Schema therapy can be difficult to implement for therapists and we wanted to begin a series of articles which look at common questions that therapists may have.
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Can you explain how you decide what to start with when commencing schema therapy, based on different client presentations? Do you always begin with a safe place?
The different approaches with clients really reminds me just how personalised the schema therapy approach is, where attunement & following the client’s unmet core needs is the focus. However, the following suggestions could be helpful.
For clients who appear very fearful of becoming overwhelmed by emotion / very disconnected from their Vulnerable Child (but are engaged, responsive and have insight into coping patterns) I begin with the safe place to promote safety in the therapy relationship and meet core needs related to a sense of connection. I then introduce imagery where the client sees their Vulnerable Child, then in another exercise connects with the feelings of their Vulnerable Child, and then experiences limited reparenting without being in a distressing situation. I do this to connect with the Vulnerable Child and validate basic core needs. Where connection is an unmet core need, we really want to enter their world (gradually) as they feel so alone. I will often discuss a safe place together to guide them, offering options, giving words before the image to support them to experience success in the image.
For clients who experience strong coping modes / protection – due to internalised messages from the parent modes (but without insight as to this process – outside awareness) I am more likely to explore the messages from the parent mode to be able to introduce the modes, especially focusing on the impact of the parent mode on the Vulnerable Child (being an advocate for the Vulnerable Child).
For those who have such strong parent modes / it is so powerful (they describe it is who they are) and where they have a lot of loyalty to parents (and experience guilt) it is essential to build a sense of safety in the therapy relationship in order to approach imagery, and an understanding of the interaction between origins of schemas / messages and the impact throughout life (behaviours, difficulties etc.) by speaking about a stranger child or telling a story.
In The Schema Therapy Bulletin Rita Younan wrote about experiential strategies:
“Therapeutic stories of little children in situations where they have needs are often used to assist clients in having compassion for a child’s emotional needs. This slowly paves the way for clients to consider how helpless children can be and how dependent they are on a good parent to have core needs met including feeling safe, secure and predictable. Through the story clients are encouraged to think about what messages the child in the story would have taken from the experience about her self-worth and the normality of needs being met by the adults in her world. Clients are then encouraged to think about their Vulnerable Child and their needs in the same way to transfer compassion for stranger children to themselves.”
I like to personalise the stories to reflect the client’s experiences, feelings and unmet needs.
Therapy Lead, Secure Nest
Clinical Psychologist – Advanced Schema Therapist Supervisor-Trainer