Schema Therapy for Personality Disorders: A Qualitative Study of Patients’ and Therapists’ Perspectives

De Klerk, N., Abma, T. A., Bamelis, L. L., & Arntz, A. (2016). Schema therapy for personality disorders: A qualitative study of patients’ and therapists’ perspectives. Behavioural and Cognitive Psychotherapy, 45(1), 31-45. https://doi.org/10.1017/s1352465816000357

Summary by: Fathimath Faseeha

In recent years, schema therapy has become increasingly popular among mental health practitioners in treating individuals with a variety of psychological issues, especially in treating personality disorders. However, despite the popularity and effectiveness, there has been little research conducted in studying the perspectives of patients and therapists with regards to schema therapy. Therefore, the current qualitative research aims to explore the experiences and perspectives of both patients and therapists involved in schema therapy for treating personality disorders, focusing primarily on borderline personality disorder and avoidant personality disorders.

To achieve this, the research conducted in-depth interviews with 16 patients and 16 therapists from an ongoing randomized controlled trial of group schema therapy for on borderline personality disorder and avoidant personality disorders in Norway. Participants shared their experiences and thoughts on the therapy process, the therapeutic relationship, change mechanisms, and outcomes. The study uses thematic analysis to examine semi-structured interview data from 16 patients and 16 therapists. The researchers employed a collaborative analysis approach involving the perspectives of both therapists who have experience in schema therapy and researchers who were not directly involved in practicing schema therapy to ensure interpretive depth and objectivity.

The results of this study were divided into three aspects; first, aspects of schema therapy that patients and therapists found helpful, second, aspects they found unhelpful and, third, recommendations given by both groups for improving schema therapy. For helpful aspects, therapeutic relationships were seen as positive, intense and substantially different from other forms of psychotherapy by both therapists and patients. The therapeutic frame of schema therapy was also mentioned by both groups as helpful where patients recognized this frame as a tool that helped them to understand their emotions and behaviors while therapists believed that this frame helped them to structure their sessions. Specific schema therapy techniques such as imagery were mentioned by both groups as a helpful aspect. For unhelpful aspects, the study revealed that patients stated that they felt a time pressure in schema therapy which was unhelpful, however, therapists had varying opinions about this aspect.  Additionally, lack of information, lack of practical application and lack of shared focus between therapists and clients were also seen by the participants as unhelpful aspects. For recommendations, providing clear information in advance was mentioned by the patients as an important aspect that needs to be incorporated into schema therapy. Therapists recommended establishing proper connection between the present and past in the imagery, giving more responsibility for patients in the final phase of therapy and providing more experiential training as recommendations to improve schema therapy.

While the study has limitations such as less sample size and low generalizability, the study provides important insights into the perspectives of patients and therapists when it comes to schema therapy. The authors also state that this is the first qualitative study that explores both patient’s and therapist’s experiences and perspectives of schema therapy, therefore, this study serves as an important foundation for future research to further expand the understanding of schema therapy. Additionally, the recommendations identified by the therapists and patients of this study can also add valuable insight to develop and increase the effectiveness of schema therapy.