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.

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.

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.

‘Traditional’ cognitive techniques such as automatic thought records sometimes bring about limited changes in thought and feeling. An example of this is when individuals experience shifts at an intellectual level (“rationally I know I am a good person”) but not an emotional level (“but deep down I feel bad”). Experiential interventions such as chairwork are particularly helpful in bringing about head-level and heart-level belief change in CBT. Chairwork can also be used as a method of exposure, allowing individuals to confront anxiety-provoking situations through enactment (e.g. rejection or criticised from others) and intense emotions. In terms of behaviour, chairwork is a particularly effective way to develop and rehearse new skills such as assertiveness.

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.

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.

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.

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.

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.

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).

Chairwork offers some creative routes to accessing the sadness and vulnerability which sometimes underlies anger. Examples include introducing a second chair which represents the vulnerability ‘sitting behind’ protective anger; inviting the client to speak as their ‘angry self’ (chair one) followed by their ‘sad self’ (chair two); interviewing the part of the client which is concerned about connecting with sadness; or setting up a dialogue between the client’s protective anger and vulnerability. Primary sadness is often much easier to access once protective anger has been heard, validated, and processed in chairwork.

Chairwork can be an empowering way for individuals to confront abusers and hold them to account. This usually involves the client imagining their abuser in an empty seat (chair one) and expressing their hurt and anger. This might be followed by the client soothing and caring for their past abused self (chair two). However, speaking with an abuser can be highly anxiety-provoking, so therapists must ensure that the client feels safe during this work. Whether or not the client adopts the role of the abuser during chairwork is a matter of clinical judgement and can be counter-therapeutic.

While speaking to the therapist can support the process, chairwork is most helpful when it is immersive and evocative. Pushing and holding the client during chairwork is a delicate balance. If speaking to the therapist seems to be detracting from the encounter, clients are encouraged to focus on the dialogue instead. Other signals to re-focus on the chairs include moments where the client makes a poignant or important statement, or if an unanswered question arises (“I still don’t understand why she left me”).

Dual-processing theories such as interacting cognitive subsystems (Teasdale & Barnard, 1993) suggest that heart-level emotional shifts often require interventions which are more evocative and multisensory than ‘standard’ cognitive techniques. Because chairwork is both emotionally-charged and incorporates multiple sensory channels simultaneously (sights, sounds, movement, and bodily feedback), it is well suited to this purpose.

Chairwork is often best when it is introduced spontaneously and in the context of a good therapeutic alliance. In fact, too much preparation can cause individuals to feel more anxious or ‘second guess’ these methods. An exception to this is when chairwork is used to recreate distressing memories (e.g. historical role-play). This type of chairwork can be very demanding and clients should be able to make an informed decision about making use of it.