Free Schema Therapy Toolkit: Case Conceptualization, Mode Maps, Flashcards, and Session Guides

Eight editable schema therapy templates, each with a completed example, free for clinicians, trainees, supervisors and faculty.

Prepared by Tony Rousmaniere, PsyD, and Alexandre Vaz, PhD, for Sentio's free therapist training.

Last updated: November 11, 2026

FreeEditableCompleted examples

Free Therapist Training›Schema Therapy Toolkit

1Case conceptualization form 2Mode map worksheet 3Schema flashcard 4Imagery rescripting guide 5Chair work guide 6Session note and goals 7Client handout 8Recording review and practice set

Schema therapy asks a clinician to keep several layers of a case in view at once: the core emotional needs that went unmet early in life, the early maladaptive schemas those experiences left behind, the coping styles and modes that take over in the present, and the techniques that change them. The templates below put each layer on paper. They follow the model as Jeffrey Young and his colleagues set it out, with eighteen schemas in five domains and three coping styles, and the mode approach that Arnoud Arntz and Gitta Jacob describe for everyday practice (Arntz & Jacob, 2011/2013; Young et al., 2003).

Randomized trials support the model for personality disorders. In borderline personality disorder, schema therapy outperformed transference-focused psychotherapy over three years (Giesen-Bloo et al., 2006), and combined individual and group schema therapy reduced severity more than usual care (Arntz et al., 2022); for several other personality disorders it led to more recovery than usual care at three years (Bamelis et al., 2014).

Every template is original and comes with a completed example for an invented client, a PDF and an editable Google Doc. The toolkit is written for schema therapists and trainees in any profession and country, and for the supervisors and faculty who teach them. Each template appears in full below, ready to copy.

The imagery rescripting and chair work guides are for clinicians trained in these interventions. Each sets out the structure of the intervention and the decisions the clinician makes along the way; neither is a script for a client to follow alone. The measures section explains what the Young Schema Questionnaire, the Schema Mode Inventory and the Maladaptive Schema Scale measure and how clinicians obtain each.

What Is in the Toolkit?

Template	Use it for	Where it fits in schema therapy
Schema Therapy Case Conceptualization Form	Bring the history, schema ratings, coping styles and modes together in one formulation, then turn it into a treatment plan.	Assessment and education phase, revised throughout
Mode Map Worksheet	Name a client's modes in the client's own words, trace a typical mode sequence, and log modes between sessions.	Assessment and education, then throughout therapy
Schema Flashcard Template	Write a short card with the client for one hard situation, to read when the schema is triggered between sessions.	Managing schema activation between sessions
Imagery Rescripting Session Guide for Clinicians	Prepare, run and record an imagery rescripting session, with the decision the clinician makes at each phase.	Experiential work in the change phase
Chair Work Session Guide for Clinicians	Choose the form of chair work for the active mode, run the session phase by phase, and record what changed.	Experiential techniques, change phase
Session Note With Treatment Goals	Set measurable goals for the modes and needs in the case conceptualization, and record each session against them.	Treatment planning and session records
Client Handout on Schemas and Modes	Explain needs, schemas, coping styles and modes to clients in plain language, with a mode diary for between sessions.	Assessment and education phase, and homework
Recording Review Form and Deliberate Practice Set	Rate observable schema therapy skills in a recorded segment, then rehearse the next skill with invented client statements.	Supervision and teaching

Schema Therapy Case Conceptualization Form

The case conceptualization form gathers a client's history, schemas, coping styles and modes into one working formulation and turns it into a treatment plan. Its eight parts run from the presenting problems to the plan, with the core emotional needs, ratings for the eighteen early maladaptive schemas, questionnaire results, coping styles, modes, the therapy relationship and the client's strengths in between, and the form is meant to be revised as therapy goes on. The guide to the case conceptualization form explains each part in more detail.

Download the PDF Make a copy in Google Docs

Template

Part 1. The client and the problem

Item	Entry
Client code, age range and gender
Referral source and reason
Presenting problems, in the client's words
Current life problems the schemas may explain (relationships, work, health, other)
Diagnoses and relevant medical issues
Risk: self-harm, harm to others, substance use, current crises, and the plan for each
Other treatment and medication

Part 2. Origins: core emotional needs

Core need	Met / Partly met / Unmet	Evidence from childhood and adolescence
Secure attachment to others: safety, stability, nurturance and acceptance
Autonomy, competence and a sense of identity
Freedom to express valid needs and emotions
Spontaneity and play
Realistic limits and self-control

Item	Entry
Temperament, as the client and others describe it
Caregivers and family climate (keep descriptions of harmful events brief and non-graphic)
Peers, school, culture and community

Part 3. Early maladaptive schemas

Rate each schema from the interview, the history, the therapy relationship and any questionnaire results: 0 not present, 1 mild, 2 moderate, 3 strong.

Domain	Schema	Rating 0 to 3	Evidence
Disconnection and Rejection	Abandonment/Instability
	Mistrust/Abuse
	Emotional Deprivation
	Defectiveness/Shame
	Social Isolation/Alienation
Impaired Autonomy and Performance	Dependence/Incompetence
	Vulnerability to Harm or Illness
	Enmeshment/Undeveloped Self
	Failure
Impaired Limits	Entitlement/Grandiosity
	Insufficient Self-Control/Self-Discipline
Other-Directedness	Subjugation
	Self-Sacrifice
	Approval-Seeking/Recognition-Seeking
Overvigilance and Inhibition	Negativity/Pessimism
	Emotional Inhibition
	Unrelenting Standards/Hypercriticalness
	Punitiveness

Questionnaire (from its official source)	Date	Results that bear on the formulation
Young Schema Questionnaire (version)
Schema Mode Inventory
Maladaptive Schema Scale or other measure
Symptom or outcome measure

Part 4. Coping styles

Coping style	How it shows up for this client
Surrender: acting as if the schema were true
Avoidance: steering clear of what triggers the schema
Overcompensation: acting as if the opposite were true

Part 5. Schema modes (map them in detail on the mode map worksheet)

Mode group	Modes present, in the client's own names	Typical triggers
Child modes
Critic modes (also called parent modes): Demanding, Punitive
Coping modes
Healthy Adult and Happy Child
Usual sequence when a schema is triggered

Part 6. The therapy relationship

Item	Entry
How the schemas and modes show up with the therapist
The therapist's own schemas or modes this client activates (for supervision)

Part 7. Strengths and resources

Item	Entry
Healthy Adult capacities, relationships, values and interests

Part 8. Treatment plan

Item	Entry
Goals, linked to the modes above (use the session note with treatment goals)
Therapy relationship: limited reparenting and empathic confrontation
Cognitive techniques
Experiential techniques: imagery rescripting, chair work
Behavioral pattern-breaking
Likely obstacles and how to respond
Date of next review

Identify the client by code. Revise the form as the therapy shows you more, and share a plain-language version with the client.

See a completed example

Part 1. The client and the problem

Item	Entry
Client code, age range and gender	L.; 35 to 39; woman
Referral source and reason	Self-referred for low mood and exhaustion after a year of fourteen-hour workdays.
Presenting problems, in the client's words	"I'm exhausted and flat all the time." "I can't say no at work." "Sam says I'm never really there."
Current life problems the schemas may explain (relationships, work, health, other)	Work: fourteen-hour days, rarely says no to colleagues, rewrites reports late at night. Relationship: Sam feels shut out, and she says "fine" and changes the subject when he asks how she feels. Health: exhaustion and low mood. Other: restless and low on weekends with nothing scheduled.
Diagnoses and relevant medical issues	No diagnosis recorded; low mood is tracked with a symptom measure (Part 3). No medical problems reported, and she has agreed to see her physician about the exhaustion.
Risk: self-harm, harm to others, substance use, current crises, and the plan for each	No thoughts of suicide or self-harm, no risk to others, no substance misuse and no current crisis. Plan: ask about mood and risk each session while her mood stays low.
Other treatment and medication	None; this is her first therapy.

