ABSTRACT
In this chapter, the authors describe schema informed therapy, offered across time limited settings and with patients with complex presentations. The authors lay out a framework for deciding how and when to use protocol based Schema Therapy (ST) as opposed to schema informed therapy. The chapter begins by describing a course of therapy (20–30 sessions’ therapy) for patients with complexity whose treatment cannot be easily accommodated within a disorder specific model – the discussion outlines indications for this, such as dissociation, self-harm, or emotional instability. The authors describe how this brief approach emphasises the use of formulation, as well as overcoming compensatory strategies, rather than focusing on longer term schema and core belief change. The authors demonstrate that this approach allows the therapist to work relatively briefly with maintaining beliefs and behaviours that can help improve functioning and begin to develop a healthy adult state. The authors then progress to describe how ST techniques can be incorporated into brief work with complex cases, and also incorporated into standard Cognitive–Behavioural Therapy (CBT) work. In standard CBT, these ways of working can be used to overcome impasses and augment cognitive and behavioural methods with emotive and experiential work. The authors include examples of the use of chair work, imagery rescripting, ‘limited reparenting’, letters that aren’t sent and ways of working with the interpersonal relationship. Finally, service considerations, including supervision and support, are discussed.
