Although CBT stresses the importance of cognitions in activating or maintaining negative affects, there has been increasing emphasis on considering the role of emotional processing. Many patients believe that one should be rational and logical all the time, never have conflicting feelings, and should ruminate in order to figure things out. Meaningful cognitive and simultaneously experiential technique for working with deep emotional schemas, formatted in childhood, is writing therapeutic letters. Inclusions of emotion regulation skills in the treatment especially for patients with personality disorder enhance the efficacy of CBT.

We used therapeutic letters to help the patient identify difficult feelings and process firstly outside of therapy session and working with them repeatedly with the therapist. Typical therapeutic letters are address to important close persons from the patient life, like parents, siblings, a partner and friends, children. The patient uses the letter to impress his/her feeling and needs, inclusive defenses of his rights in past and present.

Patient writes a letter at home, and he brings it then into the session and reads it to the therapist. These letters are not intended to be sent to that important person, but to process strong emotions inside the patient. In fact the patient writes a letter to his inner representation of an important person, who was connected with the development of the maladaptive schemas. The letter-writing process is inherently collaborative and enables the patient to work at his or her own pace while also facilitating patient empowerment.