Part 2. Origins: core emotional needs

Core need	Met / Partly met / Unmet	Evidence from childhood and adolescence
Secure attachment to others: safety, stability, nurturance and acceptance	Partly met	A safe home with no abuse reported, but little nurturance: her mother was often unwell and emotionally unavailable, and her father's approval depended on top marks.
Autonomy, competence and a sense of identity	Met	Capable and independent from an early age and successful at school; no schema in the Impaired Autonomy and Performance domain is present.
Freedom to express valid needs and emotions	Unmet	When she cried, she was told to stop being dramatic, and her needs came after her mother's illness and her brother's care.
Spontaneity and play	Unmet	Schoolwork and looking after her brother filled the time other children spent playing, and anything less than top marks drew criticism.
Realistic limits and self-control	Met	Rules were clear and consistent, she developed good self-control, and no schema in the Impaired Limits domain is present.

Item	Entry
Temperament, as the client and others describe it	Describes herself as a sensitive, serious child; friends describe her as reliable and kind.
Caregivers and family climate (keep descriptions of harmful events brief and non-graphic)	Her father praised her grades and criticized anything less than top marks. Her mother was often unwell and emotionally unavailable. From about age eight Lena looked after her younger brother, and when she cried she was told to stop being dramatic. No abuse reported.
Peers, school, culture and community	Top of her class, with a few close friends; caring for her brother left little time for clubs or play after school. Her family prized achievement and not making a fuss.

Part 3. Early maladaptive schemas

Rate each schema from the interview, the history, the therapy relationship and any questionnaire results: 0 not present, 1 mild, 2 moderate, 3 strong.

Domain	Schema	Rating 0 to 3	Evidence
Disconnection and Rejection	Abandonment/Instability	0	No fear that Sam or her friends will leave her.
	Mistrust/Abuse	0	Trusts others; no abuse reported.
	Emotional Deprivation	3	Expects no one to notice or meet her need for comfort, and tells Sam she is "fine." Her mother was emotionally unavailable, and her crying was dismissed as dramatic.
	Defectiveness/Shame	1	A mild sense of being flawed as a person, which surfaces after mistakes and fades with friends who know her well.
	Social Isolation/Alienation	0	Feels she belongs with her close friends.
Impaired Autonomy and Performance	Dependence/Incompetence	0	Manages daily life with ease, and others depend on her.
	Vulnerability to Harm or Illness	0	No fear of illness or catastrophe, despite her mother's poor health.
	Enmeshment/Undeveloped Self	0	A clear sense of her own views and tastes, separate from her family's.
	Failure	0	Successful at work and sees herself as able; the self-attack after mistakes is rated under Punitiveness.
Impaired Limits	Entitlement/Grandiosity	0	Puts others' needs first and claims no special rights.
	Insufficient Self-Control/Self-Discipline	0	Highly disciplined, if anything overcontrolled.
Other-Directedness	Subjugation	0	Agrees to requests out of duty and care; she does not fear others' anger.
	Self-Sacrifice	2	Takes on colleagues' work and rarely says no; looked after her younger brother from about age eight.
	Approval-Seeking/Recognition-Seeking	0	Driven by her own standards more than by praise.
Overvigilance and Inhibition	Negativity/Pessimism	0	Low mood, but no general expectation that things will go wrong.
	Emotional Inhibition	2	Keeps her sadness and needs to herself and changes the subject; was told to stop being dramatic when she cried.
	Unrelenting Standards/Hypercriticalness	3	Fourteen-hour days and reports rewritten late at night, and nothing she does feels good enough; her father criticized anything below top marks.
	Punitiveness	2	Calls herself "useless" after small mistakes and feels she deserves to feel bad; she is gentler with other people's mistakes.

Questionnaire (from its official source)	Date	Results that bear on the formulation
Young Schema Questionnaire (version)	Session 2	YSQ-S3: Unrelenting Standards and Emotional Deprivation highest, followed by Self-Sacrifice, Emotional Inhibition and Punitiveness; consistent with the interview.
Schema Mode Inventory	Session 3	Detached Protector, Demanding Parent and Punitive Parent highest; Happy Child lowest.
Maladaptive Schema Scale or other measure	Not given	Not needed, since the YSQ-S3 covered the schemas.
Symptom or outcome measure	Session 1	Depression symptom measure: low mood and fatigue at intake; repeated at each review.

Part 4. Coping styles

Coping style	How it shows up for this client
Surrender: acting as if the schema were true	Accepts every request at work and takes harsh criticism, her own included, as deserved.
Avoidance: steering clear of what triggers the schema	Works late and scrolls her phone to keep feelings away; says "fine" and changes the subject when Sam asks how she feels.
Overcompensation: acting as if the opposite were true	Rare: occasional rigid control over plans she shares with Sam.

Part 5. Schema modes (map them in detail on the mode map worksheet)

Mode group	Modes present, in the client's own names	Typical triggers
Child modes	Vulnerable Child ("little Lena"): lonely and unseen.	Sam asking for closeness; weekends with nothing scheduled; sadness in session.
Critic modes (also called parent modes): Demanding, Punitive	Demanding Critic ("the coach"): nothing is ever enough. Punitive Critic ("the judge"): after mistakes, says she is useless and deserves to feel bad.	Deadlines, reports and empty weekends ("the coach"); small mistakes and critical feedback at work ("the judge").
Coping modes	Detached Protector, with Detached Self-Soother features ("autopilot"): numb and "fine," and kept busy by late work and her phone. Compliant Surrenderer ("yes-Lena"): agrees to every request.	Sam asking for closeness and sadness in session ("autopilot"); requests for help at work ("yes-Lena").
Healthy Adult and Happy Child	Healthy Adult: competent and kind at work and with friends, and growing in therapy. Happy Child: rare, when hiking or singing in the car.	Time with friends and calm stretches at work (Healthy Adult); hikes and music (Happy Child).
Usual sequence when a schema is triggered	"The judge" attacks, "little Lena" feels ashamed and alone, and "autopilot" takes over: she works late, scrolls her phone and tells Sam she is "fine." After a request, "yes-Lena" agrees and "the coach" keeps her rewriting the work late at night.	A small mistake or critical feedback at work; a colleague asking for help.

Part 6. The therapy relationship

Item	Entry
How the schemas and modes show up with the therapist	Apologizes often and works hard at being a "good client" ("yes-Lena"); goes on "autopilot" when sadness comes up, saying she is fine and turning to practical topics.
The therapist's own schemas or modes this client activates (for supervision)	The therapist's own Self-Sacrifice pulls toward reassuring Lena quickly when she apologizes and praising her as a good client, which feeds "yes-Lena"; taken to supervision.

Part 7. Strengths and resources

Item	Entry
Healthy Adult capacities, relationships, values and interests	Competent, reliable and kind; close friends and a partner who wants to be closer; values loyalty and fairness; enjoys hiking and singing in the car; sought therapy on her own initiative.

