When Schema Therapy was originally developed by Jeffery Young in the 1990s, its primary use was with clients who were living with borderline personality disorder. Over the past thirty years, research has begun to show that there are other personality disorders and mental health concerns that can benefit from the use of Schema Therapy. The use of Schema Therapy outside of clients who are living with borderline personality disorder should be dependent on the Clinician and client’s preferences and treatment experiences. Keep reading to learn 50 Schema Therapy questions to ask in therapy sessions.

Clinicians who do use Schema Therapy with clients who have other mental health concerns are typically working with clients who have long-term and pervasive mental health concerns that have not been receptive to other forms of cognitive therapy. Case studies have explored the effectiveness of this approach with clients who are struggling with other personality disorders, substance use disorders, PTSD, and eating disorders.

A key concept of Schema Therapy is Early Maladaptive Schemas, also referred to as EMS. EMS is a theme, or pattern, in a person’s life that is made up of memories, emotions, thoughts, and bodily sensations regarding their relationships with others. EMS develops during childhood and adolescent years when one or more of a child’s basic psychological needs are unmet.

With Schema Therapy, the Clinician’s work focuses on learning about how the client’s difficulties and symptoms developed, and what factors have contributed to their continuation. Clients then learn to identify their emotional needs and find alternative methods to have these needs met that are more adaptive.

When schemas are developed, an individual can either accept them as truth, avoid them, or overcompensate as a result. Each of these responses can lead to unhealthy behaviors that can hurt the client’s level of functioning.

View all of our Schema Therapy Worksheets

Getting Ready for Your First Schema Therapy Session with a New Client

Regardless of the clinical setting you work in, your primary focus when meeting with a new client will be conducting your assessment, and developing psychological awareness of their presenting concern. Your assessment will focus on identifying dysfunctional patterns in your client’s life and their experiences with EMS. Additionally, time spent should also explore triggers and unmet childhood needs that coincide with their schemas.

An additional focus will be exploring and identifying your client’s coping skills. Once your client has an understanding of their schemas and coping skills, they can then begin working to take control over their responses. Attention should be drawn to developing a conscious awareness of their automatic thoughts and working to exhaust the memories, emotions, thoughts, and bodily sensations tied to their schemas.

An additional step that should be incorporated into our clinical work is to take time to check in with ourselves and our own mental health needs. Compassion fatigue can have a significant impact on our work, and more importantly, our wellness. If you find yourself feeling overwhelmed at work, losing interest in your interests, or taking a step back on your self-care, we encourage you to take time for yourself and utilize skills that help you in challenging moments. 

Common Questions to Ask Clients in Schema Therapy

Schema therapy questions are used throughout the counseling to explore our client’s experience and work towards their counseling goals. The duration of treatment will be dependent on your client’s unique needs and concerns. Continue reading for examples of questions in schema therapy that you can use!

What would you like to gain from counseling?

Can you tell me about an early memory where you felt unloved or unwanted?

Did you feel that this (feeling unloved or unwanted) was a common concern or experience while you were growing up?

In those moments when you felt unloved or unwanted, what were you feeling in your body?

Are there any changes that occur within your body today when you feel similar emotions?

Can you tell me about how your family members treated each other when you were younger?

Is there a time in your life that you can remember being ignored or dismissed? What was it about this event or situation that made it memorable for you?

Did you ever find yourself feeling as though you needed to act older than you were, or take responsibility for something that an adult around you should have taken care of?

Was this a common experience for you?

How do you feel this added responsibility as a child/adolescent/teen impacted you growing up? How does it impact your current behaviors?

Can you share with me your experience with helplessness?

What does helplessness feel like for you?

How often do you find yourself feeling helpless?

Are there any particular situations, events, or feelings that bring this emotional reaction (helplessness) up for you?

Do you find that you put pressure on yourself, or expect, perfectionism from yourself?

How do you feel when you make a mistake or fail?

Where do you feel that this reaction to failing comes from?

Can you tell me about a time that you coped with a mistake you made?

Are there any characteristics about yourself that you feel are permanent, or not likely to change?

How do you feel about the relationships you have in your life now?

What comes up for you emotionally and physically when you feel as though someone in your life is ignoring, or dismissing you?

How do you cope with feeling rejected in your relationships?

How would you describe a healthy relationship?

Can you think of any healthy relationships that you have, or have had, in your life?

How would you describe your self-esteem?

Can you think of any experiences that had a significant impact on your self-esteem? This could include abuse, neglect, or bullying when you were younger.

Can you share with me some beliefs you have about yourself?

How much truth do you believe is in these beliefs?

Can you think of anything that shows that these beliefs may be inaccurate?

Can you identify any triggers that make this belief come to mind for you?

When you find yourself thinking about this belief, what changes do you notice within your thoughts, behaviors, and physical sensations?

Do you find yourself feeling as though your emotional needs are met from your interactions with others?

Is it easy for you to trust others?

Are there any concerns, or fears, that you have that impact your ability to trust others?

Would you describe yourself as a dependent or independent person? Can you tell me about your thought process behind that?

What has your experience looked like with competitiveness?

How do you feel your early experiences impacted your competitiveness?

Would you say that you feel more comfortable being distant from others?

Is there anything about closeness, either emotional or physical, the closeness that is challenging for you?

Can you tell me about a recent time when you were vulnerable with another person?

What was the experience of being vulnerable like for you?

Do you find that you see the world in black and white, or with clear rights and “wrongs”, or do you see the world with a bit of gray?

Can you share with me how you feel when you believe that someone is criticizing, or judging you?

What changes do you notice within your thoughts, feelings, behaviors, and physical sensations when you feel criticized?

How often do you find yourself worrying? Can you tell me more about your experience in moments when you are worrying?

Do you have any worries that you haven’t been able to shake?

Would you say that you are often the first to apologize after an argument or disagreement? Does this change if you didn’t do anything wrong?

Can you share with me some of your coping skills when you feel distressed?

Do you feel as though you have coping skills to cope with the challenges you experience in your life?

What would be different for you if you had the tools and resources to cope better?

Final Thoughts On Asking the Right Questions in Schema Therapy

Thank you for taking the time to read our schema therapy questions! As mental health professionals, we have the privilege of witnessing our clients experience vulnerability during some of the challenging moments in their lives. When we work with clients who have the same mental health diagnosis, there will be commonalities regarding their symptoms and other related experiences. With that being said, every individual that we meet has a history and background that has gotten them to where they are today.

Individual differences can have an impact on which treatment modality clients are receptive to, and which ones they are not. Schema Therapy provides mental health professionals with an additional approach that can effectively be used with clients who have not made progress with other treatment approaches, so that they can work towards improving their overall sense of wellness.   

If you have found your interest in Schema Therapy peaked, we encourage you to look into continuing education and other training opportunities. The International Society of Schema Therapy can help you locate accredited training program providers, supervisors, current schema therapists, and provide you with other helpful information.

TherapyByPro is an online mental health directory that connects mental health pros with clients in need. If you’re a mental health professional, you can Join our community and add your practice listing here. We have assessments, practice forms, and worksheet templates mental health professionals can use to streamline their practice. View all of our mental health worksheets here.

View all of our Schema Therapy Worksheets

Resources:

Taylor, C., 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

 Young, Jeffrey E., Klosko, Janet S., and Weishaar, Marjorie E. (2003). Schema Therapy: A Practitioner’s Guide. Retrieved from https://www.guilford.com/excerpts/young.pdf

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