of every session,right from the start of therapy. In thefirst phase of therapy, the therapistsuggests homework that is aimed at abetter understanding of modes andthat the therapist, and the therapist’smessages and the use of an audiotapeand diary forms are helpful in achievingthis.2.15 Angry Child - Ventilate,Empathize, Reality testingIn the Angry Child mode, not only is theanger felt about the current triggersituation but also the pent-up angerabout all the injustice which the clienthas experienced in the past. If the clienthas never been given the opportunity toexpress this anger, then ventilating allanger in the session is very healthy asit validates the suppressed need forself-expression. Note that this strategyworks in child modes and not in copingmodes. Furthermore, the strategy ofventilating-empathizing-reality testingshould be adapted if other basic needsthan self-expression are relevant to yourclient.12 schema therapy step by step2.16 Angry Child - ChairworkAt the start of the therapy, the emphasisin handling the Angry Child is to ventall the old anger. In the later stages oftherapy, the Healthy Adult should learnto express the anger in a different wayso that the connection with others isnot harmed. The therapist coaches theHealthy Adult in expressing anger in acontrolled manner.2.17 Structure of complete sessionwith transitions via blackListen carefully at the beginning of thesession as to which mode is active. Thatcan be heard, among other things, by thetone of voice and the way in which theclient talks about herself. Choose astrategy that suits that particular mode:in coping mode you want to circumvent,in parent mode you want to challenge,the Angry Child should get a chance tovent all anger and the Vulnerable Childshould be validated in her basic needs.In one session, multiple techniques canbe applied depending on the process inthe session. At the end of the session,time should be allowed to cognitivelyanchor all experiences and the therapistwill address the Healthy Adult moreexplicitly. Homework is given at the endof each session.3 End of Therapy3.01 Empathic ConfrontationIn the final phase of therapy, the empathicconfrontation may be somewhat clearerthan at the beginning. The therapeuticrelationship is strong enough for thisand the client can appeal more to herHealthy Adult. The therapist speaksmore clearly to the Healthy Adult, namesthe modes he hears and tries to let herHealthy Adult take control. Addressingthe Healthy Adult is accompanied by adifferent tone of voice than in thebeginning of therapy and the therapistwill address the Healthy Adult moreexplicitly about her responsibilities.3.02 Detached Protector - Chairwork:coaching the Healthy AdultIn the final phase of therapy thetherapist coaches the Healthy Adultmode of the patient in bypassing hercoping mode.The therapist identifies that the copingmode is present in the session andasks the patient to sit in another chair.The patient explains the pro’s of thecoping mode.The therapist then asks the patient tomove to the original chair beside himand asks the patient to argue using thecoping mode from a Healthy Adult pointof view.If necessary, he asks the patient to moveback to the chair of the coping mode.13 schema therapy step by stepFinally, the patient concludes from theHealthy Adult mode that she wants thecoping mode to take a step back moreoften in the future.3.03 Detached Protector - Chairwork:therapist plays coping modeStrengthening the Healthy Adult at thefinal phase of therapy requires thepatient to argue with her coping modeherself. The therapist plays the copingmode, at the same time supporting andcoaching the patient in expressinghealthy arguments.The therapist introduces the exercise asa way of strengthening the HealthyAdult side.The therapist takes a place in the chairof the coping mode and starts explainingwhy this side is helpful.The patient has to oppose this copingmode with specific arguments.If needed, the therapist supports thepatient in the role of the Healthy Adult.The therapist goes on until the patienthas refuted all the arguments of thecoping mode.3.04 Punitive Parent - ChairworkAt the end of the therapy the role ofthe therapist is more coaching thandirecting; the Healthy Adult side ofthe client must now learn to fight thePunitive Parent. The therapist’s coachingmay entail that words are still proffered,encouragement given to repeat certain

statements or to repeat them moreforcefully. Saying these argumentsagainst the punisher out loud alsomakes these arguments more believable.3.05 Punitive Parent - ImageryRescriptingImagery with Rescripting. In the finalphase of therapy, the therapist uses theHealthy Adult in rescripting. This is donein three steps:1 First, the client makes contact withthe original situation, in which she isthe child (little Sandra) whoexperiences the unpleasant situation.2 The scene then reverts to thebeginning, but the client assumes therole of her Healthy Adult (Big Sandra)and she intervenes until it is safe forlittle Sandra. Finally, she comfortslittle Sandra.3 Again, the scene reverts to the beginning and now the client is againlittle Sandra, who experiences whatSandra does to protect and comfort her.This scene starts with the first step.It can be helpful to start theimagination exercise by visualizingthe Healthy Adult so that this mode isalready somewhat activated. Thismakes it easier to visualize thatHealthy Adult in step 2.3.06 Healthy Adult - Identifyingthe Healthy AdultThroughout the entire therapy, work is14 schema therapy step by stepbeing done to strengthen the HealthyAdult. Initially this is primarily throughexperiential techniques and psychoeducation. In the final phase of thetherapy, what the client can do to makecontact with her Healthy Adult isdiscussed more explicitly. One of thepossibilities is that when confrontedwith a difficult situation, the client willthink back to an image in which shesoundly resolved something through herHealthy Adult. During the visualizationof the Healthy Adult, attention is paid tothe various attributes of this mode suchas the physical posture, cognitions,emotions and physiological aspects thatbelong to the Healthy Adult. Finally, it isdiscussed how this side differs from thedysfunctional modes.3.07 Healthy Adult - Psycho-educationThe therapist gives psycho-educationabout a healthy adult way in coping withdifficult situations in three steps:1 Pay attention to your emotions andbe kind and accept what you feel.2 Be aware of coping and or parentmodes that try to interfere.3 Reality testing: What do you need, andwhat action validates these needs?3.08 Future Imagery - Modeawareness & mode managementThis imagery exercise in this final phaseof therapy is focused on strengtheningthe healthy adult and becoming awareof the dysfunctional modes that caninterfere. The patient learns how toreconnect to her Healthy Adult, whenthe other modes try to take over.3.09 Future Imagery - BehavioralchangeThe final phase of therapy increasinglyfocuses on the necessary behavioralchanges and the client must prepare forpossible trigger situations in the future.Imagination exercises in this phase oftherapy are now mainly used to visualizethe Healthy Adult handling thesechallenging situations.1 Pre-discussion of old modes and thedesired behavior in trigger situations.2 Visualization of a likely triggersituation and feeling the old reactions.3 Making contact with the HealthyAdult and visualizing the desiredresponse.4 Repetition of this Healthy Adult helpsto better internalize this.3.10 Healthy Adult - Dealing withconflictDifferent modes were activated uponconfrontation with a challenging andtriggering situation. The therapist isnot pointing out the modes anymorebut pushes the Healthy Adult to identifythese modes herself. He then pushesher to comfort little Sandra and practicethe three steps of the Healthy Adult.15 schema therapy step by step3.11 Homework assignmentsWhen the patient has learned tomanage conflict situations from theHealthy Adult side, the therapist givesher homework to rehearse managingthese conflicts in this way, wheneverthey occur again. He also points out thatit is possible that she will not alwayssucceed. Consequently, her otherhomework is that she has to fill in adiary form about a situation thatdidn’t go well.After three weeks, the patientdiscusses the way she handled twoconflict situations.The therapist compliments her for thethings that went well. They also discussthe fact that she didn’t fill out the diaryform after a conf

of schema therapy are, the application of these components in the different phases of therapy often raises questions. The purpose of this production is to familiarize novice therapists with all aspects of schema therapy. The treatment of a client with a Borderline Personality Disorder is shown in 91 scenes. All steps of the schema therapy