Part 8. Treatment plan

Item	Entry
Goals, linked to the modes above (use the session note with treatment goals)	1. "Stop the judge running my life" (Punitive Critic). 2. "Let Sam in" (Detached Protector; Vulnerable Child). 3. "Leave work at a normal time" (Demanding Critic; Compliant Surrenderer).
Therapy relationship: limited reparenting and empathic confrontation	Limited reparenting: warmth and steady attention to the loneliness of "little Lena," with the message that she does not have to earn care. Empathic confrontation: acknowledge that "autopilot" and "yes-Lena" got her through childhood, and name what they cost her now.
Cognitive techniques	Education about needs, schemas and modes in her own names; weighing the costs of the standards set by "the coach"; a flashcard to read after mistakes at work.
Experiential techniques: imagery rescripting, chair work	Imagery rescripting of a memory of being told to stop being dramatic, with the therapist rescripting in the early sessions; chair work to limit "the judge" and give "little Lena" a voice.
Behavioral pattern-breaking	Leave work by 6 p.m. two days a week, then more; say no to one request a week; tell Sam one feeling on three evenings a week in place of "fine."
Likely obstacles and how to respond	She may agree to homework as "yes-Lena" and then do it perfectly, and "autopilot" may flatten sad moments. Name the mode gently when it appears, ask what she wants, and slow down when sadness comes.
Date of next review	Session 12, with the symptom measure repeated; the SMI again at session 20.

Mode Map Worksheet

The mode map worksheet puts a client's schema modes on one page, named in the client's own words, and adds a typical mode sequence and a log for between sessions. Its rows follow the mode groups: child modes such as the Vulnerable Child; critic modes, the Demanding Critic and the Punitive Critic (also called the Demanding Parent and the Punitive Parent); coping modes such as the Compliant Surrenderer and the Detached Protector; the Healthy Adult; and the Happy Child. The schema modes list and mode map page describes fifteen common modes in plain language.

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Template

Part 1. My mode map (use the client's own names for each mode)

Mode group	The mode, in the client's words	When it shows up	What it says or does	What it needs, or how the Healthy Adult responds
Child modes
Critic modes
Coping modes
Healthy Adult
Happy Child

Part 2. A typical mode sequence

Step	Entry
Trigger: what happened
First mode to show up, and what it felt like
The mode that followed, and what it did
What happened next, and the cost
What the Vulnerable Child needed
What the Healthy Adult could do next time

Part 3. Mode log, between sessions

Date	What happened	Mode	What I felt, thought and did	What I needed	What my Healthy Adult can do

See a completed example

Part 1. My mode map (use the client's own names for each mode)

Mode group	The mode, in the client's words	When it shows up	What it says or does	What it needs, or how the Healthy Adult responds
Child modes	"little Lena" (Vulnerable Child)	When Sam asks for closeness, on weekends with nothing planned, and briefly in session before autopilot takes over	She feels lonely and unseen, and believes no one would notice her unless she is useful. She hides it, even from Sam.	To be noticed and comforted, and to hear that her feelings are not "dramatic." The therapist offers this first, and her Healthy Adult learns to offer it too.
Critic modes	"the coach" (Demanding Critic) and "the judge" (Punitive Critic)	The coach: deadlines, reports, any free evening. The judge: mistakes and critical feedback at work.	The coach: "It's not good enough yet. Check it again." The judge: "You're useless, and you deserve to feel bad."	The Healthy Adult answers the coach with realistic standards ("This is good enough to send") and stops the judge firmly ("Mistakes don't make me useless"). The therapist models both in chair work first.
Coping modes	"autopilot" (Detached Protector, with Detached Self-Soother features) and "yes-Lena" (Compliant Surrenderer)	Autopilot: when sadness comes up, when Sam asks how she feels, after the judge has spoken. Yes-Lena: whenever someone asks for help, and with her manager.	Autopilot says "I'm fine": she goes numb and busy, works late, scrolls her phone and changes the subject. Yes-Lena agrees to every request, apologizes often, accepts harsh criticism as deserved and tries to be a "good client."	Thank autopilot for protecting a child who had to cope alone, and name its cost: exhaustion and a partner who feels shut out. Give yes-Lena a pause before every answer.
Healthy Adult	Healthy Adult (no name of her own yet)	At work when she solves problems calmly, with friends, and more often in sessions now	She is competent and kind: patient with colleagues, warm with friends, and starting to catch the judge in session.	Practice in offering herself the kindness she gives her friends, and in leaving work at a normal time.
Happy Child	Happy Child (rare)	Hiking, and singing in the car	She feels light, playful and absorbed, and forgets to check her phone.	Unscheduled time that the coach may not fill, such as a weekend hike with Sam.

Part 2. A typical mode sequence

Step	Entry
Trigger: what happened	On Thursday afternoon her manager pointed out an error in a client report and asked her to correct it.
First mode to show up, and what it felt like	"The judge": "You're useless." Her face went hot, her stomach knotted, and she felt ashamed.
The mode that followed, and what it did	"The coach," then "autopilot": she stayed until 11 p.m. rewriting the entire report and felt nothing.
What happened next, and the cost	She told Sam she was "fine" and went to bed. She slept badly, was exhausted the next day, and Sam said again that she is "never really there."
What the Vulnerable Child needed	To hear that one error does not make her useless, and to tell someone who would listen without criticizing her.
What the Healthy Adult could do next time	Name the judge ("That's the judge talking"), correct the error and nothing more, leave by 6 p.m., and tell Sam she had a hard day.

Part 3. Mode log, between sessions

Date	What happened	Mode	What I felt, thought and did	What I needed	What my Healthy Adult can do
Monday	A colleague asked me to take over her audit file.	"yes-Lena"	Felt a jolt of panic, thought "I can't let her down," and said yes at once.	Time to check my own workload first.	Say "Let me look at my week and get back to you by noon."
Wednesday	Sam asked how I was really doing.	"autopilot"	Said "fine," went numb and picked up my phone.	To let him in.	Put the phone down and tell him one true thing: I'm tired and sad.
Saturday	Nothing was planned all afternoon.	"the coach," then "little Lena"	Thought "I should be catching up on work," felt restless and lonely, and opened my laptop.	Rest, and some company.	Close the laptop and ask Sam to go for a hike.

Schema Flashcard Template

A schema flashcard gives the client a short written answer to one hard situation, to read when a schema is triggered between sessions. Fill it in with the client, in the client's own words: the trigger, the feeling and the urge, the schema and mode behind them, what is true now, what the client needs, what the client will do instead, and a line from the Healthy Adult. The schema flashcard guide explains each part in more detail.

Download the PDF Make a copy in Google Docs

Template

Part	Write it in the client's own words
1. When this happens
2. I feel, and I want to
3. That is my schema (and mode) talking. It started when
4. What is true now
5. What I need right now
6. What I will do instead
7. My Healthy Adult says

Write the card together in session, keep it short enough to read in a minute, and keep it where the client will see it, such as a phone or a wallet. Read it when the trigger happens, and revise it when it stops fitting.

See a completed example

Lena's first card: a mistake at work

Part	Write it in the client's own words
1. When this happens	I find a mistake in my work, or someone at work points one out.
2. I feel, and I want to	I feel ashamed and panicky. I want to call myself "useless" and stay late redoing the whole report.
3. That is my schema (and mode) talking. It started when	"The judge," my Punitive Critic, with my Punitiveness and Unrelenting Standards/Hypercriticalness schemas. It started when Dad criticized anything less than top marks.
4. What is true now	Everyone makes mistakes, and this one can be fixed in the morning. I'm good at my job, and one error doesn't change that.
5. What I need right now	Kindness and rest. "Little Lena" needs to hear that she is still OK.
6. What I will do instead	Write the fix on a note for tomorrow, leave at 6 p.m. and have dinner with Sam.
7. My Healthy Adult says	"The judge" doesn't get to run your life. You made a mistake and you're fixing it, like any good accountant would. You don't deserve to feel bad. Go home.

