The Assessment and Education Phase of schema therapy has six major goals:
Identification of dysfunctional life patterns
Identification and triggering of Early Maladaptive Schemas
Understanding the origins of schemas in childhood and adolescence
Identification of coping styles and responses
Assessment of temperament
Putting it all together: the case conceptualization
Although the assessment is structured, it is not formulaic. Rather, the therapist develops hypotheses based on data and adjusts these hypotheses as more information accumulates. As the therapist assesses life patterns, schemas, coping styles, and temperament, utilizing the various assessment modalities described later, the assessment gradually coalesces into a unified schema-focused case conceptualization.
We now provide a brief overview of the steps in the assessment and education process. The therapist begins with the initial evaluation. The therapist assesses the patient’s presenting problems and goals for therapy and evaluates the patient’s suitability for schema therapy. Next, the therapist takes a life history, identifying dysfunctional life patterns that prevent the patient from meeting basic emotional needs. These patterns usually involve long-term, self-perpetuating cycles in relationships and at work that lead to dissatisfaction and symptomatology. The therapist explains the schema model and tells the patient that they will work together to identify the patient’s schemas and coping styles. The patient completes questionnaires for homework, and the therapist and patient discuss the results in the sessions. Next, the therapist uses experiential techniques, especially imagery, to access and trigger schemas and to link schemas to their childhood origins and to the presenting problems. The therapist observes the patient’s schemas and coping styles as they appear in the therapy relationship. Finally, the therapist assesses the patient’s emotional temperament.
In the course of the assessment, patients come to recognize their schemas and to understand the origins of these schemas in childhood. They analyze how these self-destructive patterns have recurred throughout their lives. Patients identify the coping styles they have developed to deal with their schemas—surrender, avoidance, or overcompensation—and elucidate how their individual temperaments and early life experiences predisposed them to develop those styles. They link their schemas to their presenting problems, so that they have a sense of continuity from childhood to the present. Thus their schemas and coping styles become unifying concepts in the way they view their lives.
We have found that using multiple methods of assessment increases the accuracy of schema identification. For example, some patients will endorse a schema on the Young Parenting Inventory, but not on the Young Schema Questionnaire. It is easier for these patients to remember their parents’ attitudes and behaviors than it is for them to access their own emotions. Patients may give inconsistent or contradictory information on questionnaires because of schema avoidance or overcompensation—processes that are likely to be less salient in the imagery work.
The Assessment Phase has both an intellectual and an emotional aspect. Patients identify their schemas rationally through the use of questionnaires, logical analysis, and empirical evidence, but they also feel their schemas emotionally through the use of experiential techniques such as imagery. The decision about whether a hypothesis about a schema “fits” the patient is based in large part on what “feels right” to the patient: A correctly identified schema usually resonates emotionally for the patient.
During the Assessment Phase, the therapist utilizes cognitive, experiential, and behavioral measures and observes the therapist-patient relationship. The assessment is thus a multifaceted endeavor in which the therapist and patient form and refine hypotheses as they gather additional sources of information. Core schemas emerge as these multiple methods converge on central themes in the patient’s life. The assessment gradually crystallizes into a schema-focused case conceptualization.
The time required to complete the assessment is variable. Relatively straightforward cases might require as few as five assessment sessions, whereas patients who are more overcompensated or avoidant usually require more time.