ABSTRACT
Psychological assessment is key in formulation, treatment planning and the evaluation of therapeutic change. Although assessment is ubiquitous in normal clinical practice, patients with personality-level problems often struggle to identify their emotions, cognitions and key problems for change. Moreover, clinicians often face interference and resistance from maladaptive coping modes in conducting the assessment itself. Schema Therapy applies a range of experiential strategies to circumnavigate some of these difficulties. First, imagery techniques can identify less accessible cognitive and emotional patterns (schemas) that link triggering situations with distressing childhood memories and associated unmet needs. Second, chair work techniques aim to assess the origin, function and ‘motives’ of patients’ coping modes. As the therapist becomes aware of recurrent, rigid and inflexible interpersonal patterns observed in session, they can use the emerging therapeutic relationship as a ‘transference ground’ to assess relational aspects of the patient’s presentation and coping modes. Self-reflection and supervision are vital, as therapist schema triggering and maintenance are common and can lead to increasingly difficult therapeutic dynamics. Core strategies are described, most importantly imagery for assessment and chair work. Clinical examples and vignettes, as well as mini therapy transcripts are given alongside therapist tips for commonly encountered difficulties.