Lena's second card: when Sam asks how she feels

Part	Write it in the client's own words
1. When this happens	Sam asks how I feel, or says he wants to talk.
2. I feel, and I want to	I go blank and tense, as if a wall comes down. I want to say "fine," change the subject and pick up my phone.
3. That is my schema (and mode) talking. It started when	"Autopilot," my Detached Protector, with my Emotional Inhibition and Emotional Deprivation schemas. It started when I cried and was told to stop being dramatic, and Mom was too unwell to notice how I felt.
4. What is true now	"Autopilot" got me through childhood, but now it shuts Sam out. He asks because he cares about me.
5. What I need right now	"Little Lena" is lonely and wants to be seen. I need a moment to notice what I feel before I answer.
6. What I will do instead	Put my phone face down, take one slow breath and tell Sam one true feeling, even if it's only "tired" or "a bit sad."
7. My Healthy Adult says	Your feelings matter, and you don't have to be "fine." Sam is safe. Let him in, one honest sentence at a time.

Imagery Rescripting Session Guide for Clinicians

This guide sets out an imagery rescripting session in three parts: the checks to make before it, the eight phases of the session with the decision the clinician makes at each, and a record of what changed in the image and in the client's distress. It follows the updated protocol described by Arntz (2025): the therapist rescripts in early sessions and the client's adult self in later ones, and rescripting begins once the most difficult moment has been reached and felt. The imagery rescripting page explains each part in more detail.

Download the PDF Make a copy in Google Docs

Template

Before the session

Check	Notes
The client understands the rationale and agrees to the exercise
Dissociation assessed, and a response agreed in advance (grounding objects, slow breathing, whether a light touch is acceptable)
Current risk reviewed, with a plan in place
Enough session time left for the exercise, the closing and the debrief

Structure of the session

Phase	What the clinician does	Decision point
1. Rationale and consent	Explains in a sentence or two why the exercise links a current feeling to a memory and changes what the memory means.	If the client declines, revisit the rationale or choose another intervention.
2. Starting point	Asks for a recent situation that carried the feeling, in the present tense: what the client sees, feels and senses in the body.	When a known memory is already the focus, start with the memory itself.
3. Bridge to the memory	Asks the client to let the current scene go, keep the feeling, and notice any image from childhood that comes.	Accept the painful image that arrives; the search is free and associative. If a positive memory comes up, ask the client to let it go and wait for another.
4. Childhood image	Has the client describe the scene in the present tense from the child's position: who is there, what happens, what the child feels and needs.	Keep it brief and non-graphic. Begin rescripting once the most difficult moment has been reached and felt; if the client dissociates severely, step in earlier.
5. Rescripting	A helper enters the image, stops what is happening and meets the child's need. When a caregiver is confronted, the helper names the child's loyalty to that caregiver and how confusing the moment is.	The therapist rescripts in early sessions and hands over to the client's Healthy Adult in later ones, as it grows stronger; the therapist steps in powerfully whenever the child cannot be protected any other way.
6. The child's experience	Asks what the child feels now and what else the child needs, and continues until the child feels fine and no need is left unmet.	Finish with a positive experience or activity, and suggest one if the child does not.
7. Closing	Brings the client back to the room and grounds attention in the present.	Do not end the session while the client is still in strong distress.
8. Debrief and homework	Links what happened to the client's schemas and modes and agrees what the client will do before the next session.	If the client feels guilty about confronting a caregiver in the image, discuss it now.

Session record

Field	Entry
Date and session number
Starting point: current situation or feeling
Childhood image (one or two lines, non-graphic)
The child's needs, as identified
Who rescripted, and what changed in the image
The child's response
Distress before and after, 0 to 10
Debrief: links to schemas and modes
Homework and follow-up

See a completed example

The record comes from an early session with Lena, the invented client used throughout the toolkit, so the therapist does the rescripting. Before the session, the therapist confirmed that Lena understood the rationale and agreed to the exercise, that the plan for "autopilot" was in place (a cushion to hold, slow breathing, no touch), that there was no current risk, and that 35 minutes remained for the exercise, the closing and the debrief.

Session record

Field	Entry
Date and session number	Week 8, session 8; Lena's first imagery rescripting session
Starting point: current situation or feeling	At Monday's team meeting, her manager pointed out an error in a report. Lena felt hot with shame, her throat tightened, and "the judge" called her useless.
Childhood image (one or two lines, non-graphic)	At about eight, "little Lena" cried after a mistake in a school recital, and her father told her to stop being dramatic and sent her to her room alone. The most difficult moment: his words, and being sent away.
The child's needs, as identified	Comfort and company while she cried, and to hear that mistakes are allowed and her feelings matter. Core needs: secure attachment, and freedom to express valid needs and emotions.
Who rescripted, and what changed in the image	The therapist, as planned for early sessions, while Lena stayed in the child's perspective. Once the most difficult moment had been reached and felt, the therapist entered the scene, told her father firmly that crying is normal and that Lena needs comfort, said to "little Lena" that she loves her dad and that this can feel confusing, took "little Lena" to a quiet park she likes, comforted her, and told her that mistakes are allowed and her feelings matter.
The child's response	At first she said she was "being silly." As the therapist stayed with her, she cried, then leaned in and said she felt warm. Asked what else she needed, she wanted to know that the therapist would still like her after another mistake; once told so, she said she felt fine and chose to end by singing her favorite song with the therapist.
Distress before and after, 0 to 10	8 before rescripting, at the most difficult moment; 2 at the end of the rescripting.
Debrief: links to schemas and modes	Lena heard her father's tone in "the judge" and saw "autopilot" as how she learned to stop crying (Emotional Inhibition, Emotional Deprivation, Punitiveness). She felt guilty about the confrontation; the therapist explained that the image stands up for what "little Lena" needed and leaves room for Lena's love for her father.
Homework and follow-up	When "the judge" speaks after a mistake, Lena will pause and tell "little Lena" what the therapist said. Next session: ask about the effects of this rescripting and write a flashcard with its message.

Chair Work Session Guide for Clinicians

The chair work session guide helps a clinician choose the form of chair work that fits the active mode, run the session in seven phases with a decision point in each, and record what each mode said and what changed, for the case file and for supervision. The chair work in schema therapy page explains each part in more detail.

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Choosing the form of chair work

Form	Use it when	The aim
Critic dialogue	A Demanding or Punitive critic mode is active.	Punitive Critic: firm limits, and send it away. Demanding Critic: question its standards and agree on realistic ones. The therapist confronts first, then the client's Healthy Adult.
Giving the Vulnerable Child a voice	The child mode's feelings are blocked or unspoken.	The client speaks as the child, and the therapist or Healthy Adult responds with care.
Empathic confrontation of a coping mode	A coping mode such as the Detached Protector keeps the client from the work.	Interview the coping mode, acknowledge what it protects against, and ask it to step back.
Mode dialogue	Two modes pull in opposite directions in a decision.	Each mode states its case from its own chair; the Healthy Adult decides.
Empty-chair dialogue with a caregiver	A memory of a caregiver keeps the schema alive.	The client tells the imagined caregiver in the empty chair what the child needed, with the therapist's support.

