Measurement and analysis are crucial to successful treatment in Schema Therapy.
Having an awareness of the client’s schemas, needs, and the childhood experiences that underpin them enables the therapist to better apply appropriate interventions and identify positive changes when they occur.
Understanding is central to the therapy’s goal that the client “finds adaptive ways to meet their core emotional needs” while regaining control from unhelpful thoughts, beliefs, and behaviors (Young, Klosko, & Weishaar, 2007).
This article looks at some questionnaires and tests that support both initial and ongoing assessments within Schema Therapy.
Before you continue, we thought you might like to download our three Positive Psychology Exercises for free. These science-based exercises explore fundamental aspects of positive psychology, including strengths, values, and self-compassion, and will give you the tools to enhance the wellbeing of your clients, students, or employees.
Like most other psychological therapies, Schema Therapy (ST) includes an assessment phase, education, and a treatment phase.
The goal of assessment is to gain insight into the schemas that are currently active (schema modes) and the coping mechanisms the client currently has in place. Based on the outcome, Schema Therapy treatment introduces a series of interventions to implement schema healing and replace what is unhelpful with what is more appropriate.
To satisfy the client’s core emotional needs and gain conscious control over their schemas – and ultimately live a more complete life – ST must form a picture of the client’s present mental state and the childhood memories beneath (Young, 1990; Arntz & Jacob, 2013).
The Schemas, Needs, and Modes Reference Sheet provides a list of the concepts that must be understood and introduced by the therapist to the client.
What are the goals of assessment and education of ST?
There are six goals for the assessment and education phase of ST (modified from Young et al., 2007):
The therapist works with the client to understand life patterns, coping styles, and schemas and then builds and evolves hypotheses until they are validated.
What is involved in assessment and evaluation?
The initial part of the assessment and evaluation phase forms a picture of the client’s problems and goals for therapy. Crucially, it also “evaluates the patient’s suitability for schema therapy” (Young et al., 2007).
Next, the therapist creates a view of the client’s life history and picks out dysfunctional life patterns. Such patterns are often long term, self-perpetuating, and stop the client from fulfilling their basic emotional needs, leading to dissatisfaction in life, relationships, and work (Young et al., 2007).
At this point, the therapist needs to share with the client that the process aims to identify their schemas and coping styles. This is facilitated by using questionnaires to be completed as part of homework, then discussed in subsequent sessions.
The next stage of the assessment requires considerable skill and deep knowledge of ST. The therapist attempts to “access and trigger schemas and to link schemas to their childhood origins and to the presenting problems” (Young et al., 2007). Such connections are achieved through experiential techniques, most notably imagery.
The therapist pays particular attention to the client’s schemas and coping styles as they crop up in the therapist–client relationship during assessment.
There are several outcomes from this assessment stage for the client:
Overall, the client’s “schemas and coping styles become unifying concepts in the way they view their lives” (Young et al., 2007).
There are several techniques for identifying and assessing schemas.
While some clients benefit from using the Young Parenting Inventory, others prefer the Young Schema Questionnaire (Young et al., 2007).
Clients sometimes favor the former as they more easily remember their parents’ attitudes and behaviors than their own emotions (Young et al., 2007).
Using more than one tool reduces the risk of inaccuracies and building an incomplete or incorrect picture. As a result, the assessment becomes a multi-faceted approach, combining information from cognitive, experiential, and behavioral measures with the knowledge gained from the therapist–client relationship. Understandings are tested as hypotheses and revised as needed in response to new information.
While questionnaires, logical analysis, and empirical evidence are intellectually valuable, they must be supplemented with emotionally rich experiential techniques such as imagery.
After all, sometimes validating a hypothesis comes down to what feels right. “A correctly identified schema usually resonates emotionally for the patient” (Young et al., 2007).
Ultimately, the output of the assessment phase is a set of core schemas captured in a case conceptualization. And it may take some time. While it is possible in as few as five sessions, it could take considerably longer if clients are more avoidant.
Enhance wellbeing with these free, science-based exercises that draw on the latest insights from positive psychology.
