By Dr Jo White & Tena Davies
The schema flashcard was originally developed by Jeff Young as a tool to support clients with schema triggers between therapy sessions (see p104-5, Schema Therapy A Practitioner’s Guide). The flashcard is a written document, created between the therapist and client, to summarise a healthy response to a common schema trigger. The client can read the flashcard between sessions to support behavioural pattern breaking.
What is an audio flashcard?
As many clients now have access to a mobile phone which can play audio notes, an audio recording of the therapist’s voice can be used to enhance the effectiveness of the schema flashcard. Voice recordings now reach beyond the traditional structure of the written flashcard providing clients with a transitional object to help bridge the gap between therapy and life outside of therapy sessions.
Why use audio flashcards?
Limited reparenting is an essential component of schema therapy and audio messages help therapists to connect with their clients for more than the therapy hour. Messages in the therapist’s voice reinforce and extend the reparenting messages provided within sessions.
Audio flashcards are a useful soothing strategy to help clients regulate their emotions, as they hear compassionate messages from the therapist. As with the written flashcard, the audio flashcard is a tool for the therapist to model and prompt healthy responses when schemas have been activated outside of sessions.
How do audio flashcards differ from the written version?
Audio flashcards differ from written flashcards because they use the voice of the therapist. This may help the client feel more connected to the therapist and less alone. In later stages of therapy, the therapist and the client’s healthy adult can work together to create a joint audio flashcard for the client’s vulnerable child or coping mode. Once a client’s healthy adult is strong enough, the client can either write a script for the audio flashcard or narrate the audio flashcard themselves. This provides an opportunity to both strengthen their healthy adult mode and to strengthen the connection between parts of self (e.g. between the healthy adult and the vulnerable child, or a coping or critic mode).
To provide an overview of some of the different functions of the audio flashcard we are going to describe their use over three phases of schema therapy: the beginning, middle and final stages of therapy.
Beginning Stage: Developing Safety & Connection
In the first stage of schema therapy, the focus is on creating safety and connection between the therapist and client. Audio flashcards can be especially helpful during this phase for supporting the development of this new relationship.
To help the development of safety and connection audio flashcards can be used to provide reparenting messages to clients that they can access at any time. The message can anticipate times when the vulnerable child mode will be triggered and provide validation of feelings and understanding about why these feelings are present. It’s a helpful time to let clients know that you are on their side and non-judgemental about their struggles. Many clients find these messages very soothing.
“I know you feel very critical of yourself for not managing well right now, but it makes sense that you are finding life so hard, your dad is ill, you have lots of changes to manage at work and you have the summer holidays to manage your kids” |
In the early stages of therapy, audio flashcards can be used to help client’s make links between their present struggles and their past.
“I hear you beating yourself up for focussing on your appearance. Your critic tells you it shouldn’t matter to you. However, it makes so much sense to me that you feel ashamed of your body given you grew up being bullied about your appearance. We’re going to work together so that you don’t feel the same way you always have about this. You’re not alone with this anymore.” |
Audio messages can be used to help your client to understand and start noticing when their coping modes have been activated or their critic mode is present. For example, you might prompt a client to listen to a message you create when they feel overwhelmed with shame.
“Hello Jane, you’re listening to this message because you are having strong feelings of shame, that tells me that your critic mode is really loud right now. It’s probably saying horrible things to you like no one cares about you. The critic mode is wrong, I care about you.” |
Finally, audio messages in the early stages of therapy provide an opportunity to model healthy adult messages through our reparenting. Over time the aim is for the client to internalise these healthy adult messages so that they can care for their own vulnerable child.
Middle Stage: Expressing Feelings, Noticing Modes and Making Changes
In the second phase or the middle phase of schema therapy we aim for clients to be able to express their feelings more freely, notice their modes and start making some changes.
Audio messages can be used during this phase to consolidate the work done in the session where the client has expressed their emotions more freely, providing praise and encouragement to keep doing this. For example, where a client tends to surrender to others, bringing awareness to and celebrating times when they have tuned into their own needs and put in a boundary is a helpful use of an audio message. This is particularly important when clients get a ‘backlash’ from their critic mode for making a change.
“I am so proud of you for showing me the part of you that feels angry when your mum lets you down – it’s brilliant that part found a voice and could speak up and defend you, that’s what you really need. I want you to keep going with this, even though it can make you feel guilty.” |
In this phase of therapy, we can use audio flashcards as an opportunity to offer alternative ways of managing.
“When you feel guilty and really feel that pull to sacrifice your needs for other people, I want you to think about the consequences of letting the guilt get the better of you. How will you feel in a day, a month or a year if you keep up with this level of sacrifice? What’s a more balanced way of managing this? Consider setting a boundary or only partially sacrificing.” |
Final Stages: Autonomy and Strengthening the Healthy Adult
The autonomy and strengthening of the healthy adult phase involves preparing the client’s healthy adult mode to be at the driver’s wheel of their life. This involves managing the critic and coping modes and soothing the vulnerable child.
In the final stages of therapy, audio flashcards can be used to encourage action over avoidance while still providing safety and support if things go wrong.
“When your avoidant protector shows up, it may be tempting to give in and let it take the metaphorical driver’s wheel of your life. However, we know this reinforces your critic mode and ultimately makes little you feel so unsupported and afraid of the consequences. I know how hard this is, these are well worn patterns. However, you have made so much progress towards leading the life that you want. You can do this and give little you what she deserves. Think about how your healthy adult can approach this situation by finding a balanced approach that feels right. Perhaps start by spending 5 minutes on this task you're avoiding” |
When clients have a well-developed healthy adult, audio messages can be used to support clients to notice and challenge their critic mode. The audio flashcard acts as a prompt for the stages the client needs to work through in the exercise. For example, first to visualise the critic mode sitting in the chair opposite, imagine what they are saying and to then challenge the mode. If more support is needed, the audio note can include challenges that have been used in sessions for the client to repeat.
“Your messages are cruel. Alex doesn’t deserve to be treated this way!” |
As the client becomes more able to challenge the critic mode independently, the message can include more encouragement than suggestions.
“I know you can do this, tell the critic what you want it to do.” |
As an intermediary step, you can take it in turns with the client to create audio flashcard messages in the therapy room.
“Therapist: Critic when you tell her she’s unfit and ugly you make her feel worthless. This is untrue and unhelpful. It doesn’t motive her to be more fit, just more depressed. Can you tell the critic what to do? Client: Critic, that’s enough. You need to go back into your box and be quiet. I don’t have to listen to you anymore. Little Sam, you are beautiful in every way. I’ll protect and care you for you always because you matter and that’s what you deserve.” |
Top Tips for Creating Audio Messages
If you're inspired to try out audio flashcards with your clients, here's how to get started:
Work with your client to write the message. Ask them what they need to hear and offer suggestions for them to adapt. Record the message onto their phone straight away or record it after the session and send it to your client.
Use the voice memo app or voice recorder app already installed on the mobile phone. Alternatively, if you are meeting via zoom, use the record function in zoom. If you record it to the ‘cloud’ you can send your client a link to the MP4 (video) or MP3 (audio recording) which they can download.
Embrace the motto ‘better done than perfect’. Your client will really value the audio message and imperfections help to model healthy adult acceptance.
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