Structure of the session

Phase	What the clinician does	Decision point
1. Notice and name the mode	Points out the mode in the moment and agrees a name for it with the client.	If the client does not recognize the mode, return to the mode map first.
2. Rationale and setup	Explains briefly why the mode gets its own chair, and places the chairs.	Use cushions or a second screen position in online sessions.
3. Give the mode a voice	Has the client sit in the mode's chair and speak as the mode, in the first person.	Keep the critic's turn short. If the client cannot stay in the mode, the therapist can voice it from the client's words.
4. Respond from the other chair	Has the client move to the Healthy Adult or child chair and respond, with coaching.	If the Healthy Adult is weak, the therapist confronts the critic first and the client watches.
5. Limit the critic	Sets firm limits on a punitive critic rather than debating it, and can move its chair out of the room; with a demanding critic, questions its standards and agrees on realistic ones with the client.	Continue until the critic loses force and the client's distress falls.
6. Care for the child	Turns to the Vulnerable Child's chair and responds to what the child feels and needs.	End with the child cared for, never with the critic.
7. Debrief	Asks what the client noticed in each chair, allows time for the feelings the exercise raised, and links it to the case conceptualization.	Keep early chair work short and the client's arousal tolerable.

Session record

Field	Entry
Date and session number
Form of chair work and the modes involved
What each mode said (brief)
The therapist's role: modeled, coached or observed
Change observed: distress before and after, 0 to 10, and what shifted
Debrief and links to the case conceptualization
Homework and follow-up

See a completed example

Session record

Field	Entry
Date and session number	Session 14, early in the change phase. Lena's first critic dialogue, about 20 minutes of a 50-minute session.
Form of chair work and the modes involved	Critic dialogue, chosen because the judge was active from the start: Lena came in calling herself useless over an error in a quarterly report. Three chairs: the Punitive Critic ("the judge"), the Healthy Adult and the Vulnerable Child ("little Lena").
What each mode said (brief)	The judge: "Useless. One mistake and everyone can see what you really are. You deserve to feel this bad." Healthy Adult, the therapist: "Stop. You don't get to call Lena useless. She made one mistake in a long report, and she fixed it." Healthy Adult, Lena: "I made a mistake and I fixed it. I'm not useless, and I'm done listening to you." Little Lena: "I feel small and stupid. I want someone to tell me I'm still OK."
The therapist's role: modeled, coached or observed	Modeled, then coached. The therapist confronted the judge from the Healthy Adult chair while Lena watched, then coached Lena once she took the same chair, offering words and asking for a firmer voice, until she set the limit herself and moved the judge's chair to the corner. When Lena moved to little Lena's chair, the therapist spoke to the child warmly and told her she was still cared for after a mistake.
Change observed: distress before and after, 0 to 10, and what shifted	Distress 8 before the dialogue, 4 after. Lena's voice was quiet on her first try in the Healthy Adult chair and firm by the third. With the judge's chair in the corner, she said it "sounds smaller from over there." In little Lena's chair she cried briefly and stayed with the feeling without going on autopilot.
Debrief and links to the case conceptualization	Lena said the judge sounds like her father when her grades fell short of top marks. Links: Punitiveness and Unrelenting Standards/Hypercriticalness, and her goal "Stop the judge running my life." She felt drained, so the last ten minutes went to the debrief and to settling before she left.
Homework and follow-up	When the judge starts after a mistake at work, Lena will name it, read the Healthy Adult flashcard she and the therapist wrote during the debrief, and do one kind thing for little Lena, such as a short walk. She will note each time in her mode log. Next session: review the log and repeat the dialogue, with Lena in the Healthy Adult chair from the start.

Session Note With Treatment Goals

The session note with treatment goals turns the case conceptualization into goals that can be measured and ties every session back to them. Part 1 sets a goal for each area of the plan, from the Healthy Adult and the Vulnerable Child's needs to symptoms and functioning, with an objective, a measure and a target date; Part 2 records the phase of therapy, the schemas and modes in the session, the interventions, the client's response and progress on each goal. The schema therapy treatment goals page explains each part in more detail.

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Part 1. Treatment goals

Goal area	Goal	Measurable objective	Measure	Target date	Progress
Healthy Adult
Vulnerable Child's needs
Critic modes
Coping modes
Behavioral pattern-breaking
Symptoms and functioning

Part 2. Session note

Field	Entry
Client code, date, session number
Phase of therapy	Assessment and education / Change
Format	Individual / Group / Couple; In person / Video
Since the last session
Risk and safety	Issues raised, actions agreed, follow-up date
Schemas activated
Modes observed in session, and shifts between them
Therapy relationship	Limited reparenting; empathic confrontation; repairs
Interventions	Cognitive / Imagery rescripting / Chair work / Behavioral pattern-breaking / Other:
Client's response
Homework reviewed and assigned
Goals addressed (goal numbers) and progress
Measures given, with scores
Plan for the next session
Clinician signature and date

Identify the client by code or initials, and record what was done and what changed, as you would in any clinical record.

See a completed example

Part 1. Treatment goals

Goal area	Goal	Measurable objective	Measure	Target date	Progress
Healthy Adult	1. Notice "the coach," "the judge" and "autopilot" as they start, and answer them with the kindness she shows her friends	Names the mode and writes a Healthy Adult reply in at least 3 of 4 weekly mode log entries	Mode log, reviewed each session; Healthy Adult scale of the Schema Mode Inventory (SMI) at assessment (session 3) and at sessions 20 and 40	Session 30 review	Session 14: 2 of 4 entries this week
Vulnerable Child's needs	2. "Let Sam in": let "little Lena" be seen and comforted, in therapy and at home	Tells Sam one feeling, without saying "fine," on at least 3 evenings a week	Weekly count in the mode log; her 0 to 10 rating of feeling close to Sam	Session 30 review	Session 14: 2 evenings this week (none at intake); closeness 5 (2 at intake)
Critic modes	3. "Stop the judge running my life": limit the Punitive Critic and bring the Demanding Critic's standards down to realistic ones	Belief in "I'm useless" after a mistake falls from 9 to 4 or lower (0 to 10)	Belief rating in the log and in session; SMI Punitive Parent and Demanding Parent scales	Session 30 review	Session 14: 6 after a report error this week (9 at intake)
Coping modes	4. Loosen "autopilot" and "yes-Lena" so her feelings and needs can come through	Stays with sadness for 10 minutes in session without going on "autopilot"; declines 1 request a week that is not her job	Clinician's estimate of minutes; weekly count of requests declined; SMI Detached Protector and Compliant Surrender scales	Session 30 review	Session 14: about 5 minutes (under 1 at intake); 1 request declined this week
Behavioral pattern-breaking	5. "Leave work at a normal time"	Leaves by 6 p.m. on at least 4 of 5 workdays, 4 weeks in a row	Weekly count from her work calendar	Session 24 review	Session 14: 3 of 5 days this week (none at intake)
Symptoms and functioning	6. Less low mood and exhaustion, and time again for hiking and singing in the car	Mood score lower than at intake at each review; a hike or another plan she enjoys on 3 weekends a month	The clinic's standard symptom measure at intake and every 12 sessions; weekend plans counted in the log	Session 36 review	Session 12: mood score lower than at intake; 1 hike in the past month

