Presenting Concerns:
- Summarise the client’s main concerns or difficulties discussed in the session in schema therapy terms
- Highlight any relevant updates to symptoms, behaviours, emotional states or situations since the previous session
- Detail any relevant life events or current circumstances contributing to the client’s presentation
- Detail the client’s current emotional state
Schema Conceptualisation:
- Schema 1: Identify the first Early Maladaptive Schema
- Identify any early childhood experiences or memories associated with its development that were discussed
- Modes: Describe the key schema modes activated in relation to schema 1, such as child, parent or coping modes
- Identify situational triggers that elicited these modes
- Unmet needs associated with schema 1: Identify any unmet core emotional needs if identified by the client or therapist in the session
- Schema 2: Repeat the structure above for schema 2, and any subsequent schemas discussed
Therapeutic Interventions Used:
- Document the therapy techniques applied (e.g., schema therapy interventions such as imagery rescripting, floatback, chair work, limited reparenting, empathic confrontation, mode dialogues and interviews, cognitive or behavioural interventions)
- Client response: Summarise key client responses and any insights gained from experiential techniques
Key Insights, Themes and Progress:
- Highlight important themes or insights that emerged during the session
- Include any shifts in schema-driven beliefs, or increased awareness of schema-driven behaviours
- Include any shifts in the client’s understanding of their difficulties or progress toward therapy goals
- Include any strengthening of Healthy Adult mode discussed
- Document any positive changes in coping strategies or emotional regulation
Therapeutic Relationship:
- Briefly comment on the therapeutic alliance or dynamics observed in the session
- Note any areas where rapport was strengthened or challenges arose
Homework or Between-Session Task:
- List any assigned homework, such as schema therapy homework like schema journaling, schema flashcards, imagery practice, pattern breaking or behavioural experiments
- Note any barriers or motivation expressed by the client regarding homework
Risk Assessment:
- Summarise any risk factors, such as self-harm or suicidal ideation
- List protective factors and any action plans if risk is present
Next Steps:
- Outline the preliminary agenda or goals for the next session, based on today’s discussion
- Provide the time, day and date of any future session agreed upon between the therapist and the client
Summary:
- Provide a brief recap of key points from the session
Presenting Concerns:
- Mary presented with continued relationship anxiety and fears of abandonment following a disagreement with her partner last week
- She reported increased vigilance and need for reassurance when her partner was less available due to work commitments
- Described feeling “defective” and unworthy of love during these periods of reduced contact
Schema Conceptualisation:
Abandonment/Instability:
- Mary’s abandonment schema was prominently activated, linked to her father leaving the family when she was eight years old
- She recalled feeling responsible for his departure and developing beliefs that loved ones will inevitably leave
- Modes: Abandoned Child mode manifested through clinging behaviours and excessive reassurance-seeking; some Angry Child responses emerged when discussing partner’s work demands
- Unmet needs: Core needs for safety, stability, and consistent nurturing identified
Defectiveness/Shame:
- Self-critical thoughts following relationship conflicts
- Connected to childhood experiences of feeling “not good enough” compared to siblings and receiving maternal criticism
- Modes: Vulnerable Child mode evident through self-deprecating beliefs; Detached Protector mode emerged as emotional withdrawal when overwhelmed
Therapeutic Interventions Used:
- Chair work facilitated dialogue between Abandoned Child mode and emerging Healthy Adult mode
- Limited reparenting techniques provided validation and reassurance about inherent worth
- Imagery rescripting introduced to help reimagine childhood father departure experience
- Client response: Mary engaged well with chair work, showed emotional release during imagery work, and appreciated validation of childhood experiences
Key Insights, Themes and Progress:
- Demonstrated increased awareness of how abandonment schema influences interpretation of partner’s behaviour
- She began recognising connections between childhood experiences and current relationship patterns
- Progress noted in ability to identify modes as they arise, particularly distinguishing Abandoned Child from Healthy Adult perspectives
- Mary expressed relief understanding her reactions as understandable rather than evidence of defectiveness
Therapeutic Relationship:
- Strong therapeutic alliance maintained with Mary expressing trust in the therapeutic process
- Increased openness about vulnerable childhood memories observed
Homework or Between-Session Task:
- Schema diary assigned to track abandonment schema triggers and associated modes
- Practice Healthy Adult dialogue technique when experiencing relationship anxiety
Next Steps:
- Continue strengthening Healthy Adult mode and explore additional imagery techniques
- Further mode dialogue work to develop internal nurturing responses
- Next appointment: Tuesday, 10th June 2025 at 2:00 PM
Summary:
Mary actively explored abandonment and defectiveness schemas, connecting childhood experiences to current relationship difficulties. Chair work and imagery techniques facilitated emotional processing and Healthy Adult perspective emergence. She demonstrated good insight into schema-driven patterns and commitment to between-session practice. The therapeutic alliance remained strong with continued progress toward secure attachment patterns.
