This chapter discusses the Assessment and Education Phase of schema therapy. This phase has six major goals: (1) identification of dysfunctional life patterns; (2) identification and triggering of Early Maladaptive Schemas; (3) understanding of the origins of schemas in childhood and adolescence; (4) identification of coping styles and responses; (5) assessment of temperament; and (6) formulation of the case conceptualization.
The assessment is multifaceted, utilizing self-report, experiential, behavioral, and interpersonal measures. It begins with the initial evaluation, in which the therapist ascertains 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 maladaptive life patterns, schemas, and coping styles. The patient gradually completes the following questionnaires as homework assignments: (1) life history assessment forms; (2) Young Schema Questionnaire; (3) Young Parenting Inventory; (4) Young-Rygh Avoidance Inventory; and (5) Young Compensation Inventory. The therapist and patient discuss the results of the questionnaires in sessions, in the course of which the therapist educates the patient about the schema model. Next, the therapist uses experiential techniques, especially imagery, to access and trigger the patient’s schemas and to link schemas to their origins in childhood and to current problems. Throughout, 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. As the therapist and patient formulate and refine hypotheses, the assessment gradually adheres into a case conceptualization.
Schema avoidance is the most common obstacle to the imagery assessment work. We present methods for overcoming schema avoidance of imagery including educating the patient about the rationale for imagery work; examining the advantages and disadvantages of doing the exercise; starting with soothing imagery and gradually introducing more emotionally charged material; conducting a dialogue with the avoidant side of the patient (mode work); using affect regulation techniques such as mindfulness or relaxation training; and initiating psychotropic medication.