Part 2. Session note

Field	Entry
Client code, date, session number	L.; therapy week 16; session 14
Phase of therapy	Change
Format	Individual; in person
Since the last session	A colleague found an error in her quarterly report on Monday; "the judge" called her useless, and she stayed until 11 p.m. redoing it. Left by 6 p.m. on 3 of 5 days. Told Sam she felt "flat" on 2 evenings.
Risk and safety	Asked directly: no thoughts of self-harm or suicide; no other risks raised. No actions needed; routine check at the next session.
Schemas activated	Unrelenting Standards/Hypercriticalness and Punitiveness, set off by the report error; Emotional Deprivation, working alone late that night
Modes observed in session, and shifts between them	Opened in "yes-Lena," apologizing for being two minutes late. As she described the error, "the judge" took over, and when sadness came up she went on "autopilot" (flat voice, talk of deadlines). After the chair work, "little Lena" came through briefly, tearful and lonely. Healthy Adult while planning the week.
Therapy relationship	Limited reparenting: said the error did not change how the therapist sees her, and stayed with her sadness. Empathic confrontation: named that "autopilot" helped her cope as a child and now keeps Sam out. Repair: she apologized for crying, and the therapist said her tears were welcome.
Interventions	Chair work, critic dialogue: the therapist confronted "the judge" while she watched, then she answered it from the Healthy Adult chair with coaching, and the work ended with care for "little Lena." Behavioral pattern-breaking: reviewed leaving work on time and planned the week.
Client's response	Hesitant at first; with coaching, told "the judge" to stop and to leave "little Lena" alone, and said it sounded smaller from the other chair. Tired but calm at the close.
Homework reviewed and assigned	Reviewed: mode log (2 of 4 entries with a Healthy Adult reply) and leaving by 6 p.m. (3 of 5 days). Assigned: read her flashcard when "the judge" starts after a mistake; leave by 6 p.m. on 4 days; tell Sam one feeling on 3 evenings.
Goals addressed (goal numbers) and progress	Goals 1 to 5. Goal 3: belief after a mistake 6 this week, 9 at intake. Goal 4: stayed with sadness for about 5 minutes. Goal 5: 3 of 5 days, up from none. Goals 1 and 2: early gains, as recorded in Part 1.
Measures given, with scores	In session: distress 8 before the chair work and 4 after; belief in "I'm useless" 7 before and 4 after (0 to 10). From the log: belief 6 after the report error, closeness to Sam 5. SMI due at session 20.
Plan for the next session	Review the log and her use of the flashcard. If "the judge" is active, repeat the critic dialogue with her Healthy Adult leading; if not, a second imagery rescripting session with "little Lena," the therapist rescripting, once she agrees.
Clinician signature and date	J.K., trainee clinician, signed the day of the session; co-signed by M.S., supervisor

Client Handout on Schemas and Modes

The client handout explains schema therapy in plain language: what a schema is, the core emotional needs of childhood, eighteen common schemas, three ways people cope when a schema is set off, and the modes that take over. It ends with a mode diary for between sessions, and it works best when the clinician goes through it with the client one section at a time, writing in the client's own names for the modes. The schema therapy worksheets page explains each part in more detail.

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What is a schema?

A schema is a pattern of feelings, beliefs, memories and body reactions that starts early in life, often when an important need was not met. It can be set off years later by something that resembles the old situation, and then it feels as if the old situation were happening again.

What everyone needs as a child

Safety, stability, warmth and acceptance from the people closest to us.
The chance to become capable and to know who we are.
Freedom to say what we need and feel.
Time for fun and play.
Fair limits that teach self-control.

Eighteen common schemas, in plain words

Schema	What it can feel like
Abandonment/Instability	People I need will leave me or will not be there.
Mistrust/Abuse	Others will hurt, use or trick me.
Emotional Deprivation	No one will really understand me or care for me.
Defectiveness/Shame	Something is wrong with me, and if people knew, they would reject me.
Social Isolation/Alienation	I am different and do not belong.
Dependence/Incompetence	I cannot manage everyday life without help.
Vulnerability to Harm or Illness	Disaster could strike at any moment.
Enmeshment/Undeveloped Self	I do not know who I am apart from someone close to me.
Failure	I will fail, and I am less capable than others.
Entitlement/Grandiosity	Rules are for other people, and I should get what I want.
Insufficient Self-Control/Self-Discipline	I cannot stand discomfort or stick with hard things.
Subjugation	I have to give in to others or something bad will happen.
Self-Sacrifice	Other people's needs come before mine.
Approval-Seeking/Recognition-Seeking	My worth depends on what others think of me.
Negativity/Pessimism	Things will go wrong, so I should expect the worst.
Emotional Inhibition	Showing feelings is dangerous or embarrassing.
Unrelenting Standards/Hypercriticalness	I must do everything perfectly, and it is never enough.
Punitiveness	Mistakes deserve punishment, mine and other people's.

Three ways people cope when a schema is set off

Giving in: acting as if the schema were true, such as staying with someone who treats you badly.
Escaping: avoiding anything that might set the schema off, such as never asking for help.
Fighting back: acting as if the opposite were true, such as becoming controlling to avoid feeling powerless.

Modes: the parts of you that take over

Mode	What it is like
Vulnerable Child	The part that feels lonely, scared, sad or ashamed.
Angry Child	The part that feels furious when needs are not met.
Impulsive or Undisciplined Child	The part that wants what it wants now, or gives up when things get hard.
Critic modes	The inner voice that pushes you too hard or punishes you.
Coping modes	The parts that shut feelings down, give in or fight back, to protect you from pain.
Healthy Adult	The part that can care for you, set limits and make good choices.
Happy Child	The part that feels safe, loved, curious and playful.

My mode diary

Date	What happened	Which part showed up	What I felt	What I needed	What my Healthy Adult can do

This handout is for use alongside therapy, where you and your therapist can work out which schemas and modes fit you. If you are in crisis, call your local emergency number. In the United States, call or text 988.

See a completed example

Date	What happened	Which part showed up	What I felt	What I needed	What my Healthy Adult can do
Monday	My manager found a wrong figure in a report I sent to a client.	"The judge": I'm useless and I deserve to feel bad. Then "the coach" kept me checking every page until ten.	Ashamed and sick to my stomach, then exhausted.	To hear that one mistake doesn't make me useless.	Fix the figure, remind myself that everyone makes mistakes, and go home at six.
Wednesday	A colleague asked me to cover her client meeting on Friday, the day of my own deadline.	"Yes-Lena." I said yes before I'd even thought about it.	Resentful, then guilty for feeling resentful. Very tired.	Permission to say no, and time for my own work.	Say, "Let me check my week and get back to you," and then decide.
Friday	After dinner, Sam asked how I was really doing.	"Autopilot." I said "fine" and picked up my phone.	A lump in my throat for a second, then nothing.	"Little Lena" needed Sam to see how sad and lonely she feels.	Put the phone down and tell Sam one true thing, even if it's only "I'm sad and I don't know why."
Sunday	I had nothing planned, and Sam was out with friends all day. The house felt very quiet.	"The coach" said I should use the time to get ahead on work, so I opened my laptop.	Restless and guilty, and lonely underneath.	Rest, some fun and some company.	Close the laptop, text a friend about a hike, and sing in the car on the way.

Learn and Practice Schema Therapy

Sentio's free schema therapy videos show the skills behind these templates in practice. The webinar with Wendy T. Behary and Joan M. Farrell demonstrates deliberate practice of schema therapy's core interventions, and the APA book that the webinar accompanies contains the full set of exercises (Behary et al., 2023). Three short Practice Time episodes model the Healthy Adult mode, an early schema therapy session and work with the critic mode. The deliberate practice method pairs well with the templates: a recording review names the skill to rehearse, and the videos and book exercises supply the practice.

