ABSTRACT
A therapeutic approach is described that draws mainly from schema therapy, but modified for psychosis and trauma, and using some ideas from narrative CBT and internal family systems. Therapy for states of the self, such as being self critical, and specific psychotic symptoms, is illustrated in particular the practice of using imagery and chair work. Finally, ideas are presented for working with psychosis and the effects of trauma. One case illustration is given of a woman who experienced a persecutory voice and delusions. After solution-focused work to enhance coping, and basic narration of the past, there was an emphasis on imagery work whereby she could attempt to give care to an image of her young self. She found this extraordinarily difficult: in visual imagery the young girl would at first not stay near and was seen running away. Over time she began to express care in imagery to the young self and to resist the voice. During therapy her states of self were described and ways of coping developed. Over time her self-harm diminished, the attacking voice declined, and eventually she began to have weeks without hearing the voice.
