Question 1

I am curious about how this approach differs/is similar to chair work in other modalities, e.g. emotion focused therapy (Greenberg et al), gestalt therapy.

Matthew Pugh · Accepted Answer

There are several ‘forms’ of chairwork which are common across psychotherapies. These include dialogues (inviting a client to speak to parts of the self or other individuals held in an empty seat), dramatisations (role-playing scenes from the past, present, or future), depictions (using the space between chairs to represent relationships and attachments), and interviews (questioning the client in the role of another person or part of the self). However, psychotherapies vary as to the aims and foci of chairwork. For example, emotion-focused chairwork seeks to transform emotional experience, while gestalt therapy aims to bring closure to unfinished situations and other internal conflicts. In CBT, the focus of chairwork is problematic cognitions and behaviour. Cognitive behavioural chairwork also tends to be more structured and goal-orientated than the gestalt approach.

Question 2

How is chairwork in CBT different from chairwork in Schema-Focused Therapy or Gestalt Therapy?

Matthew Pugh · Accepted Answer

There are similarities in how chairwork is used in CBT and schema therapy. For example, both approaches use chairwork to address maladaptive self-beliefs through dramatisations (e.g. historical role-plays) and dialogues (e.g. between a client’s positive and negative self-belief). However, cognitive behavioural chairwork rarely involves working with schema modes. Rather, its focus tends to be discrete cognitions, cognitive processes (e.g. worry, self-criticism, rumination), and behaviour.

Question 3

Question 4

What are some dos and don’ts about chairwork?

Matthew Pugh · Accepted Answer

Do: consider using chairwork if ‘traditional’ cognitive-behavioural methods prove ineffective; set sufficient time to facilitate and reflect on chairwork; support the client during evocative chairwork dialogues; work collaboratively so that the client feels safe and in control; assess the outcome of chairwork (“what have you learnt? what do you take from this experiment?”); practice delivering chairwork to build skill and confidence.

Don’t: force a client to use chairwork; push the client beyond their limits; encourage the client to enact an abuser if this could be counter-therapeutic; give up if chairwork brings about limited change (it often needs repetition); become scripted or copy the way others deliver chairwork – find your own style and be creative.

Question 5

What is the best way to introduce chairwork?

Matthew Pugh · Accepted Answer

Chairwork is best introduced as an experiment worth trying out (“I’d like to suggest doing something different today, which will involve speaking from different chairs”). Experience shows that the more confidently therapists introduce chairwork, the more confident clients feel using these methods. Collaboration is central to CBT, and for this reason chairwork is presented as an invitation - not a command.

Question 6

How does cognitive behavioural chairwork help a person express anger in a meaningful/helpful way?

Matthew Pugh · Accepted Answer

Cognitive behavioural chairwork can be used to support helpful expressions of anger in several ways. These include using empty-chair dialogues to ‘vent’ frustrations which are usually suppressed, or to test out fears about expressing one’s anger; using two-chair dialogues to validate, regulate, or instruct oneself when anger arises; and using role-plays to practice expressing anger in constructive ways.

Question 7

I have a client who I believe would benefit greatly from chairwork, but the client feels this work is “silly” and therefore hesitant to engage in it; what are some tips on helping the client genuinely engage with chairwork in order for them to gain from the experience?

Matthew Pugh · Accepted Answer

Many clients are initially apprehensive about chairwork. Some of the ways this issue could be addressed include modelling the process of chairwork to correct any misunderstandings; framing chairwork as a behavioural experiment to test out its ‘silliness’; or agreeing a brief enactment (e.g. five minutes or so), after which the client is free to stop or continue depending on how productive this feels.

Question 8

What presenting issues does chairwork interventions best target?

Matthew Pugh · Accepted Answer

Chairwork has many, many applications. Research suggests that cognitive behavioural chairwork can help tackle difficult-to-shift cognitions and negative core beliefs, as well as supporting the development of new behaviours and positive core beliefs. Studies also indicate that other styles of chairwork (e.g. emotion-focused and compassion-focused chairwork) can help address shame, self-criticism, anxiety, trauma, ‘unfinished business’, emotional regulation, distressing voice-hearing, decision making, grief, and many other issues.

Question 9

What is cognitive behavioral chairwork?

Matthew Pugh · Accepted Answer

Chairwork refers to a collection of experiential interventions which utilise chairs, their positioning, movement, and dialogue for therapeutic purposes. The aim of cognitive behavioural forms of chairwork is to bring about changes in unhelpful patterns of thought and behaviour.

Question 10

Can chairwork be delivered effectively in online therapy?

Matthew Pugh · Accepted Answer

Tele-chairwork is often just as effective as face-to-face chairwork, but may require some adaptations. For example, if extra chairs are not available, the client can be asked to move their chair to different spaces, to stand and speak from different locations, or dialogue using a seat in the therapist’s space. As long as therapists are guided by the underlying principles and processes of chairwork, chairwork is highly compatible with online therapy. Guidance on tele-chairwork can be found in a recent article: https://www.researchgate.net/publication/342425501_Process-based_chairwork_Applications_and_innovations_in_the_time_of_COVID-19).

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