Free webinarDeliberate Practice in Schema TherapyWendy T. Behary and Joan M. Farrell in dialogue with Tony Rousmaniere and Alexandre Vaz, with guidance on running the exercises. APA bookDeliberate Practice in Schema TherapyThe book by Behary, Farrell, Vaz and Rousmaniere in The Essentials of Deliberate Practice series, with the full exercise set. Practice Time, episode 19Healthy Adult ModeA short free practice video on supporting and strengthening the Healthy Adult mode. Practice Time, episode 20Beginning Schema TherapyA short free practice video on beginning schema work in an early session. Practice Time, episode 21Schema Critic ModeA short free practice video on recognizing and confronting the critic mode. Free webinarCase Formulation and Treatment PlanningAlexandre Vaz's framework for building a case formulation and turning it into a treatment plan, in any model. Free trainingFree Therapist TrainingFree deliberate practice webinars, exercises and supervision resources, covering twelve therapy models. Graduate programSentio MFT ProgramSentio's master's program in marriage and family therapy, with schema therapy among the models it teaches.

For Supervisors and Faculty

Supervisors and faculty can use the recording review form to give feedback on observable schema therapy skills, and the practice statements to rehearse the skill the review identifies. The statements pair with Practice Time episodes 19 to 21, so a supervisee can watch a skill demonstrated and then practice it with a partner.

Recording Review Form and Deliberate Practice Set

The recording review form turns a short segment of a recorded session into specific feedback: which modes were active, which schema therapy skills appeared, and the one skill to rehearse next. Its second part is a set of invented client statements for rehearsing that skill, grouped by the Practice Time episode that demonstrates it. The skills overlap with the graded exercises in Deliberate Practice in Schema Therapy, which holds a full set for each (Behary et al., 2023). For formal competence ratings, the International Society of Schema Therapy lists a Schema Therapy Rating Scale among its certification forms (International Society of Schema Therapy, n.d.-b).

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Template

Part 1. Recording review form

Item	Entry
Supervisee, supervisor, date
Recording and time stamps reviewed (client's written consent on file)
Phase of therapy	Assessment and education / Change
Modes present in the segment

Rate what you saw: 1 not yet, 2 emerging, 3 consistent, NO not observed.

Observable skill	Rating	What you saw or heard (time stamp)
Attunement: tracks and reflects the client's feelings and needs
Recognizes the active mode and names it with the client
Links the moment to schemas and unmet needs in plain language
Limited reparenting: warmth, care and appropriate limits toward the child modes
Responds to the critic modes: limits the critic and supports the client
Empathic confrontation: validates a coping mode's purpose and names its cost
Structure of any imagery or chair work: rationale, steps, closing
Models and strengthens the Healthy Adult
Agrees behavioral pattern-breaking or homework

Item	Entry
Strongest moment in the segment
One skill to rehearse next
The therapist's own schemas or modes in the room (for discussion)
Rehearsal plan: statements, number of rounds, date to review

Part 2. Practice statements for rehearsal

One person reads a client statement and the therapist responds; the observer gives feedback on one skill, and the pair repeats the statement until the response feels natural. Move to the harder statements when the response comes easily.

Practice Time episode	Level	Client statement (invented)
Ep 19: Healthy Adult Mode	Easier	I handled the meeting fine this week. I don't know why I'm still so tired.
Ep 19: Healthy Adult Mode	Harder	Part of me knows I deserve a break, but the minute I sit down I feel lazy and I get back up.
Ep 19: Healthy Adult Mode	Hardest	You keep saying I can take care of myself. I don't believe that, and honestly it makes me angry when you say it.
Ep 20: Beginning Schema Therapy	Easier	I came here for my anxiety at work. I'm not sure what my childhood has to do with it.
Ep 20: Beginning Schema Therapy	Harder	My parents did their best. I don't want to sit here blaming them.
Ep 20: Beginning Schema Therapy	Hardest	I've read about schemas online, and I think I have all eighteen. Maybe I'm just broken.
Ep 21: Schema Critic Mode	Easier	I made a stupid mistake in the report. I should have caught it.
Ep 21: Schema Critic Mode	Harder	That voice is right, though. If I stop pushing myself, I'll turn into nothing.
Ep 21: Schema Critic Mode	Hardest	You're only being nice because it's your job. If you saw what I'm really like, you'd agree with the voice.

See a completed example

The example records a supervisor's review of ten minutes from a trainee's ninth session with Lena, the invented client used throughout the toolkit. Part 2 is used as written.

Item	Entry
Supervisee, supervisor, date	J.K., trainee; M.S., supervisor; supervision week 12
Recording and time stamps reviewed (client's written consent on file)	Session 9 with client L., 22:10 to 31:40; consent on file
Phase of therapy	Change
Modes present in the segment	Detached Protector ("autopilot"), Punitive Critic ("the judge"), a brief Vulnerable Child

Observable skill	Rating	What you saw or heard (time stamp)
Attunement: tracks and reflects the client's feelings and needs	3	23:05: "You sound tired of holding everything together." Client slows down and nods.
Recognizes the active mode and names it with the client	2	25:40: notices the shift to autopilot but calls it avoidance rather than using the client's name for the mode.
Links the moment to schemas and unmet needs in plain language	2	27:15: links the judge to her father's criticism; does not name the need for acceptance.
Limited reparenting: warmth, care and appropriate limits toward the child modes	2	Warm tone throughout; reassures quickly and moves on before the sadness is acknowledged.
Responds to the critic modes: limits the critic and supports the client	1	28:30: client says she deserves to feel bad; trainee asks for evidence instead of setting a limit on the judge.
Empathic confrontation: validates a coping mode's purpose and names its cost	3	26:00 to 27:00: validates that autopilot got her through childhood and names what it costs her with Sam.
Structure of any imagery or chair work: rationale, steps, closing	NO	No experiential work in this segment.
Models and strengthens the Healthy Adult	2	Asks what her Healthy Adult would say; offers no model when she cannot answer.
Agrees behavioral pattern-breaking or homework	3	Agrees she will leave work by 6 p.m. on two days this week.

Item	Entry
Strongest moment in the segment	The empathic confrontation of autopilot, 26:00 to 27:00.
One skill to rehearse next	Responding to the Punitive Critic: name it, set a firm limit, then turn to the child's feelings.
The therapist's own schemas or modes in the room (for discussion)	The trainee noticed her own unrelenting standards when the client described working late; discussed in supervision.
Rehearsal plan: statements, number of rounds, date to review	Episode 21 statements at the easier and harder levels, five rounds each; review with a new recording in two weeks.

For the rest of the supervision paperwork, the free clinical supervision toolkit has session notes, goal worksheets and evaluation forms. Sentio's clinical supervisor training teaches deliberate practice supervision in six- and twelve-month formats, licensed clinicians can join the deliberate practice consultation group, and the deliberate practice exercise library has free client prompts for other skills.

Schema Therapy Measures

Questionnaires give a case conceptualization a second line of evidence beside the interview, the history and the therapy relationship, and the case conceptualization form has space to record their results. The schema therapy measures guide describes each of the three below in more detail.

The Young Schema Questionnaire measures the eighteen early maladaptive schemas. Its current long form, the YSQ-L3, has 232 items and its short form, the YSQ-S3, has 90, each rated on a six-point scale (Lee et al., 2015; Saggino et al., 2018). Jeffrey Young holds the copyright, and the questionnaire may not be reproduced without his written consent. Clinicians buy it, with the other Schema Therapy Institute inventories, from the Schema Therapy Institute's online order center (Schema Therapy Institute, n.d.).

The Schema Mode Inventory (SMI) measures schema modes. Its 118-item short form covers fourteen modes, from the Vulnerable Child to the Healthy Adult, and was validated by Lobbestael et al. (2010). The Institute currently sells a version labeled SMI 1.1, in the same bundle and under the same terms.

The Maladaptive Schema Scale (MSS) is an open-source measure published in 2025. Its 108 items cover 27 schemas, versions of most traditional early maladaptive schemas, some renamed or split, and nine newer ones, each rated from 0 to 4. The full scale is in the article's supplementary material (Buchanan et al., 2025), and NovoPsych, where its developers work, describes it as free for clinical and research use (NovoPsych, n.d.).

Frequently Asked Questions

Are these ISST forms, and do they count toward certification?

No. They are original templates from Sentio, free to adapt. The International Society of Schema Therapy certifies schema therapists at Standard and Advanced levels, and its certification page explains how to apply (International Society of Schema Therapy, n.d.-a).

Can I use the Young Schema Questionnaire with these forms?

Yes, once you obtain it from the Schema Therapy Institute. Its copyright holder does not allow it to be reproduced without written consent, so the toolkit includes none of its items. The case conceptualization form has space to record its results, alongside the Schema Mode Inventory and the open-source Maladaptive Schema Scale.

Who are the imagery rescripting and chair work guides for?

Clinicians trained in these interventions, and trainees working under supervision. The guides set out the structure of each intervention and the decisions a clinician makes along the way. They are not exercises for a client to do alone, and a memory that is too distressing to approach belongs in therapy with a clinician.

Can I give the client handout to my clients?

Yes. The handout explains schemas, coping styles and modes in plain language and includes a mode diary for use between sessions. It works best when you go through it together in session and connect each part to the client's own patterns.

Can I change the templates?

Yes. Change anything to fit your setting, your record system and the way you work. Each template comes as an editable Google Doc and as a PDF.

Is there a cost?

No. Every template is free to read, copy and use with any client or supervisee.

References

Arntz, A. (2025). Imagery rescripting: An update of the treatment protocol. Behaviour Research and Therapy, 195, Article 104913. https://doi.org/10.1016/j.brat.2025.104913

Arntz, A., & Jacob, G. (2013). Schema therapy in practice: An introductory guide to the schema mode approach. Wiley-Blackwell. (Original work published 2011)

Arntz, A., Jacob, G. A., Lee, C. W., Brand-de Wilde, O. M., Fassbinder, E., Harper, R. P., Lavender, A., Lockwood, G., Malogiannis, I. A., Ruths, F. A., Schweiger, U., Shaw, I. A., Zarbock, G., & Farrell, J. M. (2022). Effectiveness of predominantly group schema therapy and combined individual and group schema therapy for borderline personality disorder: A randomized clinical trial. JAMA Psychiatry, 79(4), 287–299. https://doi.org/10.1001/jamapsychiatry.2022.0010

Bamelis, L. L. M., Evers, S. M. A. A., Spinhoven, P., & Arntz, A. (2014). Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders. American Journal of Psychiatry, 171(3), 305–322. https://doi.org/10.1176/appi.ajp.2013.12040518

Behary, W. T., Farrell, J. M., Vaz, A., & Rousmaniere, T. (2023). Deliberate practice in schema therapy. American Psychological Association. https://doi.org/10.1037/0000326-000

Buchanan, B., Bartholomew, E., Smyth, C., & Hegarty, D. (2025). The Maladaptive Schema Scale (MSS): Development and validation of a comprehensive questionnaire for beliefs related to psychopathology. Assessment. Advance online publication. https://doi.org/10.1177/10731911251390083

Giesen-Bloo, J., van Dyck, R., Spinhoven, P., van Tilburg, W., Dirksen, C., van Asselt, T., Kremers, I., Nadort, M., & Arntz, A. (2006). Outpatient psychotherapy for borderline personality disorder: Randomized trial of schema-focused therapy vs transference-focused psychotherapy. Archives of General Psychiatry, 63(6), 649–658. https://doi.org/10.1001/archpsyc.63.6.649

International Society of Schema Therapy. (n.d.-a). Certification. Retrieved November 9, 2026, from https://schematherapysociety.org/Certification

International Society of Schema Therapy. (n.d.-b). Certification forms. Retrieved November 9, 2026, from https://schematherapysociety.org/Certification-Forms

Lee, S. J., Choi, Y. H., Rim, H. D., Won, S. H., & Lee, D.-W. (2015). Reliability and validity of the Korean Young Schema Questionnaire-Short Form-3 in medical students. Psychiatry Investigation, 12(3), 295–304. https://doi.org/10.4306/pi.2015.12.3.295

Lobbestael, J., van Vreeswijk, M., Spinhoven, P., Schouten, E., & Arntz, A. (2010). Reliability and validity of the short Schema Mode Inventory (SMI). Behavioural and Cognitive Psychotherapy, 38(4), 437–458. https://doi.org/10.1017/S1352465810000226

NovoPsych. (n.d.). Maladaptive Schema Scale (MSS). Retrieved November 9, 2026, from https://novopsych.com/assessments/formulation/maladaptive-schema-scale-mss/

Saggino, A., Balsamo, M., Carlucci, L., Cavalletti, V., Sergi, M. R., da Fermo, G., Dèttore, D., Marsigli, N., Petruccelli, I., Pizzo, S., & Tommasi, M. (2018). Psychometric properties of the Italian version of the Young Schema Questionnaire L-3: Preliminary results. Frontiers in Psychology, 9, Article 312. https://doi.org/10.3389/fpsyg.2018.00312

Schema Therapy Institute. (n.d.). Schema inventories order page. Retrieved November 9, 2026, from https://www.schematherapy.org/

Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner's guide. Guilford Press.

About These Templates

Prepared by Tony Rousmaniere, PsyD, and Alexandre Vaz, PhD, for Sentio's free therapist training. Corrections and suggestions: mabundez@sentio.org.

Tony Rousmaniere, PsyD is the President of Sentio University and the Executive Director of the Sentio Counseling Center. He is Past-President of the psychotherapy division of the American Psychological Association and the author of many books on deliberate practice, including the series The Essentials of Deliberate Practice (APA Books). In 2017 he published the widely cited Atlantic article “What your therapist doesn’t know.” He is a licensed psychologist in California and Washington. Learn more

Alexandre Vaz, PhD is the Chief Academic Officer and Faculty Supervisor for Sentio University and provides advanced clinical training and supervision to clinicians around the world. He is the author or co-editor of many books on deliberate practice and psychotherapy training, including the series The Essentials of Deliberate Practice (APA Books). He is founder and host of Psychotherapy Expert Talks. He is a licensed clinical psychologist in Portugal. Learn more

Free Schema Therapy Toolkit: Case Conceptualization, Mode Maps, Flashcards, and Session Guides

Free Therapist Training›Schema Therapy Toolkit

What Is in the Toolkit?

Schema Therapy Case Conceptualization Form

Mode Map Worksheet

Schema Flashcard Template

Imagery Rescripting Session Guide for Clinicians

Chair Work Session Guide for Clinicians

Session Note With Treatment Goals

Client Handout on Schemas and Modes

Learn and Practice Schema Therapy

For Supervisors and Faculty

Recording Review Form and Deliberate Practice Set

Schema Therapy Measures

Frequently Asked Questions

Are these ISST forms, and do they count toward certification?

Can I use the Young Schema Questionnaire with these forms?

Who are the imagery rescripting and chair work guides for?

Can I give the client handout to my clients?

Can I change the templates?

Is there a cost?

References

About These Templates

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